Kayexalate

Antidotes, Adsorbents
Mineral Binding Agents

In the event of clinically significant constipation, treatment with sodium polystyrene sulfonate should be discontinued until normal bowel motion is resumed. Magnesium-containing laxatives or sorbitol should not be used for treatment of constipation. Concomitant use of sorbitol with sodium polystyrene sulfonate has been implicated in cases of colonic necrosis.
 

Separate sodium polystyrene sulfonate from other orally administered medications by at least 3 hours. For patients with gastroparesis or other conditions resulting in delayed emptying of food from the stomach into the small intestine, separate sodium polystyrene sulfonate from other orally administered medications by at least 6 hours. Sodium polystyrene sulfonate binds to many commonly prescribed oral medicines, decreasing the absorption and therefore the effectiveness of those oral medicines.
 
Commercially Available Suspension
Shake the suspension well before administering.
If necessary, sodium polystyrene sulfonate may be administered into the stomach through a plastic tube.
 
Powdered Resin for Suspension
Prior to administration, mix each dose of powdered resin in water or syrup to form a suspension. The amount of fluid usually ranges from 20 to 100 mL, depending on the dose. Alternatively, 3 to 4 mL of water/syrup can be used for each gram of resin.
Shake the suspension well before administering.
If necessary, sodium polystyrene sulfonate may be administered into the stomach through a plastic tube.
Storage: Each dose should be freshly prepared; store no longer than 24 hours.

Preparation
Commercially Available Suspension: No further dilution is required.
Powdered Resin for Suspension: For small doses, mix with at least 2 to 3 mL aqueous vehicle per gram sodium polystyrene sulfonate. For doses of 30 to 50 g, mix each dose with at least 100 mL aqueous vehicle.
 
Administration
Administer a cleansing enema before administering the sodium polystyrene sulfonate retention enema.
The suspension should be approximately body temperature when administered; however, the manufacturer states that the resin itself should not be heated because heating may alter the resin's exchange properties.
Instruct patient to lie down on left side with lower leg extended and the upper leg flexed for support or place the patient in the knee-chest position.
Gently insert a soft, rubber tube of age-appropriate size into the rectum for a distance that will place the tip well into the sigmoid colon. In adult patients, a tube size of 28-French and insertion distance of about 20 cm is recommended.
Tape the tube in place.
Shake the sodium polystyrene sulfonate suspension well.
Administer the suspension through the tube by gravity. The particles should be kept suspended by gently agitating the suspension during administration. After administration is complete, flush the tube with an age-appropriate amount of fluid (50 to 100 mL is recommended for adults), clamp the tube, and leave in place. The suspension should be retained in the colon for at least 30 to 60 minutes or for several hours, if possible.
After the rentention enema is complete, administer a sodium-free cleansing enema warmed to body temperature to remove the resin. In adults, up to 2 quarts of fluid may be necessary. Constantly drain fluid through a Y-tube connection. If the enema contained sorbitol, particular attention should be paid to the cleansing enema to ensure proper removal.

bowel necrosis / Delayed / 0-1.0
GI bleeding / Delayed / Incidence not known
GI perforation / Delayed / Incidence not known
GI obstruction / Delayed / Incidence not known
bezoar / Delayed / Incidence not known

constipation / Delayed / Incidence not known
colitis / Delayed / Incidence not known
hypomagnesemia / Delayed / Incidence not known
hypokalemia / Delayed / Incidence not known
hypocalcemia / Delayed / Incidence not known

anorexia / Delayed / Incidence not known
vomiting / Early / Incidence not known
diarrhea / Early / Incidence not known
nausea / Early / Incidence not known

Kayexalate, Kionex, Marlexate, SPS

Rx

Cation-exchange resin used for hyperkalemia; exerts its effects over several hours; not appropriate for life-threatening hyperkalemia.

Limited data are available; the ideal dosage has not been established. A dosage of 0.5 to 1 g sodium polystyrene sulfonate powder per 100 mL formula/breast milk appears to be a common initial dosage range used. One small study (n = 13, patient weights 2.4 to 7.5 kg) reports doses of 0.4 to 1.5 g per 100 mL formula/breast milk; 6 of the 13 patients received a starting dosed of 1 g/100 mL. Authors from another study suggest an initial dose of 5 mL of sodium polystyrene powder (measured as leveled powder in a medicine cup) per 770 mL formula (this dose corresponds to about 0.5 to 0.65 g per 100 mL formula, depending on the brand of sodium polystyrene sulfonate used). When mixed with infant formula or breast milk, sodium polystyrene sulfonate binds with potassium in exchange for sodium, lowering the bioavailable potassium content and leaving the formula rich in sodium. After binding has occurred and the resin particulate has settled to the bottom, the ingestible formula/breast milk is decanted off of the top. The sodium polystyrene sulfonate resin is not ingested by the infant. Because the resin can alter other electrolytes (e.g. binds with calcium, magnesium, and phosphate and increases the sodium content in the milk), careful monitoring of all electrolytes is necessary. Supplementation of some electrolytes may be required. Pretreatment of formula or breast milk with sodium polystyrene sulfate resulted in a 24% decrease in serum potassium concentrations (mean: 6.3 to 4.8 mEq/L, p < 0.0001) in 13 infants (age: 1.4 to 33 weeks) with nonoliguric hyperkalemia within 48 hours of treatment initiation; hyperkalemia resolved in all subjects within 72 hours of initiation. There was a significant difference in before and after calcium (10.7 to 10 mg/dL) and creatinine (2 to 1.9 mg/dL) concentrations, but not other electrolytes.

15 g PO of sodium polystyrene sulfonate (about 4 level teaspoonfuls of the powder mixed in water or 60 mL of the commercially available suspension) given 1 to 4 times per day.

1 g/kg/dose PO every 6 hours (Max: 15 g/dose), as needed to correct hyperkalemia. The FDA-approved product labeling recommends using an exchange rate of 1 mEq of potassium per gram of resin as the basis for calculating the dosage for infants and small children. Because efficacy is variable, carefully monitor serum electrolytes to determine appropriateness of dosage and duration of therapy.

30 to 50 g rectally as a retention enema every 6 hours.

1 g/kg/dose rectally (Max: 50 g/dose) every 6 hours as needed to correct hyperkalemia. The FDA-approved product labeling recommends using an exchange rate of 1 mEq of potassium per gram of resin as the basis for calculating the dosage for infants and small children. The usual adult dose is 30 to 50 g/dose. Because efficacy is variable, carefully monitor serum electrolytes to determine appropriateness of dosage and duration of therapy.

Insulin with glucose is preferred over treatment with rectal cation-resin in pre-term neonates. Some products are contraindicated by the manufacturer for use in neonates. Individual doses of 0.5 to 1 g/kg/dose rectally have been recommended. The frequency of administration depends on the severity of hyperkalemia and patient response; every 6 hours as needed is recommended in other age groups. To minimize the risk of impaction, use the lowest effective dose, properly dilute the powder for suspension, and after the enema is complete, adequately irrigate using a sodium-free cleansing fluid to ensure full recovery of the resin. Sodium polystyrene sulfonate 1 g/kg/dose rectally every 4 hours has been studied; however, the authors concluded that early continuous regular insulin infusion therapy for the treatment of non-oliguric hyperkalemia in very low birth weight infants is more effective than sodium polystyrene sulfonate. If sodium polystyrene sulfonate therapy is necessary, do not use commercially available liquid formulations containing sorbitol because their hyperosmolality has been associated with intestinal hemorrhage in premature neonates; freshly compounded suspensions prepared from the powdered resin are preferred.

Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

Aluminum Hydroxide: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Aluminum Hydroxide; Magnesium Carbonate: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Aluminum Hydroxide; Magnesium Hydroxide: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Aluminum Hydroxide; Magnesium Hydroxide; Simethicone: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Aluminum Hydroxide; Magnesium Trisilicate: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Moderate) Sodium polystyrene sulfonate should be used cautiously with other agents that can induce hypokalemia such as loop diuretics, insulins, or intravenous sodium bicarbonate. Because of differences in onset of action, sodium polystyrene sulfonate is often used with these agents. With appropriate monitoring, hypokalemia can be avoided.
Bumetanide: (Moderate) Sodium polystyrene sulfonate should be used cautiously with other agents that can induce hypokalemia such as loop diuretics, insulins, or intravenous sodium bicarbonate. Because of differences in onset of action, sodium polystyrene sulfonate is often used with these agents. With appropriate monitoring, hypokalemia can be avoided.
Bupivacaine; Meloxicam: (Major) Meloxicam oral suspension contains sorbitol and use of sorbitol with sodium polystyrene sulfonate has been implicated in cases of upper gastrointestinal injury and colonic necrosis, both potentenially fatal complications. Concomitant use of the oral solution of meloxicam and sodium polystyrene sulfonate is not recommended. Patients with renal insufficiency may be at increased risk while on such therapy. This risk of interaction does not apply to other forms of meloxicam.
Calcium Carbonate: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Calcium Carbonate; Famotidine; Magnesium Hydroxide: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Calcium Carbonate; Magnesium Hydroxide: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Calcium Carbonate; Magnesium Hydroxide; Simethicone: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Calcium Carbonate; Simethicone: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Calcium; Vitamin D: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Cardiac glycosides: (Moderate) Since electrolyte disorders modify the actions of digoxin, drugs that can affect electrolyte balance, such as sodium polystyrene sulfonate, potentially can increase the effect and potentiate the toxicity of digoxin.
Citric Acid; Potassium Citrate; Sodium Citrate: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Digoxin: (Moderate) Since electrolyte disorders modify the actions of digoxin, drugs that can affect electrolyte balance, such as sodium polystyrene sulfonate, potentially can increase the effect and potentiate the toxicity of digoxin.
Ethacrynic Acid: (Moderate) Sodium polystyrene sulfonate should be used cautiously with other agents that can induce hypokalemia such as loop diuretics, insulins, or intravenous sodium bicarbonate. Because of differences in onset of action, sodium polystyrene sulfonate is often used with these agents. With appropriate monitoring, hypokalemia can be avoided.
Furosemide: (Moderate) Sodium polystyrene sulfonate should be used cautiously with other agents that can induce hypokalemia such as loop diuretics, insulins, or intravenous sodium bicarbonate. Because of differences in onset of action, sodium polystyrene sulfonate is often used with these agents. With appropriate monitoring, hypokalemia can be avoided.
Ibritumomab Tiuxetan: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Insulins: (Moderate) Sodium polystyrene sulfonate should be used cautiously with other agents that can induce hypokalemia such as loop diuretics, insulins, or intravenous sodium bicarbonate. Because of differences in onset of action, sodium polystyrene sulfonate is often used with these agents. With appropriate monitoring, hypokalemia can be avoided.
Iodine; Potassium Iodide, KI: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Lithium: (Major) Sodium polystyrene sulfonate can reduce the absorption of lithium.
Loop diuretics: (Moderate) Sodium polystyrene sulfonate should be used cautiously with other agents that can induce hypokalemia such as loop diuretics, insulins, or intravenous sodium bicarbonate. Because of differences in onset of action, sodium polystyrene sulfonate is often used with these agents. With appropriate monitoring, hypokalemia can be avoided.
Magnesium Citrate: (Major) Concurrent use of oral magnesium citrate with sodium polystyrene sulfonate (Kayexalate) is not recommended. Sodium polystyrene sulfonate may bind with magnesium administered orally; however, the risk of binding with oral magnesium may be less with rectal administration of sodium polystyrene sulfonate.
Magnesium Hydroxide: (Major) Simultaneous oral administration of cation-donating antacids or laxatives may reduce the potassium exchange capability of sodium polystyrene sulfonate. Examples of cation-donating antacids and laxatives include aluminum hydroxide, calcium carbonate, magnesium carbonate, magnesium citrate, and magnesium hydroxide. Patients who received concomitant oral sodium polystyrene sulfonate and non-absorbable cation-donating antacids and laxatives have developed systemic alkalosis. Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has also been reported. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene with magnesium hydroxide as laxative. Normally, antacids like magnesium hydroxide and calcium carbonate neutralize hydrochloric acid in the stomach, forming magnesium chloride and calcium chloride. As these compounds enter the small intestine, they react with bicarbonate, forming magnesium carbonate and calcium carbonate, which are insoluble. If polystyrene is administered, it blocks this reaction by binding to the magnesium and calcium ions before they can react with the bicarbonate. More hydrogen ions are lost from the stomach than are lost from the intestine, resulting in metabolic alkalosis. Rectal administration of sodium polystyrene sulfonate may reduce the severity of these interactions.
Meloxicam: (Major) Meloxicam oral suspension contains sorbitol and use of sorbitol with sodium polystyrene sulfonate has been implicated in cases of upper gastrointestinal injury and colonic necrosis, both potentenially fatal complications. Concomitant use of the oral solution of meloxicam and sodium polystyrene sulfonate is not recommended. Patients with renal insufficiency may be at increased risk while on such therapy. This risk of interaction does not apply to other forms of meloxicam.
Omeprazole; Sodium Bicarbonate: (Moderate) Sodium polystyrene sulfonate should be used cautiously with other agents that can induce hypokalemia such as loop diuretics, insulins, or intravenous sodium bicarbonate. Because of differences in onset of action, sodium polystyrene sulfonate is often used with these agents. With appropriate monitoring, hypokalemia can be avoided.
Potassium Acetate: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Potassium Bicarbonate: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Potassium Chloride: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Potassium Citrate: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Potassium Citrate; Citric Acid: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Potassium Gluconate: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Potassium Iodide, KI: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Potassium: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Sodium Bicarbonate: (Moderate) Sodium polystyrene sulfonate should be used cautiously with other agents that can induce hypokalemia such as loop diuretics, insulins, or intravenous sodium bicarbonate. Because of differences in onset of action, sodium polystyrene sulfonate is often used with these agents. With appropriate monitoring, hypokalemia can be avoided.
Sodium Sulfate; Magnesium Sulfate; Potassium Chloride: (Contraindicated) Sodium polystyrene sulfonate is indicated for the treatment of hyperkalemia. Administration of all potassium salts should be discontinued whenever therapy with sodium polystyrene sulfonate is indicated.
Sorbitol: (Contraindicated) Concomitant use of oral sorbitol solution with sodium polystyrene sulfonate has been implicated in cases of colonic necrosis. Concomitant administration is not recommended. Interactions of this nature have not been reported with sorbitol lozenge and irrigation dosage forms.
Thyroid hormones: (Moderate) Administer thyroid hormones at least 4 hours apart from cation exchange resins, like sodium polystyrene sulfonate. Cation exchange resins can bind thyroxine or levothyroxine in the GI tract and inhibit oral absorption, potentially leading to hypothyroidism.
Torsemide: (Moderate) Sodium polystyrene sulfonate should be used cautiously with other agents that can induce hypokalemia such as loop diuretics, insulins, or intravenous sodium bicarbonate. Because of differences in onset of action, sodium polystyrene sulfonate is often used with these agents. With appropriate monitoring, hypokalemia can be avoided.

Kayexalate/Kionex/Marlexate/Sodium Polystyrene Sulfonate Oral Pwd F/Recon: 15g, 453.6g
Kayexalate/Kionex/Marlexate/Sodium Polystyrene Sulfonate Rectal Pwd F/Recon: 15g, 453.6g
Kionex/Sodium Polystyrene Sulfonate/SPS Oral Susp: 15g, 60mL
Kionex/Sodium Polystyrene Sulfonate/SPS Rectal Susp: 15g, 60mL

Specific maximum dosage information is not available. Individualize dosage based on careful monitoring of serum potassium concentrations and other clinical parameters in all patient populations.

Sodium polystyrene sulfonate (SPS) is a non-absorbed, cation-exchange polymer indicated for the treatment of hyperkalemia. The drug can be administered either orally or as a retention enema. Once in the gastrointestinal lumen, the insoluble resin swells allowing for the sodium contained within the polymer to be exchanged for potassium and other cations dissolved within the gastrointestinal tract; this action occurs primarily in the large intestine. The potassium that is now bound to the polymer continues through the colon and is eventually eliminated in the feces. By binding and eliminating free potassium from the gastrointestinal lumen, SPS reduces serum potassium concentrations. The in vivo exchanges ratio is estimated to be approximately 1 meq of potassium for each gram of SPS administered. However, drug efficacy is unpredictable, as competition from other cations (i.e., calcium and magnesium) may reduce the potassium exchange capacity to as low as 0.4 meq per gram of SPS.
 
Sodium polystyrene sulfonate has a delayed onset of action (1 to 2 hours); therefore, the drug is not indicated as an emergency treatment for severe or life-threatening hyperkalemia. Alternative treatment options may include dialysis, insulin with 5% dextrose (15 to 30 minutes), nebulized albuterol (15 to 30 minutes), and intravenous furosemide (15 minutes to 1 hour).[49262] [63873][63874]

Sodium polystyrene sulfonate is administered orally or rectally. It is not absorbed after administration; therefore, it does not distribute in the body and is not metabolized. The cationically modified resin is excreted in the feces. The resin's onset of action is typically within a few hours.
 
Affected cytochrome P450 isoenzymes: none

Maternal use during pregnancy is not expected to result in fetal risk. Sodium polystyrene sulfate is not systemically absorbed after oral or rectal administration.

Breast-feeding is not expected to result in risk to the infant. Sodium polystyrene sulfate is not systemically absorbed after oral or rectal administration.