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Sodium zirconium cyclosilicate: a profile of its use

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posted on 2020-02-14, 03:06 authored by Julia Paik

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Disclosure: The preparation of this review was not supported by any external funding.

Conflicts of interest: J. Paik is an employee of Adis International Ltd./Springer Nature, is responsible for the article content and declares no conflicts of interest.

Additional information about this Adis Drug Review can be found here


Sodium zirconium cyclosilicate (SZC) [Lokelma] is a useful, orally-administered option for the treatment of hyperkalaemia in adults. As a non-absorbed, non-polymer compound, SZC lowers serum potassium levels by binding potassium in the gastrointestinal (GI) tract and promoting faecal potassium excretion. SZC is effective in restoring and maintaining normokalaemia and is generally well tolerated; most adverse events (AEs) reported in phase 3 clinical trials were manageable without treatment interruption. SZC appears to be effective and generally well tolerated regardless of common factors associated with hyperkalaemia, including concomitant renin-angiotensin-aldosterone system inhibitor (RAASi) therapy, chronic kidney disease, diabetes and heart failure. Recent data suggest that SZC is also effective and similarly well tolerated in patients with end-stage kidney disease (ESKD) receiving haemodialysis, who typically have persistent predialysis hyperkalaemia. Real-world data and additional long-term data will be valuable in more definitively establishing the position of SZC in the treatment of hyperkalaemia.

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