PDR MEMBER LOGIN:
  • PDR Search

    Required field
  • Advertisement
  • CLASSES

    Antidotes, Adsorbents
    Mineral Binding Agents

    DEA CLASS

    Rx

    DESCRIPTION

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

    COMMON BRAND NAMES

    Kalexate, Kayexalate, Kionex, Marlexate, SPS

    HOW SUPPLIED

    Kalexate/Kayexalate/Kionex/Marlexate/Sodium Polystyrene Sulfonate Oral Pwd F/Recon: 15g, 453.6g
    Kalexate/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

    DOSAGE & INDICATIONS

    For the treatment of hyperkalemia.
    NOTE: The dosage must be individualized, depending on the daily assessment of total body potassium.
    Oral dosage
    Adults

    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—4 times per day.

    Infants, Children, and Adolescents

    1 g/kg PO 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.

    Rectal dosage
    Adults

    30—50 g PR as a retention enema every 1—2 hours initially, as needed to correct hyperkalemia, and then every 6 hours.

    Infants, Children, and Adolescents

    1 g/kg PR 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.

    MAXIMUM DOSAGE

    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.

    DOSING CONSIDERATIONS

    Hepatic Impairment

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

    Renal Impairment

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

    ADMINISTRATION

    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.
     

    Oral Administration
    Other Oral Formulations

    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.

    Rectal Administration

    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.

    STORAGE

    Generic:
    - Store at 77 degrees F; excursions permitted to 59-86 degrees F
    - Use within 24 hours from time of preparation
    Kalexate:
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    Kayexalate:
    - Store at 77 degrees F; excursions permitted to 59-86 degrees F
    - Use within 24 hours from time of preparation
    Kionex :
    - Store at 77 degrees F; excursions permitted to 59-86 degrees F
    - Use within 24 hours from time of preparation
    Marlexate:
    - Store at 77 degrees F; excursions permitted to 59-86 degrees F
    - Use within 24 hours from time of preparation
    SPS:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    - Store away from excessive heat and cold

    CONTRAINDICATIONS / PRECAUTIONS

    General Information

    Sodium polystyrene sulfonate is contraindicated in patients with a history of hypersensitivity to polystyrene sulfonate resins.

    Binding to other oral medications

    Administer sodium polystyrene sulfonate 3 hours before or 3 hours after other orally administered medications to prevent sodium polystyrene sulfonate from binding to other oral medications, which may result in decreased gastrointestinal absorption and reduced efficacy of the bound drug. 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.

    Burns

    Because sodium polystyrene sulfonate may take several hours to lower serum potassium and the effect is variable, it is not appropriate monotherapy for the urgent treatment of severe hyperkalemia or for the correction of severe hyperkalemia associated with rapid tissue breakdown states (e.g. burns). Other treatment options, including dialysis, should also be considered in patients with severe hyperkalemia.

    Children, GI bleeding, GI obstruction, infants, neonates, premature neonates

    Sodium polystyrene sulfonate is contraindicated in patients with GI obstruction or obstructive bowel disease and neonates with reduced gut motility (postoperatively or drug induced). The effectiveness of sodium polystyrene sulfonate in pediatric patients has not been established. In neonates, sodium polystyrene sulfonate should not be given by the oral route and certain products containing sorbitol are contraindicated for use in neonates by any route. In both children and neonates, particular care should be observed with rectal administration, as excessive dosage or inadequate dilution could result in impaction of the resin. Due to the risk of GI bleeding or colonic necrosis, particular care should be observed in premature neonates or low birth weight infants.

    Colitis, constipation, fecal impaction, hypovolemia, inflammatory bowel disease, renal failure, surgery

    Sodium polystyrene sulfonate should only be used in patients with normal bowel function; avoid use in patients at risk for developing constipation or fecal impaction (i.e., those with a history of fecal impaction, chronic constipation, inflammatory bowel disease, ischemic colitis, previous bowel resection, or bowel obstruction). Do not use in post-operative patients who have not had a bowel movement post-surgery. Intestinal necrosis and other serious GI adverse events such as bleeding, ischemic colitis, and perforation have been reported in association with sodium polystyrene sulfonate. Patients with a history of intestinal disease or surgery, hypovolemia, and renal insufficiency, and/or renal failure may be at higher risk for intestinal necrosis. Concomitant use of sorbitol with sodium polystyrene sulfonate has been implicated in the majority cases of colonic necrosis. Additional sorbitol should not be used. In the event of clinically significant constipation, discontinue treatment with sodium polystyrene sulfonate until normal bowel motion is resumed. Magnesium-containing laxatives or sorbitol should not be used for treatment of constipation.

    Edema, heart failure, hypernatremia, hypertension, hypocalcemia, hypokalemia, hypomagnesemia, sodium restriction

    Sodium polystyrene sulfonate reduces total body potassium and is contraindicated in patients with hypokalemia. The drug also reduces total body calcium and should be used with caution in patients with hypocalcemia. Sodium polystyrene sulfonate is not completely selective for potassium; other cations, such as calcium and magnesium, can also be lost during treatment; therefore, use sodium polystyrene sulfonate therapy with caution in patients with hypocalcemia or hypomagnesemia. In addition, sodium polystyrene sulfonate should be used with caution in patients with hypernatremia or who require sodium restriction (i.e. severe congestive heart failure, severe hypertension, or marked edema) because administration of the resin can introduce a significant sodium load. In an effort to minimize the amount of sodium retained, ensure that adequate volumes of sodium-free cleansing enemas are used after rectal administration of sodium polystyrene sulfonate. Monitor all electrolytes carefully and correct using supplements or dosage adjustments as needed.

    Pregnancy

    Sodium polystyrene sulfonate products are classified as FDA pregnancy risk category C. Because there have been no adequate or well-controlled reproductive studies in humans, sodium polystyrene sulfonate should only be used during pregnancy if the potential benefits justify the unknown risk. Because sodium polystyrene sulfonate is not systemically absorbed, direct exposure to the fetus is not likely. GI motility is often decreased during pregnancy; carefully consider the risks associated with administering the resin to patients with constipation.

    Breast-feeding

    According to the manufacturer, it is not known whether sodium polystyrene sulfonate is excreted in human milk. Because many drugs are excreted in human milk, a decision should be made whether to discontinue breast-feeding or to discontinue the drug, taking into account the importance of the drug to the mother. However, sodium polystyrene sulfonate is not systemically absorbed and therefore, exposure to the infant via breast milk is not likely.

    ADVERSE REACTIONS

    Severe

    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

    Moderate

    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

    Mild

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

    DRUG INTERACTIONS

    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.
    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.
    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; 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; Risedronate: (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.
    Chondroitin; Glucosamine: (Severe) 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.
    Citric Acid; Potassium Citrate: (Severe) 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.
    Citric Acid; Potassium Citrate; Sodium Citrate: (Severe) 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: (Severe) 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.
    Digitoxin: (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.
    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.
    Glucosamine: (Severe) 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.
    Guaifenesin; Potassium Guaiacolsulfonate: (Severe) 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.
    Hetastarch; Dextrose; Electrolytes: (Severe) 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.
    Hydrocodone; Potassium Guaiacolsulfonate: (Severe) 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.
    Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: (Severe) 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.
    Ibritumomab Tiuxetan: (Severe) 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: (Severe) 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 Citrate: (Severe) 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: (Severe) 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 Phosphate; Sodium Phosphate: (Severe) 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 Salts: (Severe) 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: (Severe) 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.
    Sorbitol: (Severe) 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: (Major) Cation exchange resins like sodium polystyrene sulfonate, can bind thyroxine or levothyroxine in the GI tract and inhibit T4 absorption. Administer thyroid hormones at least 4 hours apart from cation exchange resins.
    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.

    PREGNANCY AND LACTATION

    Pregnancy

    Sodium polystyrene sulfonate products are classified as FDA pregnancy risk category C. Because there have been no adequate or well-controlled reproductive studies in humans, sodium polystyrene sulfonate should only be used during pregnancy if the potential benefits justify the unknown risk. Because sodium polystyrene sulfonate is not systemically absorbed, direct exposure to the fetus is not likely. GI motility is often decreased during pregnancy; carefully consider the risks associated with administering the resin to patients with constipation.

    According to the manufacturer, it is not known whether sodium polystyrene sulfonate is excreted in human milk. Because many drugs are excreted in human milk, a decision should be made whether to discontinue breast-feeding or to discontinue the drug, taking into account the importance of the drug to the mother. However, sodium polystyrene sulfonate is not systemically absorbed and therefore, exposure to the infant via breast milk is not likely.

    MECHANISM OF ACTION

    Mechanism of Action: Following oral administration, polystyrene resin releases sodium ions that are exchanged for excess hydrogen ions in the stomach. As the resin enters the large intestine, it is subjected to a high concentration of potassium ions. These excess potassium ions replace the hydrogen ions, and the modified resin is eliminated in the feces, carrying the potassium ions with it. Cationic exchange occurs primarily in the large intestine following either oral or rectal administration of polystyrene. Other cations in the large intestine, including calcium, magnesium, iron, lipids, and organic cations such as proteins and steroids, also bind with the resin, so the resin can be used clinically to reduce the concentrations of these cations as well.The potassium-lowering activity of sodium polystyrene sulfonate is relatively slow compared with agents such as sodium bicarbonate, dextrose, or calcium salts. Thus, sodium polystyrene sulfonate is inappropriate for the acute treatment of life-threatening hyperkalemia.

    PHARMACOKINETICS

    Sodium polystyrene sulfonate is not absorbed following administration, and the resin's onset of action varies from several hours to days. This compound does not distribute in the body and is not metabolized. The cationically modified resin is excreted in the feces.