Sodium zirconium cyclosilicate (SZC) [Lokelma™] is a useful oral 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 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 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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The article was updated from Drugs 2018;78(15):1605–13  by writers/editors of Adis International Ltd./Springer Nature and was reviewed by: B. Geavlete, Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania; J. Jose, School of Pharmacy, University of Nizwa, Nizwa, Oman; R. B. Shah, Department of Pharmacology, GMERS Medical College and Hospital, Gandhinagar, Gujarat, India; S. Hiremath, Division of Nephrology, Ottawa Hospital Research Institute, Ottawa, ON, Canada. During the peer review process, AstraZeneca, the marketing-authorization holder of sodium zirconium cyclosilicate, was also offered an opportunity to provide a scientific accuracy review of their data. Changes resulting from comments received were made on the basis of scientific and editorial merit.
The preparation of this review was not supported by any external funding.
Conflict 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.
for this Adis Drug Q&A can be found at https://doi.org/10.6084/m9.figshare.11594193.
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Paik, J. Sodium zirconium cyclosilicate in hyperkalaemia: a profile of its use. Drugs Ther Perspect 36, 89–96 (2020). https://doi.org/10.1007/s40267-020-00706-0