Kayexelate (Sodium Polystyrene Sulfonate Cation Exchange Resin)

Indications


Contraindications

  • Bowel Obstruction (see Small Bowel Obstruction, [[Small Bowel Obstruction]])
  • Constipation (see Constipation, [[Constipation]])
  • Inability to Tolerate Sodium Load: use of kayexelate should be carefully considered in these patient populations
  • Post-Operative Ileus (see Ileus, [[Ileus]])

Pharmacology

  • Sodium Polystyrene Sulfonate Cation Exchange Resin: sodium ions are partially released from the resin and are replaced by potassium ions
    • This occurs mostly in the colon, which excretes potassium ions to a greater degree than the small intestine
    • Efficiency of potassium binding is highly variable
    • Latency of potassium-lowering effect: hours-days
    • Small amounts of magnesium and calcium may be bound by the resin, as well

Administration

  • PO: 15g 1-4x/day
    • Avoid concomitant sorbitol use
  • PR (less effective than PO administration): 30g 1-4x/day

Adverse Effects

Renal Adverse Effects

  • Hypokalemia (see Hypokalemia, [[Hypokalemia]])
  • Metabolic Alkalosis (see Metabolic Alkalosis, [[Metabolic Alkalosis]]): reported when kayexelate has been given in combination with non-absorbable cation-donating antacids and laxatives (such as magnesium hydroxide and aluminum carbonate)

Gastrointestinal Adverse Effects

  • Gastrointestinal Hemorrhage (see Gastrointestinal Hemorrhage, [[Gastrointestinal Hemorrhage]]): most cases have occurred in association with concomitant sorbitol use
  • Intestinal Necrosis/Perforation (see xxxx, [[]]): most cases have occurred in association with concomitant sorbitol use
    • Cases associated with fatality have been reported
  • Ischemic Colitis (see Ischemic Colitis, [[Ischemic Colitis]]): most cases have occurred in association with concomitant sorbitol use

Other Adverse Effects

  • xxx

References

  • xxxx