The FDA has approved sodium zirconium cyclosilicate (Lokelma, AstraZeneca) for the treatment of hyperkalemia in adults.

Formerly called ZS-9, sodium zirconium cyclosilicate selectively exchanges potassium for hydrogen and sodium throughout the gastrointestinal tract. Its approval is supported by data from 3 double-blind, placebo-controlled trials and 2 open-label long-term trials.

In a trial, the onset of action in patients with hyperkalemia taking the drug was at 1 hour and the median time to achieving normal potassium levels was 2.2 hours. In addition, 92% of patients achieved normal potassium levels within 48 hours from baseline.

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Data also show that sodium zirconium cyclosilicate was effective in lowering potassium levels in patients with chronic kidney disease, heart failure, diabetes, and those taking renin-aldosterone-angiotensin-system inhibitors.

The most common adverse event, occurring in 6% of patients, was mild to moderate edema with the recommended dose of 10 grams once daily.