Dosing and uses of Veltassa (patiromer)
Adult dosage forms and strengths
oral powder for suspension
- 8.4g/packet
- 16.8g/packet
- 25.2g/packet
Hyperkalemia
Indicated for hyperkalemia
Initial: 8.4 g PO qDay
Monitor serum potassium and adjust dose based on the serum potassium level and the desired target range
May increase or decrease dose as necessary; not to exceed 25.2 g qDay
May titrate upward at 1-week or longer intervals, in increments of 8.4 g
Note: Doses exceeding 50.4 g/day have not been tested; excessive doses may result in hypokalemia; restore serum potassium if hypokalemia occurs
Dosage modifications
Renal impairment
- No dosing adjustments are needed
- Of the 666 patients treated with patiromer in clinical studies, 93% had chronic kidney disease
Dosing Considerations
Limitations of use
- Should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action
- Administer patiromer at least 6 hr before or 6 hr after other oral medications; patiromer may decrease absorption other oral medications
Pediatric dosage forms and strengths
Safety and efficacy not established
Veltassa (patiromer) adverse (side) effects
1-10%
Constipation (7.2%)
Hypomagnesemia (5.3%)
Diarrhea (4.8%)
Hypokalemia, <3.5 mEq/L (4.7%)
Nausea (2.3%)
Abdominal discomfort (2%)
Flatulence (2%)
Warnings
Black box warnings
Binds many other orally administered drugs in the GI tract, which could decrease their absorption and reduce their effectiveness
Separate doses of patiromer and any other orally administered medication at least 6 hr; monitor for clinical response and/or blood levels where possible
If adequate dosing separation is not possible, choose continuing either patiromer or the other oral medication
In clinical trials, patiromer was shown to bind about half of the oral medications that were tested
Contraindications
Hypersensitivity to patiromer or its components
Cautions
Patiromer binds many orally administered medications, which could decrease their GI absorption and lead to reduced efficacy (see Black box warnings)
Avoid use with severe constipation, bowel obstruction, or impaction, including abnormal postoperative bowel motility disorders; patiromer may be ineffective with these conditions present and may worsen GI conditions
Patients with a history of bowel obstruction or major GI surgery, severe GI disorders, or swallowing disorders were not included in clinical trials
Binds to magnesium in the colon, which can lead to hypomagnesemia; monitor serum magnesium; consider magnesium supplementation if low serum magnesium levels observed
Pregnancy
Pregnancy
Not absorbed systemically following oral administration, and maternal use is not expected to result in fetal risk
Lactation
Not absorbed systemically by the mother, so breastfeeding is not expected to result in risk to the infant
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Veltassa (patiromer)
Mechanism of action
Binds and removes potassium from the GI tract, particularly the colon
Patiromer is a nonabsorbed, cation exchange polymer that contains a calcium-sorbitol counterion
Absorption
Not systemically absorbed
Quantitative whole-body autoradiography analysis in rats demonstrated that radioactivity was limited to the GI tract, with no detectable level of radioactivity in any other tissues or organs
Elimination
Excretion: Feces
Administration
Oral suspension preparation
Prepare each dose immediately prior to administration following the steps below
- 1: Add about 1 ounce (30 mL) of water to an empty glass or cup
- 2: Empty the entire contents of the packet(s) into the glass or cup
- 3: Stir the mixture thoroughly
- 4: Add an additional 2 ounces (60 mL) of water to the glass or cup containing the mixture
- 5: Stir the mixture thoroughly; the powder will not dissolve and the mixture will look cloudy
- 6: Drink the mixture immediately; if some powder remains in the glass after drinking, add more water, stir and drink immediately; repeat as needed to ensure the entire dose is administered
Oral administration
Administer patiromer at least 6 hr before or 6 hr after other oral medications; patiromer may decrease absorption other oral medications
Administer with food
Do not heat patiromer (eg, microwave) or add to heated foods or liquids
Do not take patiromer in its dry form
Storage
Stored refrigerated at 2-8°C (36-46°F)
If stored at room temperature (25°C [77°F]), patiromer must be used within 3 months of being taken out of the refrigerator
For either storage condition, do not use after the expiration date printed on the packet
Avoid exposure to excessive heat >40°C (>104°F)
