Blog | Friday, July 6, 2018

New drugs for hyperkalemia

The FDA has approved sodium zirconium cyclosilicate (Lokelma, AstraZeneca), a medication that rapidly restores normal potassium levels, for adults with hyperkalemia.

Formerly known as ZS-9, the drug is a “highly-selective, oral potassium-removing agent,” the company explains in a company news release.

Hyperkalemia has become a significant problem. With more type 2 diabetes, we are seeing an explosion of chronic kidney disease. In patients with chronic kidney disease stages 3b and 4, patients often develop hyporenin, hypoaldosterone and thus type IV RTA. However, many patients have relative hyporenin and therefore decreased angiotensin 1. When these patients take an ACE inhibitor or and ARB, they develop hyperkalemia because of inadequate aldosterone.

And these patients have an absolute indication for an ACE-I or ARB. Thus, we have a conundrum. How do we successfully treat their systolic dysfunction or progressive CKD.

Drug companies see an niche. Sodium polysterene (Kayexalate) is not adequate due to dangerous side effects. Patiromer (Valtessa) was released first, now this new option.

What will be their roles? What will be the pricing?

This is all interesting, and we will follow the indications for its use with interest.

db is the nickname for Robert M. Centor, MD, MACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and the former Regional Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds regularly at the Birmingham VA and Huntsville Hospital. His current titles are Professor-Emeritus and Chair-Emeritus of the ACP Board of Regents. This post originally appeared at his blog, db's Medical Rants.