How does this medication work? What will it do for me?

Sodium zirconium cyclosilicate belongs to the class of medications called potassium binders. It is used to reduce high levels of potassium in the blood.

This medication starts to reduce potassium 1 hour after taking a dose. It works by binding potassium in the digestive system to prevent it from being absorbed into the blood stream.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each sachet of white-to-grey, insoluble powder contains either 5 g or 10 g of sodium zirconium cyclosilicate.

How should I use this medication?

The starting dose of sodium zirconium cyclosilicate is 10 g taken by mouth, 3 times a day, for up to 48 hours. This dose reduces the amount of potassium in the blood. After 2 days, your doctor will adjust the dose to maintain a normal amount of potassium in the blood. The maximum maintenance dose is 10 g taken by mouth, once daily. This medication can be taken with or without food.

The contents of a sachet should be emptied into a drinking glass containing approximately 45 mL of water. Stir the water and powder until the powder is suspended. It will appear to be cloudy since the powder will not dissolve. The liquid will be tasteless. Immediately drink the water with the powder in it. To make sure you get all the medication, add some water into the empty glass, stir it again and drink the water. Make sure the powder solution is either consumed or disposed of after being mixed. Do not store the solution of powder in water for later use.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor. If you are receiving hemodialysis, your dose may be higher.

It is important to take this medication exactly as prescribed by your doctor.

If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you are allergic to sodium zirconium cyclosilicate or any ingredients of the medication.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain
  • constipation
  • diarrhea
  • nausea
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • muscle spasms
  • signs of heart failure (e.g., shortness of breath, fatigue, swelling in legs, ankles, feet)
  • swelling in the ankles and feet
  • symptoms of irregular heartbeat (e.g., chest pain, dizziness, rapid, pounding heartbeat, shortness of breath)
  • symptoms of low levels of calcium in the blood (e.g., confusion, memory loss, muscle spasms, numbness and tingling in the hands and feet, muscle cramps, weak and brittle nails)
  • symptoms of low magnesium in the blood (e.g., abnormal eye movements, fatigue, muscle spasms or cramps, muscle weakness, numbness)
  • symptoms of a low level of potassium in the blood (e.g., fatigue, muscle weakness, cramps)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Heart rhythm: Changes in the amount of potassium in the blood can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low magnesium levels), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Stomach problems: The safety and effectiveness of this medication for people who have had major surgery to the digestive system have not been determined. If you have a history of severe constipation, bowel obstruction or major surgery, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if sodium zirconium cyclosilicate passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between sodium zirconium cyclosilicate and any of the following:

  • clopidogrel
  • dabigatran
  • tacrolimus
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over the counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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