ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Calcium polystyrene sulfonate (United States: Not available): Drug information

Calcium polystyrene sulfonate (United States: Not available): Drug information
(For additional information see "Calcium polystyrene sulfonate (United States: Not available): Patient drug information" and see "Calcium polystyrene sulfonate (United States: Not available): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: Canada
  • Resonium Calcium
Pharmacologic Category
  • Antidote
Dosing: Adult

Note: Each gram of resin has a theoretical in vitro exchange capacity of about 1.3 to 2 mmol (1.3 to 2 mEq) of potassium. In vivo, the actual amount of potassium bound will be less than this.

Hyperkalemia, nonemergent

Hyperkalemia, nonemergent: Note: Initiate treatment if serum potassium level >6 mmol/L (6 mEq/L); discontinue when serum potassium level ≤5 mmol/L (5 mEq/L).

Oral: Usual dose: 15 g 3 to 4 times daily; dose based on clinical presentation and serum potassium level.

Rectal enema: 30 g once daily.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no specific dosage adjustments provided in the manufacturer's labeling; however, dosage adjustments may be necessary based on changes in serum potassium and/or calcium levels.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Calcium polystyrene sulfonate (United States: Not available): Pediatric drug information")

Note: Each gram of resin can potentially bind up to 0.5 to 1 mEq of potassium (Ref).

Hyperkalemia

Hyperkalemia: Due to delayed onset of action, exchange resins should not be used as emergency treatment for life-threatening hyperkalemia (Ref).

Infants, Children, and Adolescents:

Oral: 0.5 to 1 g/kg/day in divided doses every 6 to 8 hours as needed; maximum dose: 15 g/dose (Ref); doses as high as 1 g/kg/dose have been reported (Ref).

Rectal: 0.5 to 1 g/kg/day in divided doses every 6 to 8 hours as needed; maximum dose: 30 g/dose (Ref); doses as high as 1 g/kg/dose have been reported (Ref). Once retention time is complete, irrigate the colon to ensure adequate removal of the resin (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no specific dosage adjustments provided in the manufacturer's labeling; however, dosage adjustments may be necessary based on changes in serum potassium and/or calcium levels.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined: Gastrointestinal: Anorexia, constipation, diarrhea, gastric irritation, nausea, vomiting

Postmarketing:

Endocrine & metabolic: Hypercalcemia (Arroyo 2012), hypomagnesemia

Gastrointestinal: Abdominal distention (Kao 2015), abdominal pain (Kao 2015), bezoar formation (oral administration) (Fiel 2019), fecal impaction (Fiel 2019), gastrointestinal necrosis (Joo 2009; Kao 2015), gastrointestinal stenosis, gastrointestinal ulcer (Fung 2020), ileitis (including ulcerative ileocolitis) (Mansour 2021), intestinal obstruction (Fung 2020; Kao 2015), ischemic colitis, mesenteric ischemia, peritonitis, rectal hemorrhage

Contraindications

Hypersensitivity to polystyrene sulfonate resins or any component of the formulation; potassium <5 mmol/L (5 mEq/L); conditions associated with hypercalcemia (eg, metastatic carcinoma, multiple myeloma, hyperparathyroidism, or sarcoidosis); obstructive bowel disease; oral administration in neonates; use in neonates with reduced gut motility (postoperative, drug induced)

Warnings/Precautions

Concerns related to adverse effects:

• Electrolyte disturbances: Use may be associated with electrolyte disturbances including hypokalemia, hypercalcemia, and/or hypomagnesemia. Closely monitor electrolytes during therapy. Discontinue use if potassium ≤5 mmol/L (5 mEq/L).

• GI effects: Gastrointestinal stenosis, intestinal ischemia, ischemic colitis, rectal hemorrhage, gastrointestinal necrosis, and intestinal perforation with fatal outcomes have been reported, particularly in patients with underlying risk factors (eg, prematurity, history of intestinal disease or surgery, renal impairment, hypovolemia, severe burn, immunosuppressive therapy). Fecal impaction with rectal administration and concretion formation with oral administration have also occurred. Effects may be related to use of sorbitol enema with inadequate/absence of lavage after resin use. Avoid excess dosing or inadequate dilution with rectal administration to avoid resin impaction. Discontinue use in patients with clinically significant constipation. Intermittent therapy may be considered for patients developing nausea/vomiting, diarrhea, gastric irritation and anorexia, and the use of mild laxatives may be considered if constipation occurs.

Disease-related concerns:

• Renal impairment: Use with caution in renal impairment and/or dialysis patients. Sudden increases in calcium may be observed; monitor calcium weekly (or more frequently if clinically indicated). Dosage adjustments may be necessary.

Special populations:

• Neonates/infants: Oral administration is contraindicated in neonates. Use caution with rectal administration to avoid resin impaction. Premature/low-birth-weight infants may be at risk for GI hemorrhage or colonic necrosis.

Product Availability

Not available in the US

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Powder for suspension, oral/rectal:

Resonium Calcium: 300 g [contains calcium 1.6 to 2.4 mmol/g, sodium <1 mg/g; packaging contains 15 g measuring device]

Administration: Adult

Oral: Administer orally (via nasogastric tube if unable to swallow) at least 3 hours before or 3 hours after other oral medications (patients with gastroparesis may require a 6 hour separation) as a prepared suspension or paste. Patient should be positioned carefully during ingestion to avoid aspiration. Note: More rapid lowering of potassium may be achieved with concomitant oral and rectal administration. Rectal route may be discontinued once orally administered resin has reached rectum.

Rectal: Enema route is less effective than oral administration. Administer rectally as a prepared suspension.

Enema should be retained as long as possible (product labeling suggests for at least 9 hours in adults or as long as possible) as greater amounts of potassium are excreted as retention time increases. Follow enema with irrigation to remove resin. Note: More rapid lowering of potassium may be achieved with concomitant oral and rectal administration. Rectal route may be discontinued once orally administered resin has reached rectum.

Administration: Pediatric

Note: Plastic spoon provided with jar measures 15 g of powdered resin when level.

Oral: Infants, Children, and Adolescents:

Administer orally (or via gastric tube if unable to swallow) as a suspension or paste prepared with honey, jam, water, or other liquids with low potassium content. Patients should be positioned carefully during ingestion to avoid aspiration. Note: Oral administration in neonates is contraindicated.

Rectal: Rectal route is less effective than oral administration. Administer rectally as a prepared suspension; enema should be retained as long as possible, as greater amounts of potassium are excreted as retention time increases; recommended retention times: Neonates: At least 30 minutes (Ref); Infants, Children, and Adolescents: At least 30 to 60 minutes (Ref). Once retention time is complete, irrigate colon with NS to remove resin and prevent impaction (Ref).

Use: Labeled Indications

Note: Not approved in the US.

Hyperkalemia, nonemergent: Treatment of hyperkalemia associated with anuria or severe oliguria.

Medication Safety Issues
Sound-alike/look-alike issues:

Calcium polystyrene sulfonate may be confused with sodium polystyrene sulfonate

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Aluminum Hydroxide: Calcium Polystyrene Sulfonate may enhance the adverse/toxic effect of Aluminum Hydroxide. More specifically, concomitant use of these agents may increase the risk for intestinal obstruction. Management: Monitor for signs/symptoms of intestinal obstruction with concomitant use of calcium polystyrene sulfonate and aluminum hydroxide. Adequate fluid intake, laxative use, alternative antacid agents, and/or limiting duration of therapy may help reduce risks. Risk D: Consider therapy modification

Antacids: May enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. The combined use of these two agents may result in metabolic alkalosis. Risk C: Monitor therapy

Cardiac Glycosides: Calcium Polystyrene Sulfonate may enhance the adverse/toxic effect of Cardiac Glycosides. Specifically, the risk for increased digoxin toxicity may occur if hypokalemia is present. Risk C: Monitor therapy

Laxatives (Magnesium Containing): May enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. More specifically, concomitant use of calcium polystyrene sulfonate with magnesium-containing laxatives may result in metabolic alkalosis or with sorbitol may result in intestinal necrosis. Management: Avoid concomitant use of calcium polystyrene sulfonate (rectal or oral) and magnesium-containing laxatives. Risk X: Avoid combination

Lithium: Calcium Polystyrene Sulfonate may decrease the serum concentration of Lithium. Management: Consider separating administration of lithium from administration of oral calcium polystyrene sulfonate by at least 6 hours. Risk D: Consider therapy modification

Meloxicam: May enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. More specifically, concomitant use of meloxicam oral suspension (which contains sorbitol) may increase the risk for intestinal necrosis. Risk X: Avoid combination

Sorbitol: May enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. More specifically, concomitant use of these agents may increase the risk for intestinal necrosis. Risk X: Avoid combination

Thyroid Products: Calcium Polystyrene Sulfonate may decrease the serum concentration of Thyroid Products. Management: Consider administering thyroid products at least 4 hours prior to calcium polystyrene sulfonate. Monitor for signs and symptoms of hypothyroidism with concomitant use. Risk D: Consider therapy modification

Pregnancy Considerations

Calcium polystyrene sulfonate does not undergo gastrointestinal (GI) absorption. In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant women if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey 2003).

Breastfeeding Considerations

Does not undergo GI absorption

Dietary Considerations

May administer orally with honey, jam, or liquids with low potassium content. Do not mix in fruit juices (eg, orange juice) or other beverages with high potassium content. Some products may contain sodium.

Monitoring Parameters

Close monitoring of serum electrolytes (may decrease potassium, sodium, increase calcium, decrease magnesium); ECG.

Reference Range

Serum potassium: Adults: 3.5 to 5 mEq/L (SI: 3.5 to 5 mmol/L).

Mechanism of Action

Removes potassium by exchanging calcium ions for potassium ions in the intestine before the resin is excreted from the body

Pharmacokinetics (Adult Data Unless Noted)

Onset of action: May be delayed 1 to 2 days due to GI transit time

Absorption: None

Excretion: Feces (100%)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Calcium resonium;
  • (AR) Argentina: Resincalcio;
  • (AU) Australia: Calcium resonium;
  • (BE) Belgium: Kayexalate calcium | Sorbisterit;
  • (BR) Brazil: Sorcal;
  • (CO) Colombia: Kelassens;
  • (CZ) Czech Republic: Sorbisterit;
  • (DE) Germany: Calcium resonium | Cps;
  • (DO) Dominican Republic: Resincalcio;
  • (EE) Estonia: Sorbisterit;
  • (EG) Egypt: Renostrite | Sorbisterit;
  • (ES) Spain: Resincalcio | Sorbisterit;
  • (FI) Finland: Sorbisterit;
  • (FR) France: Calcium fresenius | Resikali;
  • (GB) United Kingdom: Calcium resonium | Sorbisterit;
  • (HK) Hong Kong: Calcium resonium;
  • (IN) India: Calcium resonium | Pebind;
  • (IT) Italy: Sorbisterit;
  • (JO) Jordan: Calcium resonium;
  • (JP) Japan: Exmate | Kaliaid | Kalimate | Mitapillarin | Poscarl;
  • (KR) Korea, Republic of: Casca | Huons karos | Inist polystyrene | K down | K low | K sumer | Kalimet | Kashut | Kaska;
  • (LB) Lebanon: Calcium resonium | Resical;
  • (LT) Lithuania: Resincalcio | Sorbisterit;
  • (LU) Luxembourg: Sorbisterit;
  • (LV) Latvia: Anti Kalium | Sorbisterit;
  • (MX) Mexico: Novefazol;
  • (MY) Malaysia: Kalimate;
  • (NL) Netherlands: Sorbisterit;
  • (NO) Norway: Sorbisterit;
  • (NZ) New Zealand: Calcium resonium;
  • (PH) Philippines: Resincal;
  • (PL) Poland: Calcium resonium;
  • (QA) Qatar: Calcium Resonium | Resical;
  • (RU) Russian Federation: Sorbisterit;
  • (SA) Saudi Arabia: Calcium resonium | Resocal;
  • (SI) Slovenia: Kayexalate calcium | Sorbisterit;
  • (SK) Slovakia: Sorbisterit;
  • (ZA) South Africa: Sorbisterit
  1. Arroyo D, Panizo N, García de Vinuesa S, Goicoechea M, Verdalles U, Luño J. Hypercalcemia as a side effect of potassium binding agents. Nefrologia. 2012;32(5):655-658. doi:10.3265/Nefrologia.pre2012.Jun.11500 [PubMed 23013952]
  2. Bailey B, "Are There Teratogenic Risks Associated With Antidotes Used in the Acute Management of Poisoned Pregnant Women?" Birth Defects Res A Clin Mol Teratol, 2003, 67(2):133-40. [PubMed 12769509]
  3. Doherty EG. Fluid and electrolyte management. In: Eichenwald EC, Hansen AR, Martin CR, Stark AR. Cloherty and Stark's Manual of Neonatal Care. 8th edition. Lippincott Williams & Wilkins; 2017:chap 23.
  4. Fiel DC, Santos I, Santos JE, et al. Cecum perforation associated with a calcium polystyrene sulfonate bezoar - a rare entity. J Bras Nefrol. 2019;41(3):440-444. doi:10.1590/2175-8239-JBN-2018-0158 [PubMed 30534857]
  5. Fung WW, Chi WK, Szeto CC, Li PK, Chow KM. Lessons of the month 3: duodenal perforation after polystyrene sulfonate. Clin Med (Lond). 2020;20(1):107-109. doi:10.7861/clinmed.2019-0327 [PubMed 31941743]
  6. Grammatikopoulos T, Greenough A, Pallidis C, Davenport M. Benefits and risks of calcium resonium therapy in hyperkalaemic preterm infants. Acta Paediatr. 2003;92(1):118-120. doi:10.1111/j.1651-2227.2003.tb00481.x [PubMed 12650312]
  7. Haycock GB. Management of acute and chronic renal failure in the newborn. Semin Neonatol. 2003;8(4):325-334. doi:10.1016/S1084-2756(03)00044-7 [PubMed 15001136]
  8. Joo M, Bae WK, Kim NH, Han SR. Colonic mucosal necrosis following administration of calcium polystryrene sulfonate (Kalimate) in a uremic patient. J Korean Med Sci. 2009;24(6):1207-1211. doi:10.3346/jkms.2009.24.6.1207 [PubMed 19949685]
  9. Kao CC, Tsai YC, Chiang WC, Mao TL, Kao TW. Ileum and colon perforation following peritoneal dialysis-related peritonitis and high-dose calcium polystyrene sulfonate. J Formos Med Assoc. 2015;114(10):1008-1010. doi:10.1016/j.jfma.2013.02.006 [PubMed 23602017]
  10. Lehnhardt A, Kemper MJ. Pathogenesis, diagnosis and management of hyperkalemia. Pediatr Nephrol. 2011;26(3):377-384. doi:10.1007/s00467-010-1699-3 [PubMed 21181208]
  11. Mansour A, Lakis A, Gallez J, Elkoulali M, Laterre E, Salame M. An unusual recurrent ileocolonic injury. Acta Gastroenterol Belg. 2021;84(4):666-668. doi:10.51821/84.4.019 [PubMed 34965050]
  12. Masilamani K, van der Voort J. The management of acute hyperkalaemia in neonates and children. Arch Dis Child. 2012;97(4):376-380. doi:10.1136/archdischild-2011-300623 [PubMed 21920871]
  13. Nafday SM, Woda CB, Saland JM, et al. Renal disease. In: MacDonald MG, Seshia MMK, eds. Avery's Neonatology: Pathophysiology and Management of the Newborn. 7th ed. Wolters Kluwer; 2016:750-805.
  14. Ohlsson A, Hosking M. Complications following oral administration of exchange resins in extremely low-birth-weight infants. Eur J Pediatr. 1987;146(6):571-574. doi:10.1007/BF02467356 [PubMed 3428292]
  15. Refer to manufacturer's labeling.
  16. Resonium Calcium (calcium polystyrene sulfonate) [product monograph]. Laval, Quebec, Canada: Sanofi Aventis Canada Inc; July 2022. [PubMed 19751641]
  17. Weisberg LS. Management of severe hyperkalemia. Crit Care Med. 2008;36(12):3246-3251. doi:10.1097/CCM.0b013e31818f222b [PubMed 18936701]
Topic 8498 Version 115.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟