Sodium polystyrene sulfonate
KAYEXALATE
What it isSodium polystyrene sulfonate, a cation exchange resin; hyperkalemia.
Why this oneUnlike newer potassium binders, its effect is poorly predictable and supported by weak evidence.
What limits itIt acts too slowly for emergencies, and sorbitol co-formulation has caused fatal colonic necrosis.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hyperkalemia (oral) | Adults | 15 g (60 mL) QD | 15 g (60 mL) 1–4×/day | 60 g/day |
| Hyperkalemia (rectal enema) | Adults | 30–50 g q6h | 30–50 g q6h | — |
| Hyperkalemia | Children/infants | Dose based on 1 mEq potassium per gram of resin | — | — |
Renal Undefined
Hepatic Undefined
Instructions
- Administer at least 3 hours before or after other oral medications (6 hours in gastroparesis)
- Administer with patient in an upright position
- May be given via gastric tube or as a retention enema (followed by cleansing enema)
- Do not heat the suspension
Contraindications
- Hypokalemia
- Obstructive bowel disease
- Oral or rectal administration in neonates
Cautions
- Intestinal necrosis, GI ulceration/perforation, ischemic colitis
- Electrolyte disturbances (hypokalemia, hypocalcemia, hypomagnesemia)
- Significant sodium retention / fluid overload
- Fecal impaction (esp. rectal use in children, elderly)
- GI concretions/bezoars
Adverse reactions
- Gastric irritation
- Anorexia
- Nausea
- Vomiting
- Constipation
- Diarrhea
- Hypokalemia
- Hypocalcemia
- Hypomagnesemia
- Sodium retention
Pregnancy Animal reproduction studies not conducted; use only if clearly needed
Lactation Undefined
NO BOXED WARNINGS
Principal riskColonic necrosis with sorbitol; slow and poorly effective
Cost, est. cash$5–$500/month
Generic entry1982
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityLocal irritation, sensitization or administration-site injury; negligible systemic toxicity at usual use.
Mechanism of action: Sodium polystyrene sulfonate ballicule
Open Sodium polystyrene sulfonate in the interactive console ↗
Memory aids: mascots and interaction avatars
swaps Na+ for K+
Open Sodium polystyrene sulfonate in the interactive console ↗