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Calcium polystyrene sulfonate powder


Oral/rectal powder for suspension containing calcium polystyrene sulfonate.

Drugs List

  • calcium polystyrene sulfonate powder sugar-free
  • Therapeutic Indications


    Hyperkalaemia associated with anuria or severe oliguria
    Hyperkalaemia in patients requiring dialysis


    Dosages detailed below are approximate, the precise requirements should be determined based on regular serum electrolyte determinations.


    Oral administration
    15g three to four times a day, taken in water or syrup (but not fruit juices which contain potassium) in the ratio of 3ml to 4ml per gram of resin.

    Rectal administration
    Rectal administration may be appropriate in a patient who is vomiting or who has upper gastrointestinal tract problems including paralytic ileus. It may be used simultaneously with the oral route for more rapid initial results or in patients with gastroparesis, who have other orally administered medications that are administered within 6 hours of calcium polystyrene sulfonate.

    Suspend 30g power in 150ml water or 10% dextrose, as a daily retention enema.
    Enema should be retained for at least 9 hours and then the colon irrigated to remove the resin.

    In the initial stages of treatment, administration by both the oral and rectal routes may achieve a rapid lowering of serum potassium. If both routes are used initially it is probably unnecessary to continue rectal administration once the oral resin has reached the rectum.


    Oral administration
    In smaller children and infants correspondingly smaller doses should be employed by using as a guide a rate of 1mEq of potassium per gram of resin as the basis for calculation.

    Initial dose: 1g/kg, to be administered daily in divided doses.
    Maintenance dose: 0.5g/kg daily in divided doses.
    When administered orally it is preferable to give with a drink (but not a fruit squash due to the high potassium content) or a little jam or honey.

    Some reference sources suggest the maximum daily dose should be 60g.

    Rectal administration
    The dose should be at least as great as that for oral administration, diluted in the same ratio as described for adults.

    Some reference sources suggest that the maximum daily dose should be 30g.

    On retention of the enema, the colon should be irrigated to ensure adequate removal of the resin. Some sources suggest that the colon should be irrigated after 8 to 12 hours.


    Oral route

    Rectal administration
    The minimum effective dosage, within the range of 0.5g/kg to 1g/kg, should be employed. The resin should be diluted in the same ratio as described for adults.

    On retention of the enema, the colon should be irrigated to ensure adequate removal of the resin. Some sources suggest that the colon should be irrigated after 8 to 12 hours.


    For oral or rectal administration.


    Serum potassium below 5mmol/L
    Gastrointestinal obstruction
    Metastatic carcinoma
    Multiple myeloma
    Neonates with reduced gastrointestinal motility

    Precautions and Warnings

    Low birth weight infant
    Premature infants
    Decreased gastrointestinal motility

    Not all routes are licensed for all age groups
    May contain sodium benzoate: mild mucous membrane irritant
    Advise patient to avoid other oral medicines 3 hours before or after dose
    Avoid concurrent use of products containing sorbitol
    Gastroparesis: Consider avoiding other oral medicines for 6hrs before/after
    Monitor periodically for signs of fluid or electrolyte imbalance
    Monitor serum calcium weekly
    Discontinue if significant constipation occurs, until resolved
    Discontinue treatment when serum potassium falls to 5mmol/litre
    Advise patient to avoid magnesium-containing laxatives
    Advise patient to avoid mixing with fruit juice or squash
    Advise patient to remain upright while taking to avoid aspiration

    In neonates, the resin should only be administered by the rectal route. In children and neonates impaction may occur if excessive dosage or dilution is inadequate.

    Caution in premature infants and low weight infants due to the risk of digestive haemorrhage or colonic necrosis.

    Fatal cases of intestinal necrosis and other serious gastrointestinal adverse reactions have been reported when concomitant use of sorbitol with calcium polystyrene sulfonate.

    Careful monitoring is particularly important in patients receiving concurrent digitalis.

    Pregnancy and Lactation


    Use calcium polystyrene sulfonate with caution during pregnancy.

    The manufacturer advises use only if potential benefit outweighs risk. At the time of writing, no reports of the use of calcium polystyrene sulfonate during pregnancy have been located.


    Use calcium polystyrene sulfonate with caution during breastfeeding.

    The manufacturer advises use only if potential benefit outweighs risk. At the time of writing, no reports have been located concerning the safety of the use of polystyrene sulfonate resins during breastfeeding.

    Side Effects

    Decreased appetite
    Faecal impaction
    Gastric irritation
    Gastro-intestinal bezoars (concretions)
    Gastro-intestinal perforation
    Gastro-intestinal ulceration
    Intestinal ischaemia
    Intestinal necrosis
    Intestinal obstruction
    Ischaemic colitis


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last full review: February 2019

    Reference Sources

    Summary of Product Characteristics: Calcium Polystyrene Sulfonate 99.75% Powder for Oral/Rectal Suspension. Sovereign Medical. Revised February 2022.

    Summary of Product Characteristics: Calcium Resonium 99.934% w/w Powder for Oral/Rectal Suspension. Sanofi-Aventis. Revised August 2022.

    NICE Evidence Services Available at: Last accessed: 17 January 2023.

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.