Calcium polystyrene sulfonate powder
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral/rectal powder for suspension containing calcium polystyrene sulfonate.
Drugs List
Therapeutic Indications
Uses
Hyperkalaemia associated with anuria or severe oliguria
Hyperkalaemia in patients requiring dialysis
Dosage
Dosages detailed below are approximate, the precise requirements should be determined based on regular serum electrolyte determinations.
Adults
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.
Children
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.
Neonates
Oral route
Contraindicated.
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.
Administration
For oral or rectal administration.
Contraindications
Serum potassium below 5mmol/L
Gastrointestinal obstruction
Hypercalcaemia
Hyperparathyroidism
Metastatic carcinoma
Multiple myeloma
Neonates with reduced gastrointestinal motility
Sarcoidosis
Precautions and Warnings
Low birth weight infant
Neonates
Premature infants
Breastfeeding
Decreased gastrointestinal motility
Pregnancy
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
Pregnancy
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.
Lactation
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
Anorexia
Bronchitis
Bronchopneumonia
Constipation
Decreased appetite
Diarrhoea
Faecal impaction
Gastric irritation
Gastro-intestinal bezoars (concretions)
Gastro-intestinal perforation
Gastro-intestinal ulceration
Hypercalcaemia
Hypokalaemia
Hypomagnesaemia
Intestinal ischaemia
Intestinal necrosis
Intestinal obstruction
Ischaemic colitis
Nausea
Vomiting
Overdosage
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 ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
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: www.nice.org.uk Last accessed: 17 January 2023.
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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.