Kayexalate (sodium polystyrene sulfonate) is indicated for the treatment of hyperkalemia. The U.S. Food & Drug Administration (FDA) has warned that orally-administered Kayexalate should not be taken with any other oral medications because it may reduce the effectiveness of those drugs.

Kayexalate and Hyperkalemia

Kayexalate was approved in by the U.S. Food & Drug Administration (FDA) in 1958 to treat hyperkalemia, or dangerously high levels (greater than 6.0 (mmol/L) of potassium. Potassium levels of 6.1 mEq/L to 7.0 mEq/L are considered moderate hyperkalemia, while levels above 7 mEq/L are severe hyperkalemia.

General signs and symptoms of hyperkalemia include:

  • Nausea
  • Fatigue
  • Muscle weakness
  • Tingling sensations

More serious symptoms include:

  • Slow heartbeat
  • Weak pulse

Severe cases of hyperkalemia can result in in fatal cardiac standstill (heart stoppage).

How Does Kayexalate Work?

Kayexalate can be administered as an oral suspension or in an enema.

The drug works by binding with potassium in the intestines so that it can be removed from the body. However, because of its delayed onset, sodium polystyrene sulfonate should not be used as an emergency treatment for life-threatening hyperkalemia.

Sodium polystyrene sulfonate is available as the brand name Kayexalate, as generic versions, and as non-branded generics.

Kayexalate Side Effects

Kayexalate is contraindicated for:

  • Patients with hypersensitivity to polystyrene sulfonate resins
  • Patients with obstructive bowel disease
  • Newborns with reduced gut motility

The most serious side effects associated with Kayexalate include:

  • Intestinal Necrosis
  • Electrolyte Disturbances
  • Aspiration

Other possible side effects include:

  • Anorexia
  • Constipation
  • Diarrhea
  • Fecal impaction
  • Gastrointestinal concretions (bezoars)
  • Ischemic colitis
  • Nausea
  • Ulcerations
  • Vomiting
  • Gastric irritation
  • Intestinal obstruction (due to concentration of aluminum hydroxide)

Kayexalate and Other Oral Medications

In September 2017, the FDA warned that orally-administered Kayexalate should not be taken at the same time as other oral medications, as sodium polystyrene sulfonate binds to many commonly prescribed oral drugs, decreasing the absorption and thus the effectiveness of those medicines.

“Patients should take orally administered prescription and over-the-counter (OTC) medicines at least 3 hours before or 3 hours after sodium polystyrene sulfonate,” the FDA said in a Drug Safety Communication published on September 6, 2017. “Patients should not stop taking their potassium-lowering medicines without talking to their health care professional first. If you have questions or concerns, including about how to take sodium polystyrene sulfonate with other medicines, talk to a pharmacist or other health care professional.”

  1. Sanofi-Aventis U.S. LLC (2000) “Kayexalate” https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/011287s022lbl.pdf
  2. FDA (2017) “FDA Drug Safety Communication: FDA recommends separating dosing of potassium-lowering drug sodium polystyrene sulfonate (Kayexalate) from all other oral drugs” https://www.fda.gov/Drugs/DrugSafety/ucm572484.htm
Last Modified: May 10, 2018

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