Sodium Zirconium Cyclosilicate (Lokelma)


Hyperkalemia (see Hyperkalemia)

Clinical Efficacy

  • Multicenter, Double-Blind, Phase 3 Trial of Sodium Zirconium Cyclosilicate in the Treatment of Hyperkelmia (NEJM, 2015) [MEDLINE]
    • Patients with hyperkalemia who received ZS-9, as compared with those who received placebo, had a significant reduction in potassium levels at 48 hours, with normokalemia maintained during 12 days of maintenance therapy
  • Phase II, Randomized, Double-blind, Placebo-controlled Study (ENERGIZE) (Acad Emerg Med, 2020) [MEDLINE]
    • This pilot study suggested that SZC with insulin and glucose may provide an incremental benefit in the emergency treatment of hyperkalemia over insulin and glucose alone


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  • PO: XX
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Dose Adjustment

  • Hepatic
  • Renal

Use in Pregnancy (see Pregnancy)

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Use During Lactation

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Adverse Effects


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Other Adverse Effects

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  • Sodium zirconium cyclosilicate in hyperkalemia. N Engl J Med. 2015 Jan 15;372(3):222-31. doi: 10.1056/NEJMoa1411487 [MEDLINE]
  • Sodium Zirconium Cyclosilicate: A Review in Hyperkalaemia. Drugs. 2018 Oct;78(15):1605-1613. doi: 10.1007/s40265-018-0991-6 [MEDLINE]
  • Emergency Potassium Normalization Treatment Including Sodium Zirconium Cyclosilicate: A Phase II, Randomized, Double-blind, Placebo-controlled Study (ENERGIZE). Acad Emerg Med. 2020 Jun;27(6):475-486. doi: 10.1111/acem.13954 [MEDLINE]