Sodium Polystyrene Sulfonate is indicated for the treatment of hyperkalemia. Hyperkalemia is mainly caused by acute or chronic kidney disease. Other causes include liver failure, adrenal insufficiency, and the use of certain drugs such as ARBs, ACE inhibitors, beta blockers, or excessive intake of potassium supplements.

Sodium Polystyrene Sulfonate is a cation-exchange resin. It releases sodium ions in the stomach in exchange for hydrogen ions. When the resin reaches the large intestine, hydrogen ions are exchanged for free potassium ions, and the resin is then eliminated in the feces. This process reduces potassium absorption into the bloodstream and increases its excretion through feces, thereby lowering serum potassium levels in the body.

Adults (including the elderly)

• Oral Dose: The average daily oral dose for adult is 15 gm to 60 gm (1 sachet 1–4 times daily).
• Rectal dose: In patients who are unable to take this medicine orally, rectal administration is possible (as enema). 30 gm to 50 gm of resin is given once or twice daily (at intervals of 6 hours). Each dose is administered as a warm emulsion (at body temperature) in 150 ml to 200 ml of aqueous vehicle (such as plain water, 10% dextrose in water or equal parts of water and 2% Methylcellulose suspension). The emulsion should be agitated gently during administration. The enema should be retained for as long as possible and should be followed by a cleansing enema.

Children

• Oral dose: In smaller children and infants correspondingly lower doses should be employed. An appropriate initial dose is 1 gm/kg body weight daily in divided doses in acute hyperkalemia. For maintenance therapy, dosage may be reduced to 0.5 gm/kg body weight daily.
• Rectal dose: When refused by mouth, the resin may be given rectally using a dose at least as much as that which would have been given orally. The resin should be suspended in a proportional amount of 10% Dextrose in water. Following retention of the enema, the colon should be irrigated to ensure adequate removal of the resin.

Neonates

• Rectal dose: Since it is advised that the oral route should not be employed, only rectal administration should be considered. With rectal administration, the minimum effective dosage within the range of 0.5 to 1 gm/kg of resin should be employed. The resultant suspension should be diluted as for adults. Following administration of the resin, the colon should be adequately irrigated to ensure recovery of the resin.

Mixing procedure: Each dose should be given as a suspension in a small quantity of water or, for greater palatability, in sweetened liquid or syrup (but not with orange or other fruit juices which contain potassium). The amount of fluid usually ranges from 20 ml to 100 ml, depending on the dose. It may be simply determined by allowing 3 ml to 4 ml per gram of drug. The prepared suspension should be administered by placing and maintaining the patient in an upright position. The resin may be introduced into the stomach through a plastic tube. If desired, it may be mixed with a diet appropriate for a patient in renal failure. The intensity and duration of therapy depend upon the severity and resistance of hyperkalemia. Sodium Polystyrene Sulfonate should not be heated because it may alter the exchange properties of the resin. Suspension of this drug should be freshly prepared and not to be stored beyond 24 hours.

Sodium Polystyrene Sulfonate may interact with antacids, non-absorbable cation-donating antacids, and laxatives, as well as with digitalis, sorbitol, lithium, and thyroxine. These interactions may affect drug efficacy or increase the risk of adverse effects.

Sodium Polystyrene Sulfonate is contraindicated in the following conditions: Hypokalemia, Known hypersensitivity to polystyrene sulfonate resins, Obstructive bowel disease, Neonates with reduced gut motility (postoperative or drug-induced), Oral use in neonates.

This drug may cause gastric irritation. Common side effects include anorexia, nausea, vomiting, and constipation, especially at higher doses. Other possible effects include hypokalemia, hypocalcemia, significant sodium retention, and related clinical symptoms. Diarrhea may occur occasionally. In elderly patients, large doses may lead to fecal impaction. Rare cases of colonic necrosis have been reported. Intestinal obstruction has also been reported when used with aluminum hydroxide.

Pregnancy Category C. Animal reproduction studies are not available. It is also unknown whether this drug can harm the fetus or affect reproductive capacity in humans. It should be used during pregnancy only if clearly needed. It is not known whether the drug is excreted in human milk. Since many drugs are excreted in breast milk, caution is advised when administering to nursing mothers.

Caution should be used in patients who cannot tolerate increased sodium load, such as those with severe congestive heart failure, severe hypertension, or marked edema. Sodium intake from other sources may need to be restricted. If significant constipation occurs, treatment should be stopped until normal bowel function returns. Magnesium-containing laxatives or sorbitol should be avoided.

Use in Children: Safety and efficacy in pediatric patients have not been established. In neonates, oral use is contraindicated. Special caution is required in premature or low-birth-weight infants due to risk of gastrointestinal bleeding or colonic necrosis.

Overdose may lead to electrolyte disturbances such as hypokalemia, hypocalcemia, and hypomagnesemia. Clinical symptoms may include irritability, confusion, delayed thinking, muscle weakness, and reduced reflexes, which may progress to paralysis or apnea

Calcium regulator

Store below 30°C. Keep out of the reach of children. The suspension should be freshly prepared and should not be stored for more than 24 hours.