Patiromer 💊
Related Subjects:
|Hyperkalaemia
|Sodium Zirconium Cyclosilicate
|ECG - Hyperkalaemia
💊 Patiromer (Veltassa) is an oral, non-absorbed potassium binder. It is mainly used for persistent hyperkalaemia so that RAAS inhibitors can be continued in CKD or heart failure. Onset is slow (~7 hours), so it does not replace emergency treatment.
📖 About
- Exchanges calcium for potassium in the colon → ↑ faecal potassium loss.
- An alternative to sodium zirconium cyclosilicate (SZC); it does not add sodium, so it may suit patients with fluid overload.
- Always check the BNF for up-to-date prescribing advice.
⚙️ Mode of Action
- Cation-exchange polymer (with a calcium–sorbitol counter-ion) that binds K⁺ mainly in the distal colon.
- Also binds magnesium → hypomagnesaemia.
🎯 Indications (NICE TA623)
- Acute life-threatening hyperkalaemia in emergency care, alongside standard treatment (calcium, insulin–glucose, etc.).
- Persistent hyperkalaemia (K⁺ ≥6.0 mmol/L) in outpatients with CKD stage 3b–5 (not on dialysis) or heart failure, when it allows a RAAS inhibitor to be started or continued at an optimised dose.
- See the UKKA hyperkalaemia guideline for current thresholds; the July 2026 update lowered the SZC threshold for persistent hyperkalaemia to 5.5 mmol/L.
💊 Dose
| Stage | Dose |
|---|
| Starting | 8.4 g once daily, mixed with water and taken with food |
| Titration | Adjust by 8.4 g steps at intervals of at least 1 week, according to K⁺ |
| Maximum | 25.2 g once daily |
🧪 Monitoring
- Serum K⁺ within about a week of starting or changing dose, then as clinically indicated.
- Serum magnesium at baseline and during treatment; replace if low.
- Stop if K⁺ falls below the desired range.
🔄 Interactions
- Binds other oral drugs → take other oral medicines at least 3 hours before or after patiromer.
- Ciprofloxacin, levothyroxine and metformin are among those whose absorption may fall.
⚠️ Cautions
- Severe constipation, bowel obstruction or impaction, or major GI surgery - may worsen GI motility problems.
- Hypomagnesaemia; hypercalcaemia (calcium is released).
- Limited data in pregnancy - avoid unless essential.
🚫 Contraindications
- Hypersensitivity to patiromer or excipients.
💥 Side Effects
- Common: constipation, diarrhoea, abdominal pain, flatulence, hypomagnesaemia.
- Uncommon: nausea, vomiting.
📦 Practical
- Sachets are stored in the fridge; they can be kept at room temperature for up to 6 months.
- Mix with water (or apple/cranberry juice) and take promptly; do not heat.
📚 References
