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Evaluation of sodium zirconium cyclosilicate usage for hyperkalaemia secondary to sulfamethoxazole/trimethoprim
Dixie Pyles1, Nicole Kovacic Scherrer1, Erika Zarfoss Ponce1
1Department of Pharmacy, West Virginia University Medicine-West Virginia University Hospitals, 1 Medical Center Drive, Morgantown, WV, USA.
Background:
Sulfamethoxazole/trimethoprim is utilized to treat various infections, but its use can be limited by hyperkalaemia. Sodium zirconium cyclosilicate is a potassium binder, which has been shown to lower potassium in chronic kidney disease.
Objectives:
To determine the safety and efficacy of sodium zirconium cyclosilicate for patients experiencing sulfamethoxazole/trimethoprim-induced hyperkalaemia.
Methods:
Patients receiving treatment with sulfamethoxazole/trimethoprim and sodium zirconium cyclosilicate therapy concomitantly for at least 48 h between 2021 and 2024 were identified. Efficacy was evaluated by potassium change from baseline, proportion of patients achieving normokalaemia by 24 and 48 h, and time to potassium normalization. Safety was assessed by evaluating hypokalaemia occurrence while on sodium zirconium cyclosilicate therapy.
Results:
There were 22 patients included. The median total daily dose of sulfamethoxazole/trimethoprim was 960 mg or 15 mg/kg/day. Fifteen patients (68%) were treated for confirmed Stenotrophomonas maltophilia or Pneumocystis pneumonia infections. Eight patients (36%) received a loading dose of sodium zirconium cyclosilicate 10 g three times daily for 48 h prior to receiving 10 g daily. The median difference in potassium at baseline and the end of sodium zirconium cyclosilicate therapy was 0.9 mmol/L. Fourteen patients of 22 (64%) and 19 of 21 patients (90%) achieved normokalaemia by 24 and 48 h, respectively. The median time to potassium normalization was 23.5 h. There were no instances of hypokalaemia while on sodium zirconium cyclosilicate therapy.
Conclusions:
Sodium zirconium cyclosilicate was efficacious at lowering elevated potassium in patients receiving sulfamethoxazole/trimethoprim therapy without inducing hypokalaemia. This suggests sodium zirconium cyclosilicate may be considered in patients with treatment-limiting hyperkalaemia due to sulfamethoxazole/trimethoprim, especially when sulfamethoxazole/trimethoprim is preferred therapy.
Insights
Sodium zirconium cyclosilicate effectively lowers potassium levels in patients treated with sulfamethoxazole/trimethoprim. This potassium binder safely manages hyperkalaemia without causing hypokalaemia, making it a viable option when this antibiotic combination is necessary.
Area of Science:
- Pharmacology
- Nephrology
- Infectious Diseases
Background:
- Sulfamethoxazole/trimethoprim is a common antibiotic treatment.
- Hyperkalaemia is a significant side effect limiting its use.
- Sodium zirconium cyclosilicate is a known potassium binder for chronic kidney disease.
Purpose of the Study:
- To assess the safety and efficacy of sodium zirconium cyclosilicate.
- To manage sulfamethoxazole/trimethoprim-induced hyperkalaemia.
- To evaluate potassium levels during combined therapy.
Main Methods:
- Retrospective study of patients on both medications (2021-2024).
- Measured potassium change from baseline and time to normalization.
- Assessed incidence of hypokalaemia as a safety measure.
Main Results:
- 64% and 90% achieved normokalaemia within 24 and 48 hours, respectively.
- Median time to potassium normalization was 23.5 hours.
- No cases of hypokalaemia were observed during sodium zirconium cyclosilicate therapy.
Conclusions:
- Sodium zirconium cyclosilicate effectively reduces potassium in patients on sulfamethoxazole/trimethoprim.
- The treatment is safe, with no induced hypokalaemia.
- Consider sodium zirconium cyclosilicate for managing hyperkalaemia when sulfamethoxazole/trimethoprim is essential.
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