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Sodium Polystyrene Sulfonate
Overview
What is Kionex?
Kionex(Sodium Polystyrene Sulfonate Suspension USP) can be administered orally or in an enema. It is a raspberry-flavored suspension containing 15 grams of cation-exchange resin (Sodium Polystyrene Sulfonate USP); 0.12 mL (0.2%) of Alcohol per 60 mL of suspension. Also contains Purified Water USP, Propylene Glycol USP, Magnesium Aluminum Silicate NF, Xanthan Gum NF, Sodium Saccharin USP, Sorbic Acid NF, Methylparaben NF, Propylparaben NF, and flavor.
Sodium polystyrene sulfonate is a benzene, diethenyl-, polymer with ethenylbenzene, sulfonated, sodium salt and has the following structural formula:
The sodium content of the suspension is 1500 mg (65 mEq) per 60 mL. It is a brown, slightly viscous suspension with an exchange capacity of approximately 3.1 mEq ( approximately 1 mEq) of potassium per 4 mL (1 gram) of suspension. It can be administered orally or in an enema.
What does Kionex look like?
What are the available doses of Kionex?
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What should I talk to my health care provider before I take Kionex?
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How should I use Kionex?
KionexSuspension is indicated for the treatment of hyperkalemia.
The average daily adult dose is 15 g (60 mL) to 60 g (240 mL) of suspension. This is best provided by administering 15 g (60 mL) of KionexSuspension one to four times daily. Each 60 mL of KionexSuspension contains 1500 mg (65 mEq) of sodium. Since the efficiency of sodium-potassium exchange resins is approximately 33%, about one-third of the resin's actual sodium content is being delivered to the body.
In smaller children and infants, lower doses should be employed by using as a guide a rate of 1 mEq of potassium per gram of resin as the basis for calculation.
KionexSuspension may be introduced into the stomach through a plastic tube and, if desired, given with a diet appropriate for a patient in renal failure.
KionexSuspension may also be given, although with less effective results, as an enema consisting (for adults) of 30 g (120 mL) to 50 g (200 mL) every six hours. The enema should be retained as long as possible and followed by a cleansing enema.
After an initial cleansing enema, a soft, large size (French 28) rubber tube is inserted into the rectum for a distance of about 20 cm, with the tip well into the sigmoid colon, and taped into place. The suspension is introduced at body temperature by gravity. The suspension is flushed with 50 or 100 mL of fluid, following which the tube is clamped and left in place. If back leakage occurs, the hips are elevated on pillows or a knee-chest position is taken temporarily. The suspension is kept in the sigmoid colon for several hours, if possible.
The intensity and duration of therapy depend upon the severity and resistance of hyperkalemia.
KionexSuspension should not be heated for to do so may alter the exchange properties of the resin.
What interacts with Kionex?
KionexSuspension is contraindicated in the following conditions: patients with hypokalemia, patients with a history of hypersensitivity to polystyrene sulfonate resins, obstructive bowel disease, (see ).
What are the warnings of Kionex?
Alternative Therapy in Severe Hyperkalemia:
Since the effective lowering of serum potassium with sodium polystyrene sulfonate may take hours to days, treatment with this drug alone may be insufficient to rapidly correct severe hyperkalemia associated with states of rapid tissue breakdown (e.g., burns and renal failure) or hyperkalemia so marked as to constitute a medical emergency. Therefore, other definitive measures, including dialysis, should always be considered and may be imperative.
Hypokalemia:
Serious potassium deficiency can occur from sodium polystyrene sulfonate therapy. The effect must be carefully controlled by frequent serum potassium determinations within each 24 hour period. Since intracellular potassium deficiency is not always reflected by serum potassium levels, the level at which treatment with sodium polystyrene sulfonate should be discontinued must be determined individually for each patient. Important aids in making this determination are the patient's clinical condition and electrocardiogram. Early clinical signs of severe hypokalemia include a pattern of irritable confusion and delayed thought processes.
Electrocardiographically, severe hypokalemia is often associated with a lengthened Q-T interval, widening, flattening, or inversion of the T wave, and prominent U waves. Also, cardiac arrhythmias may occur, such as premature atrial, nodal, and ventricular contractions, and supraventricular and ventricular tachycardias. The toxic effects of digitalis are likely to be exaggerated. Marked hypokalemia can also be manifested by severe muscle weakness, at times extending into frank paralysis.
Electrolyte Disturbances:
Like all cation-exchange resins, sodium polystyrene sulfonate is not totally selective (for potassium) in its actions, and small amounts of other cations such as magnesium and calcium can also be lost during treatment. Accordingly, patients receiving sodium polystyrene sulfonate should be monitored for all applicable electrolyte disturbances.
Systemic Alkalosis:
Systemic alkalosis has been reported after cation-exchange resins were administered orally in combination with nonabsorbable cation-donating antacids and laxatives such as magnesium hydroxide and aluminum carbonate. Magnesium hydroxide should not be administered with sodium polystyrene sulfonate. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene sulfonate with magnesium hydroxide as a laxative. (See ).
What are the precautions of Kionex?
Caution is advised when sodium polystyrene sulfonate is administered to patients who cannot tolerate even a small increase in sodium loads (i.e., severe congestive heart failure, severe hypertension, or marked edema). In such instances, compensatory restriction of sodium intake from other sources may be indicated.
Caution is advised when KionexSuspension is administered to patients with end stage diabetic renal disease.
KionexSuspension should not be administered to patients following surgery until normal bowel function resumes.
Precautions should be taken to ensure the use of adequate volumes of sodium-free cleansing enemas after rectal administration.
In the event of clinically significant constipation, treatment with KionexSuspension should be discontinued until normal bowel motion is resumed. Magnesium-containing laxatives should not be used (see ).
Drug Interactions
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Non-absorbable cation-donating antacids and laxatives:
Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate has been reported.
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Carcinogenesis, Mutagenesis, Impairment of Fertility
Studies have not been performed.
Pregnancy Category C
Animal reproduction studies have not been conducted with sodium polystyrene sulfonate. It is also not known whether sodium polystyrene sulfonate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Sodium polystyrene sulfonate should be given to a pregnant woman only if clearly needed.
Nursing Mothers
It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when sodium polystyrene sulfonate is administered to a nursing woman.
Pediatric Use
The effectiveness of KionexSuspension in pediatric patients has not been established. In children, particular care should be observed with rectal administration, as excessive dosage or inadequate dilution could result in impaction of the resin.
What are the side effects of Kionex?
KionexSuspension may cause some degree of gastric irritation. Anorexia, nausea, vomiting, and constipation may occur especially if high doses are given. Also, hypokalemia, hypocalcemia, and significant sodium retention may occur. (See ) Occasionally diarrhea develops. Large doses in elderly individuals may cause fecal impaction (See ). Rare instances of colonic necrosis have been reported. Intestinal obstruction due to concretions of aluminum hydroxide, when used in combination with sodium polystyrene sulfonate, has been reported.
The following events have been reported from worldwide post marketing experience with sodium polystyrene sulfonate powder:
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What should I look out for while using Kionex?
KionexSuspension is contraindicated in the following conditions: patients with hypokalemia, patients with a history of hypersensitivity to polystyrene sulfonate resins, obstructive bowel disease, (see ).
What might happen if I take too much Kionex?
Biochemical disturbances resulting from overdosage may give rise to clinical signs and symptoms of hypokalemia, including: irritability, confusion, delayed thought processes, muscle weakness, hyporeflexia, which may progress into frank paralysis and/or apnea.
Electrocardiographic changes may be consistent with hypokalemia or hypercalcemia; cardiac arrhythmias may occur. Appropriate measures should be taken to correct serum electrolytes (potassium, calcium), and the resin should be removed from the alimentary tract by appropriate use of laxatives or enemas.
How should I store and handle Kionex?
StorageStore Pantoprazole Sodium Delayed-Release Tablets, USP at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F) [ ]. StorageStore Pantoprazole Sodium Delayed-Release Tablets, USP at 20° to 25°C (68° to 77°F); excursions permitted to 15° to 30°C (59° to 86°F) [ ]. KionexSuspension is a light brown, raspberry-flavored suspension supplied in pint (473 mL) bottles (NDC 0574-2002-16) and 60 mL unit dose bottles (NDC 0574-2002-02).Dispense in a tight container, as defined in the USP. If repackaging into other containers, store in refrigerator and use within 14 days of packaging.SHAKE WELL BEFORE USING.KionexSuspension is a light brown, raspberry-flavored suspension supplied in pint (473 mL) bottles (NDC 0574-2002-16) and 60 mL unit dose bottles (NDC 0574-2002-02).Dispense in a tight container, as defined in the USP. If repackaging into other containers, store in refrigerator and use within 14 days of packaging.SHAKE WELL BEFORE USING.KionexSuspension is a light brown, raspberry-flavored suspension supplied in pint (473 mL) bottles (NDC 0574-2002-16) and 60 mL unit dose bottles (NDC 0574-2002-02).Dispense in a tight container, as defined in the USP. If repackaging into other containers, store in refrigerator and use within 14 days of packaging.SHAKE WELL BEFORE USING.
Clinical Information
Chemical Structure
No Image foundClinical Pharmacology
As the resin passes along the intestine or is retained in the colon after administration by enema, the sodium ions are partially released and are replaced by potassium ions. For the most part, this action occurs in the large intestine, which excretes potassium ions to a greater degree than does the small intestine. The efficiency of this process is limited and unpredictably variable. It commonly approximates the order of 33%, but the range is so large that definitive indices of electrolyte balance must be clearly monitored.
Metabolic data are unavailable.
Non-Clinical Toxicology
KionexSuspension is contraindicated in the following conditions: patients with hypokalemia, patients with a history of hypersensitivity to polystyrene sulfonate resins, obstructive bowel disease, (see ).Caution is advised when sodium polystyrene sulfonate is administered to patients who cannot tolerate even a small increase in sodium loads (i.e., severe congestive heart failure, severe hypertension, or marked edema). In such instances, compensatory restriction of sodium intake from other sources may be indicated.
Caution is advised when KionexSuspension is administered to patients with end stage diabetic renal disease.
KionexSuspension should not be administered to patients following surgery until normal bowel function resumes.
Precautions should be taken to ensure the use of adequate volumes of sodium-free cleansing enemas after rectal administration.
In the event of clinically significant constipation, treatment with KionexSuspension should be discontinued until normal bowel motion is resumed. Magnesium-containing laxatives should not be used (see ).
KionexSuspension may cause some degree of gastric irritation. Anorexia, nausea, vomiting, and constipation may occur especially if high doses are given. Also, hypokalemia, hypocalcemia, and significant sodium retention may occur. (See ) Occasionally diarrhea develops. Large doses in elderly individuals may cause fecal impaction (See ). Rare instances of colonic necrosis have been reported. Intestinal obstruction due to concretions of aluminum hydroxide, when used in combination with sodium polystyrene sulfonate, has been reported.
The following events have been reported from worldwide post marketing experience with sodium polystyrene sulfonate powder:
Reference
This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"
While we update our database periodically, we cannot guarantee it is always updated to the latest version.
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