KIONEX
Clinical safety rating: caution
Comprehensive clinical and safety monograph for KIONEX (KIONEX).
Sodium polystyrene sulfonate is a cation-exchange resin that exchanges sodium ions for potassium ions in the gastrointestinal tract, binding potassium and eliminating it via feces, thereby reducing serum potassium levels.
| Metabolism | Not metabolized; excreted unchanged in feces. |
| Excretion | Primarily fecal elimination of the exchanged potassium; the resin itself is not absorbed and is excreted unchanged in feces. Renal excretion is negligible as sodium polystyrene sulfonate is not systemically absorbed. |
| Half-life | Not applicable; the drug is not absorbed, so no systemic half-life exists. The elimination of exchanged potassium follows gastrointestinal transit. |
| Protein binding | Not applicable; no systemic absorption occurs. |
| Volume of Distribution | Not applicable; not systemically distributed. |
| Bioavailability | 0% due to lack of systemic absorption. |
| Onset of Action | Oral: 2-12 hours for reduction in serum potassium; Rectal enema: 30-60 minutes for initial effect. |
| Duration of Action | Duration of effect is variable, typically 4-6 hours after a single dose, dependent on bowel transit time and continued dosing. |
15 to 60 grams orally once daily, or 15 grams two to four times daily, as a 15-gram powder suspension in water or juice.
| Dosage form | POWDER |
| Renal impairment | Contraindicated in severe renal impairment (GFR <20 mL/min) due to risk of hyperkalemia and aluminum accumulation if sorbitol is co-administered. Use with caution and monitor potassium levels in mild to moderate impairment. |
| Liver impairment | No dose adjustment required for Child-Pugh Class A or B. For Class C, monitor electrolytes closely; no specific dosing change recommended. |
| Pediatric use | Infants and children: 1 g/kg orally per dose as needed, not to exceed 60 g total daily dose, given as a suspension in water or juice. |
| Geriatric use | Start at lower end of dosing range (15 g once daily) and titrate based on serum potassium response. Monitor renal function and electrolyte levels frequently due to age-related decline in renal function. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for KIONEX (KIONEX).
| Breastfeeding | Not absorbed systemically; minimal excretion into breast milk expected. M/P ratio not applicable. Compatible with breastfeeding. |
| Teratogenic Risk | KIONEX (sodium polystyrene sulfonate) is not absorbed systemically; therefore, direct teratogenic effects are unlikely. No fetal risks have been reported in any trimester. Use only if clearly needed. |
| Fetal Monitoring | Monitor serum potassium, sodium, calcium, and magnesium levels. Monitor for signs of hypokalemia, hypernatremia, and gastrointestinal adverse effects. Fetal monitoring not required due to lack of systemic absorption. |
■ FDA Black Box Warning
None.
| Common Effects | Application site reactions burning irritation itching and redness Skin peeling Headache Diarrhea Rash Indigestion Abnormal liver enzyme Itching Taste change Nausea Abdominal pain Flatulence |
| Serious Effects |
["Hypokalemia","Obstructive bowel disease","Neonates with reduced gut motility","Hypersensitivity to sodium polystyrene sulfonate"]
| Precautions | ["Risk of gastrointestinal adverse events including ischemia, necrosis, and perforation, especially in patients with a history of bowel surgery, intestinal obstruction, or constipation.","Monitor serum electrolytes, particularly potassium, calcium, and magnesium, during therapy.","Use with caution in patients with renal impairment due to potential for hypercalcemia and fluid overload.","Avoid concomitant use with sorbitol due to increased risk of colonic necrosis.","May cause sodium overload in patients with congestive heart failure, hypertension, or edema."] |
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| Fertility Effects | No known effects on fertility. |