1913:
517:
42:
1923:
1949:
652:
and the process of using the same, US Patent 5,888,472) the recognition of the unique ion exchange properties and the potential use to remove toxins from the body were identified shortly thereafter ("process for removing toxins from bodily fluids using zirconium or titanium microporous compositions,
533:. Zirconium silicates have been extensively used in medical and dental applications because of their proven safety. 11 zirconium silicates were screened by an iterative optimization process. ZS-9 selectively captures potassium ions, presumably by mimicking the actions of physiologic
520:
Cross-sections of ZS-9 pores with three different ions (K⁺ = potassium, Na⁺ = sodium, Ca²⁺ = calcium). The specificity for potassium is thought to be caused by the diameter and composition of the pores, which resembles
1430:
1423:
625:
for an increased risk of death. However, there is disagreement regarding whether a modestly elevated levels directly causes problems. One viewpoint is that mild to moderate hyperkalemia is a
1416:
222:
732:
1303:
762:
645:(FDA) in May 2016, due to issues associated with manufacturing. On 18 May 2018, the FDA approved sodium zirconium cyclosilicate for treatment of adults with hyperkalemia.
177:
935:
563:
Hyperkalemia is rare among those who are otherwise healthy. Among those who are in hospital, rates are between 1% and 2.5%. Common causes include
847:
75:
1353:"Systematic Review and Meta-Analysis of Patiromer and Sodium Zirconium Cyclosilicate: A New Armamentarium for the Treatment of Hyperkalemia"
590:
There is no universally accepted definition of what level of hyperkalemia is mild, moderate, or severe. However, if hyperkalemia causes any
1639:
126:
956:
Denry I, Kelly JR. State of the art of zirconia for dental applications. Dental
Materials. Volume 24, Issue 3, March 2008, Pages 299–307
798:
722:
584:
1984:
1969:
1824:
1299:
754:
1561:
1187:
488:
Sodium zirconium cyclosilicate was approved for medical use in the
European Union and in the United States in 2018. It was
46:
Crystal structure of ZS-9. Blue spheres = oxygen atoms, red spheres = zirconium atoms, green spheres = silicon atoms.
1503:
580:
1329:
1694:
1679:
1408:
648:
It was first practically synthesized by UOP in the late 1990s. (reference -zirconium silicate and zirconium germate
630:
923:
304:
207:
107:
1974:
1867:
1979:
1926:
929:
642:
615:
361:
1939:
839:
85:
1554:
792:
1528:
1862:
163:
57:
1898:
1814:
1809:
1704:
665:
661:
One review found a decrease in potassium of 0.17 mEq/L at one hour and 0.67 mEq/L at 48 hours.
546:
478:
33:
1769:
1634:
1470:
787:
1916:
1547:
979:
370:
330:
17:
8:
1518:
1493:
603:
591:
538:
467:
321:
170:
1074:
McDonald TJ, Oram RA, Vaidya B (October 2015). "Investigating hyperkalaemia in adults".
983:
1989:
1377:
1352:
1275:
1250:
1146:
1121:
1099:
1051:
1026:
1002:
967:
900:
875:
606:
in the absence of ECG changes are managed aggressively. Several approaches are used to
534:
530:
137:
1403:
1654:
1508:
1444:
1438:
1382:
1280:
1226:
1183:
1151:
1103:
1091:
1056:
1007:
905:
622:
607:
595:
568:
522:
246:
234:
99:
1485:
1457:
1372:
1364:
1270:
1262:
1216:
1141:
1133:
1083:
1046:
1038:
997:
987:
895:
887:
599:
537:. ZS-9 is an inorganic cation exchanger crystalline with a high capacity to entrap
489:
406:
268:
190:
696:
1953:
1784:
1624:
1498:
1205:"Damned if you do, damned if you don't: potassium binding resins in hyperkalemia"
992:
649:
276:
1594:
1448:
629:
that denotes underlying medical problems. Accordingly, these problems are both
576:
572:
564:
1137:
1042:
891:
1963:
1649:
1604:
1584:
1325:
968:"Characterization of structure and function of ZS-9, a K+ selective ion trap"
727:
673:
626:
1893:
1839:
1829:
1759:
1669:
1619:
1614:
1440:
1386:
1284:
1249:
Elliott MJ, Ronksley PE, Clase CM, Ahmed SB, Hemmelgarn BR (October 2010).
1230:
1155:
1095:
1060:
1011:
909:
558:
505:
452:
185:
1834:
1789:
1779:
1774:
1754:
1749:
1734:
1729:
1714:
1684:
1644:
1599:
1589:
1570:
1221:
1204:
493:
470:. Use is likely safe in pregnancy and breastfeeding. It works by binding
93:
1266:
575:. A number of medications can also cause high blood potassium including
350:
1819:
1804:
1764:
1744:
1724:
1709:
1664:
1659:
1629:
1513:
1178:
Taal MW, Chertow GM, Marsden PA, Skorecki K, Yu AS, Brenner BM (2012).
448:
1368:
1087:
641:
In the United States, regulatory approval of ZS-9 was rejected by the
1872:
1799:
1699:
1689:
1674:
1523:
1465:
611:
471:
286:
79:
516:
1857:
1739:
1719:
1609:
669:
542:
456:
390:
341:
121:
602:
and is treated urgently. Potassium levels greater than 6.5 to 7.0
924:"Drug Approval Package: Lokelma (sodium zirconium cyclosilicate)"
41:
755:"Lokelma- sodium zirconium cyclosilicate powder, for suspension"
610:. Other approved potassium binders in the United States include
1877:
1326:"Lokelma (Sodium zirconium cyclosilicate) FDA Approval History"
1539:
1027:"Updates in hyperkalemia: Outcomes and therapeutic strategies"
1300:"AstraZeneca's $ 2.7B hyperkalemia drug ZS-9 rejected by FDA"
482:
463:
840:"Sodium Zirconium Cyclosilicate Monograph for Professionals"
966:
Stavros F, Yang A, Leon A, Nuttall M, Rasmussen HS (2014).
876:"Sodium Zirconium Cyclosilicate: A Review in Hyperkalaemia"
474:
455:. Onset of effects occurs in one to six hours. It is taken
381:
1177:
1248:
1122:"Pathogenesis, diagnosis and management of hyperkalemia"
312:
Silicic acid, sodium zirconium(4+) salt (3:2:1), hydrate
1209:
Clinical
Journal of the American Society of Nephrology
965:
1937:
1350:
1351:
Meaney CJ, Beccari MV, Yang Y, Zhao J (April 2017).
1073:
1173:
1171:
1169:
1167:
1165:
1961:
1251:"Management of patients with acute hyperkalemia"
1202:
1182:(Chapter 17, page 672, 9th ed.). Elsevier.
747:
504:Sodium zirconium cyclosilicate is used to treat
1119:
691:
689:
508:. Onset of effects occurs in one to six hours.
329:
1162:
1031:Reviews in Endocrine & Metabolic Disorders
782:
780:
1555:
1424:
1244:
1242:
1240:
1203:Watson M, Abbott KC, Yuan CM (October 2010).
723:"Summary Basis of Decision (SBD) for Lokelma"
27:Medication used to treat high blood potassium
1640:Budesonide/glycopyrronium bromide/formoterol
686:
125:
777:
621:Hyperkalemia, particularly if severe, is a
260:In general: ℞ (Prescription only)
1562:
1548:
1431:
1417:
1237:
1196:
1115:
1113:
834:
832:
830:
828:
826:
824:
822:
820:
818:
816:
40:
1376:
1297:
1274:
1220:
1145:
1050:
1001:
991:
899:
869:
867:
865:
676:. Use has been studied for up to a year.
369:
585:angiotensin converting enzyme inhibitors
515:
1110:
1067:
1024:
1018:
813:
349:
98:
14:
1962:
862:
701:Therapeutic Goods Administration (TGA)
511:
252:
1543:
1412:
1120:Lehnhardt A, Kemper MJ (March 2011).
240:
116:
84:
1922:
765:from the original on 5 December 2022
664:It appears effective in people with
541:cations, specifically potassium and
189:
1504:Calcium acetate/magnesium carbonate
873:
801:from the original on 8 January 2021
598:due to a risk of potentially fatal
389:
24:
1397:
938:from the original on 13 April 2021
850:from the original on 1 August 2020
25:
2001:
1695:Glycopyrronium bromide/formoterol
1332:from the original on 12 June 2018
216:
148:
1947:
1921:
1912:
1911:
1306:from the original on 28 May 2016
735:from the original on 31 May 2022
1569:
1344:
1318:
1291:
1180:Brenner and Rector's The Kidney
1985:Drugs developed by AstraZeneca
1970:Chelating agents used as drugs
1795:Sodium zirconium cyclosilicate
1476:Sodium zirconium cyclosilicate
959:
950:
916:
715:
499:
441:Sodium zirconium cyclosilicate
229:
127:Sodium zirconium cyclosilicate
34:Sodium zirconium cyclosilicate
13:
1:
1868:Cambridge Antibody Technology
679:
631:proximate and ultimate causes
552:
993:10.1371/journal.pone.0114686
930:Food and Drug Administration
643:Food and Drug Administration
616:sodium polystyrene sulfonate
462:Common side effects include
443:, sold under the brand name
7:
656:
10:
2006:
636:
594:change it is considered a
556:
481:which is then lost in the
401:Chemical and physical data
1907:
1886:
1848:
1577:
1484:
1456:
1298:Ben Adams (27 May 2016).
1138:10.1007/s00467-010-1699-3
1043:10.1007/s11154-016-9384-x
1025:Kovesdy CP (March 2017).
892:10.1007/s40265-018-0991-6
793:European Medicines Agency
405:
400:
380:
360:
340:
320:
300:
295:
285:
275:
267:
206:
201:
176:
162:
136:
106:
92:
74:
66:
56:
51:
39:
1529:Sucroferric oxyhydroxide
1863:Alexion Pharmaceuticals
1439:Drugs for treatment of
874:Hoy SM (October 2018).
1815:Trastuzumab deruxtecan
1810:Tixagevimab/cilgavimab
1705:Isosorbide mononitrate
666:chronic kidney disease
653:US Patent 6,332,985).
600:abnormal heart rhythms
526:
479:gastrointestinal tract
1975:Nephrology procedures
1770:Salbutamol/budesonide
1635:Budesonide/formoterol
1471:Polystyrene sulfonate
797:. 17 September 2018.
761:. 30 September 2022.
519:
1222:10.2215/CJN.03700410
1126:Pediatric Nephrology
506:high blood potassium
453:high blood potassium
1980:Zirconium compounds
1519:Lanthanum carbonate
1494:Aluminium hydroxide
1267:10.1503/cmaj.100461
984:2014PLoSO...9k4686S
731:. 23 October 2014.
512:Mechanism of action
468:low blood potassium
225:(Prescription only)
36:
1851:acquired companies
608:treat hyperkalemia
535:potassium channels
531:zirconium silicate
527:
523:potassium channels
32:
1935:
1934:
1655:Disufenton sodium
1537:
1536:
1509:Calcium carbonate
1486:Phosphate binders
1458:Potassium binders
1445:hyperphosphatemia
1369:10.1002/phar.1906
1302:. FierceBiotech.
1189:978-1-4160-6193-9
1088:10.1136/bmj.h4762
886:(15): 1605–1613.
596:medical emergency
569:hypoaldosteronism
438:
437:
256:
244:
232:
220:
152:
119:
16:(Redirected from
1997:
1952:
1951:
1950:
1943:
1925:
1924:
1915:
1914:
1899:Louis Schweitzer
1849:Predecessors and
1564:
1557:
1550:
1541:
1540:
1433:
1426:
1419:
1410:
1409:
1391:
1390:
1380:
1348:
1342:
1341:
1339:
1337:
1322:
1316:
1315:
1313:
1311:
1295:
1289:
1288:
1278:
1246:
1235:
1234:
1224:
1200:
1194:
1193:
1175:
1160:
1159:
1149:
1117:
1108:
1107:
1071:
1065:
1064:
1054:
1022:
1016:
1015:
1005:
995:
963:
957:
954:
948:
947:
945:
943:
920:
914:
913:
903:
871:
860:
859:
857:
855:
836:
811:
810:
808:
806:
784:
775:
774:
772:
770:
751:
745:
744:
742:
740:
719:
713:
712:
710:
708:
693:
650:molecular sieves
627:secondary effect
393:
373:
353:
333:
254:
251:
242:
239:
231:
228:
218:
215:
193:
150:
147:
129:
118:
115:
102:
88:
44:
37:
35:
31:
21:
2005:
2004:
2000:
1999:
1998:
1996:
1995:
1994:
1960:
1959:
1958:
1948:
1946:
1938:
1936:
1931:
1903:
1882:
1850:
1844:
1785:Sebelipase alfa
1625:Brompheniramine
1573:
1568:
1538:
1533:
1499:Calcium acetate
1480:
1452:
1437:
1400:
1398:Further reading
1395:
1394:
1357:Pharmacotherapy
1349:
1345:
1335:
1333:
1324:
1323:
1319:
1309:
1307:
1296:
1292:
1247:
1238:
1201:
1197:
1190:
1176:
1163:
1118:
1111:
1072:
1068:
1023:
1019:
978:(12): e114686.
964:
960:
955:
951:
941:
939:
934:. 8 June 2018.
922:
921:
917:
872:
863:
853:
851:
838:
837:
814:
804:
802:
786:
785:
778:
768:
766:
753:
752:
748:
738:
736:
721:
720:
716:
706:
704:
697:"Lokelma APMDS"
695:
694:
687:
682:
659:
639:
561:
555:
514:
502:
434:
430:
426:
422:
418:
414:
396:
376:
356:
336:
316:
313:
308:
307:
277:Bioavailability
269:Pharmacokinetic
263:
197:
165:
158:
139:
132:
47:
28:
23:
22:
15:
12:
11:
5:
2003:
1993:
1992:
1987:
1982:
1977:
1972:
1957:
1956:
1933:
1932:
1930:
1929:
1919:
1908:
1905:
1904:
1902:
1901:
1896:
1890:
1888:
1884:
1883:
1881:
1880:
1875:
1870:
1865:
1860:
1854:
1852:
1846:
1845:
1843:
1842:
1837:
1832:
1827:
1822:
1817:
1812:
1807:
1802:
1797:
1792:
1787:
1782:
1777:
1772:
1767:
1762:
1757:
1752:
1747:
1742:
1737:
1732:
1727:
1722:
1717:
1712:
1707:
1702:
1697:
1692:
1687:
1682:
1677:
1672:
1667:
1662:
1657:
1652:
1647:
1642:
1637:
1632:
1627:
1622:
1617:
1612:
1607:
1602:
1597:
1595:Andexanet alfa
1592:
1587:
1581:
1579:
1575:
1574:
1567:
1566:
1559:
1552:
1544:
1535:
1534:
1532:
1531:
1526:
1521:
1516:
1511:
1506:
1501:
1496:
1490:
1488:
1482:
1481:
1479:
1478:
1473:
1468:
1462:
1460:
1454:
1453:
1436:
1435:
1428:
1421:
1413:
1407:
1406:
1399:
1396:
1393:
1392:
1363:(4): 401–411.
1343:
1317:
1290:
1261:(15): 1631–5.
1236:
1215:(10): 1723–6.
1195:
1188:
1161:
1109:
1066:
1017:
958:
949:
915:
861:
812:
788:"Lokelma EPAR"
776:
746:
714:
684:
683:
681:
678:
658:
655:
638:
635:
577:spironolactone
573:rhabdomyolysis
565:kidney failure
557:Main article:
554:
551:
513:
510:
501:
498:
451:used to treat
436:
435:
432:
428:
424:
420:
416:
412:
409:
403:
402:
398:
397:
395:
394:
386:
384:
378:
377:
375:
374:
366:
364:
358:
357:
355:
354:
346:
344:
338:
337:
335:
334:
326:
324:
318:
317:
315:
314:
311:
303:
302:
301:
298:
297:
293:
292:
289:
283:
282:
279:
273:
272:
265:
264:
262:
261:
258:
249:
237:
226:
212:
210:
204:
203:
199:
198:
196:
195:
182:
180:
174:
173:
168:
166:administration
160:
159:
157:
156:
154:
144:
142:
134:
133:
131:
130:
112:
110:
104:
103:
96:
90:
89:
82:
72:
71:
68:
64:
63:
60:
54:
53:
49:
48:
45:
26:
9:
6:
4:
3:
2:
2002:
1991:
1988:
1986:
1983:
1981:
1978:
1976:
1973:
1971:
1968:
1967:
1965:
1955:
1945:
1944:
1941:
1928:
1920:
1918:
1910:
1909:
1906:
1900:
1897:
1895:
1892:
1891:
1889:
1885:
1879:
1876:
1874:
1871:
1869:
1866:
1864:
1861:
1859:
1856:
1855:
1853:
1847:
1841:
1838:
1836:
1833:
1831:
1828:
1826:
1823:
1821:
1818:
1816:
1813:
1811:
1808:
1806:
1803:
1801:
1798:
1796:
1793:
1791:
1788:
1786:
1783:
1781:
1778:
1776:
1773:
1771:
1768:
1766:
1763:
1761:
1758:
1756:
1753:
1751:
1748:
1746:
1743:
1741:
1738:
1736:
1733:
1731:
1728:
1726:
1723:
1721:
1718:
1716:
1713:
1711:
1708:
1706:
1703:
1701:
1698:
1696:
1693:
1691:
1688:
1686:
1683:
1681:
1678:
1676:
1673:
1671:
1668:
1666:
1663:
1661:
1658:
1656:
1653:
1651:
1650:Dapagliflozin
1648:
1646:
1643:
1641:
1638:
1636:
1633:
1631:
1628:
1626:
1623:
1621:
1618:
1616:
1613:
1611:
1608:
1606:
1605:Asfotase alfa
1603:
1601:
1598:
1596:
1593:
1591:
1588:
1586:
1585:Acalabrutinib
1583:
1582:
1580:
1576:
1572:
1565:
1560:
1558:
1553:
1551:
1546:
1545:
1542:
1530:
1527:
1525:
1522:
1520:
1517:
1515:
1512:
1510:
1507:
1505:
1502:
1500:
1497:
1495:
1492:
1491:
1489:
1487:
1483:
1477:
1474:
1472:
1469:
1467:
1464:
1463:
1461:
1459:
1455:
1450:
1446:
1442:
1434:
1429:
1427:
1422:
1420:
1415:
1414:
1411:
1405:
1402:
1401:
1388:
1384:
1379:
1374:
1370:
1366:
1362:
1358:
1354:
1347:
1331:
1327:
1321:
1305:
1301:
1294:
1286:
1282:
1277:
1272:
1268:
1264:
1260:
1256:
1252:
1245:
1243:
1241:
1232:
1228:
1223:
1218:
1214:
1210:
1206:
1199:
1191:
1185:
1181:
1174:
1172:
1170:
1168:
1166:
1157:
1153:
1148:
1143:
1139:
1135:
1132:(3): 377–84.
1131:
1127:
1123:
1116:
1114:
1105:
1101:
1097:
1093:
1089:
1085:
1081:
1077:
1070:
1062:
1058:
1053:
1048:
1044:
1040:
1036:
1032:
1028:
1021:
1013:
1009:
1004:
999:
994:
989:
985:
981:
977:
973:
969:
962:
953:
937:
933:
931:
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1840:Zolmitriptan
1830:Ximelagatran
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1760:Rosuvastatin
1670:Esomeprazole
1620:Bicalutamide
1615:Benralizumab
1475:
1441:hyperkalemia
1404:CADTH review
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559:Hyperkalemia
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281:Not absorbed
208:Legal status
202:Legal status
108:License data
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1835:Zafirlukast
1790:Selumetinib
1780:Saxagliptin
1775:Savolitinib
1755:Roflumilast
1750:Ravulizumab
1735:Palivizumab
1730:Osimertinib
1715:Motavizumab
1685:Fulvestrant
1645:Candesartan
1600:Anifrolumab
1590:Anastrozole
1571:AstraZeneca
769:27 February
500:Medical use
494:AstraZeneca
296:Identifiers
94:MedlinePlus
67:Other names
58:Trade names
1964:Categories
1820:Vandetanib
1805:Ticagrelor
1765:Roxadustat
1745:Quetiapine
1725:Omeprazole
1710:Metoprolol
1665:Eculizumab
1660:Durvalumab
1630:Budesonide
1514:Colestilan
854:11 October
805:11 October
680:References
633:of death,
553:Background
539:monovalent
529:ZS-9 is a
449:medication
371:D652ZWF066
331:17141-74-1
322:CAS Number
305:IUPAC name
1990:Potassium
1873:MedImmune
1825:Vaxzevria
1800:Tamoxifen
1700:Goserelin
1690:Gefitinib
1675:Exenatide
1524:Sevelamer
1466:Patiromer
1104:206907572
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844:Drugs.com
612:patiromer
490:developed
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287:Excretion
164:Routes of
138:Pregnancy
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1954:Medicine
1917:Category
1858:Astra AB
1740:Propofol
1720:Olaparib
1610:Atenolol
1578:Products
1387:28122118
1330:Archived
1304:Archived
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1231:20798253
1156:21181208
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763:Archived
759:DailyMed
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670:diabetes
657:Research
547:GI tract
543:ammonium
464:swelling
457:by mouth
342:DrugBank
178:ATC code
171:By mouth
153: B1
140:category
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1927:Commons
1680:FluMist
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