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Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective?

Abstract

Sodium polystyrene sulfonate (SPS), an ion-exchange resin designed to bind potassium in the colon, was approved in 1958 as a treatment for hyperkalemia by the US Food and Drug Administration, 4 years before drug manufacturers were required to prove the effectiveness and safety of their drugs. In September 2009, citing reports of colonic necrosis, the Food and Drug Administration issued a warning advising against concomitant administration of sorbitol, an osmotic cathartic used to prevent SPS-induced fecal impaction and to speed delivery of resin to the colon, with the powdered resin; however, a premixed suspension of SPS in sorbitol, the only preparation stocked by many hospital pharmacies, is prescribed routinely for treatment of hyperkalemia. We can find no convincing evidence that SPS increases fecal potassium losses in experimental animals or humans and no evidence that adding sorbitol to the resin increases its effectiveness as a treatment for hyperkalemia. There is growing concern, however, that suspensions of SPS in sorbitol can be harmful. It would be wise to exhaust other alternatives for managing hyperkalemia before turning to these largely unproven and potentially harmful therapies.

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  • Authors+Show Affiliations

    ,

    Rochester General Hospital and University of Rochester School of Medicine and Dentistry, Rochester, New York 14621, USA. richard.sterns@rochestergeneral.org

    , ,

    Source

    MeSH

    Animals
    Cathartics
    Drug Interactions
    Humans
    Hyperkalemia
    Ion Exchange Resins
    Polystyrenes
    Sorbitol

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    20167700

    Citation

    Sterns, Richard H., et al. "Ion-exchange Resins for the Treatment of Hyperkalemia: Are They Safe and Effective?" Journal of the American Society of Nephrology : JASN, vol. 21, no. 5, 2010, pp. 733-5.
    Sterns RH, Rojas M, Bernstein P, et al. Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective? J Am Soc Nephrol. 2010;21(5):733-5.
    Sterns, R. H., Rojas, M., Bernstein, P., & Chennupati, S. (2010). Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective? Journal of the American Society of Nephrology : JASN, 21(5), pp. 733-5. doi:10.1681/ASN.2010010079.
    Sterns RH, et al. Ion-exchange Resins for the Treatment of Hyperkalemia: Are They Safe and Effective. J Am Soc Nephrol. 2010;21(5):733-5. PubMed PMID: 20167700.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Ion-exchange resins for the treatment of hyperkalemia: are they safe and effective? AU - Sterns,Richard H, AU - Rojas,Maria, AU - Bernstein,Paul, AU - Chennupati,Sreedevi, Y1 - 2010/02/18/ PY - 2010/2/20/entrez PY - 2010/2/20/pubmed PY - 2010/6/22/medline SP - 733 EP - 5 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 21 IS - 5 N2 - Sodium polystyrene sulfonate (SPS), an ion-exchange resin designed to bind potassium in the colon, was approved in 1958 as a treatment for hyperkalemia by the US Food and Drug Administration, 4 years before drug manufacturers were required to prove the effectiveness and safety of their drugs. In September 2009, citing reports of colonic necrosis, the Food and Drug Administration issued a warning advising against concomitant administration of sorbitol, an osmotic cathartic used to prevent SPS-induced fecal impaction and to speed delivery of resin to the colon, with the powdered resin; however, a premixed suspension of SPS in sorbitol, the only preparation stocked by many hospital pharmacies, is prescribed routinely for treatment of hyperkalemia. We can find no convincing evidence that SPS increases fecal potassium losses in experimental animals or humans and no evidence that adding sorbitol to the resin increases its effectiveness as a treatment for hyperkalemia. There is growing concern, however, that suspensions of SPS in sorbitol can be harmful. It would be wise to exhaust other alternatives for managing hyperkalemia before turning to these largely unproven and potentially harmful therapies. SN - 1533-3450 UR - https://www.unboundmedicine.com/medline/citation/20167700/full_citation L2 - http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=20167700 DB - PRIME DP - Unbound Medicine ER -