Sodium Polystyrene Sulfonate

Registered South African indications:

• Hyperkalaemia

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Plasma potassium levels below 5mmol/L
• Obstructive bowel disease
• Oral administration in neonates
• Neonates with reduced gut motility

Cautions

• Pregnancy
• Breastfeeding
• Renal impairment 
• Premature infants
• Low birthweight infants
• Children
• Congestive heart failure
• Hypertension
• Oedema

Forms avail. in SA and covered in this monograph: pdr

Hyperkalaemia

• Oral (pdr): 15g, 6-24hrly
• Rectal (pdr): 30-60g

The enema should be retained for at least 8hrs following which the colon should be irrigated to remove the resin

See additional prescribing points for administration directions

Paed. forms avail. in SA and covered in this monograph: pdr

Hyperkalaemia

Younger than 1 month

• Oral (pdr): Not established for use
• Rectal (pdr): 0.5-1g/kg

Older than 1 month

• Oral (pdr): Initial: 1g/kg, 12-24hrly; Maintenance: 0.5-1mg/kg, 12-24hrly
• Rectal (pdr): See adult dosage

The enema should be retained for at least 8hrs following which the colon should be irrigated to remove the resin

See additional prescribing points for administration directions

Pregnancy

• Caution
• No data are available regarding the use of polystyrene sulfonate resins in pregnancy. The administration of sodium polystyrene sulfonate in pregnancy, therefore, is not advised unless, the potential benefits outweigh any potential risks

Breastfeeding

• Caution
• No data are available regarding the use of polystyrene sulfonate resins in breastfeeding mothers. The administration of sodium polystyrene sulfonate during breastfeeding, therefore, is not advised unless, the potential benefits outweigh any potential risks

Renal Impairment

• Caution; no dose adjustment recommended

Hepatic Impairment

• No dose adjustment recommended

Elderly

• No dose adjustment recommended

Porphyria Information

• Not porphyrinogenic (NP)

Drugs in Sport

• Permitted - No warnings

Respiratory Disorders

• Acute bronchitis 
• Broncho-pneumonia

Gastrointestinal Disorders

• Gastric irritation
• Anorexia
• Nausea and vomiting
• Constipation 
• Diarrhoea 
• Faecal impaction 
• Gastrointestinal concretions 
• Gastrointestinal stenosis 
• Intestinal obstruction 
• Gastrointestinal ischemia
• Ischemic colitis
• Gastrointestinal tract ulcera
• Gastrointestinal tract necrosis
• Intestinal perforation

Endocrine and Metabolic Disorders

• Sodium retention
• Hypokalaemia
• Hypocalcaemia
• Hypomagnesaemia 

• Sorbitol
• Cation-donating agents
• Non-absorbable cation-donating antacids
• Non-absorbable cation-donating laxatives
• Aluminium hydroxide
• Digitalis
• Lithium
• Levothyroxine

• Serum electrolytes  

Specific cases may require

• ECG

Administration directions

Oral

• Mix powder with 20-100ml of water or syrup from 20-100ml
• Sorbitol should be coadministered to prevent constipation

Rectal

• Dose should be given at body temperature in a 150-200ml plain water, 10% dextrose in water or equal parts of water and 2% methyl cellulose suspension

Polystyrene sulfonate is a cation exchange resin for the treatment of hyperkalaemia. It binds ingested potassium and the indigestible potassium polystryene sulfonate complex is excreted with the faeces, preventing the absorption of potassium into the bloodstream. This results in decreased serum potassium levels.

Polystyrene Sulfonate is available in several formulations. Please note the list below gives examples of products which are available and is not necessarily comprehensive. The listing of a product does not constitute endorsement of the product by EMGuidance; likewise, failure to list a product does not imply that EMGuidance disapproves of the product. This information is put together on the basis of the National Government's Medicines Price Registry at the time of publication

Powder

• Kexelate (Adcock)