patiromer
Brand: Veltassa
Prototype Drug
Drug Class: potassium binder
Drug Family: electrolyte agent
Subclass: non-absorbed potassium exchanger (calcium-patiromer)
Organ Systems: renal
Mechanism of Action
Non-absorbed polymer that exchanges calcium for potassium in the GI lumen, reducing potassium absorption; useful for chronic hyperkalemia management.
gastrointestinal potassium exchange (lumen)
Indications
- hyperkalemia (chronic — especially in CKD with RAAS inhibitor use)
Contraindications
- bowel obstruction
- severe constipation
Adverse Effects
Common
- constipation
- hypomagnesemia
- diarrhea
Serious
- severe hypomagnesemia
Pharmacokinetics (ADME)
| Absorption | not absorbed (GI-local action) |
| Distribution | GI lumen |
| Metabolism | not applicable — exchanges K+ for Ca2+ |
| Excretion | fecal (bound K+) |
| Half-life | not applicable (onset 7h) |
| Onset | 7+ hours |
| Peak | multiple days |
| Duration | days |
| Protein Binding | not applicable |
| Vd | GI lumen |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| other oral medications | patiromer may bind and reduce absorption of other drugs — separate by 3 hours | major |
Nursing Considerations
- Separate other oral medications by at least 3 hours (patiromer binds drugs in GI tract)
- Steady state effect requires several days
- Monitor K+ and Mg2+ levels
- Onset delayed: not for acute hyperkalemia (use calcium gluconate, insulin/dextrose, or sodium bicarb first)
- Mix with water; do not heat (alters polymer structure)
Clinical Pearls
- Unlike sodium polystyrene sulfonate (Kayexalate), patiromer uses calcium-based exchange — less sodium load
- Approved to allow continuation of RAAS inhibitors in CKD by controlling hyperkalemia
Safety Profile
Pregnancy insufficient-data
Lactation insufficient-data
Renal Adjustment Required
Hepatic Adjustment Not required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.