Start and maintain hyperkalemia treatment¹

Choose LOKELMA for dosing and administration that is tasteless and odorless

INDICATION AND LIMITATION OF USE

LOKELMA is indicated for the treatment of hyperkalemia in adults.

LOKELMA should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

ADULT PATIENTS NOT ON DIALYSIS
ADULT PATIENTS ON DIALYSIS

For patients with hyperkalemia not on dialysis,

LOKELMA is a once-daily medication after an initial treatment period of up to 2 days¹

Recommended starting dose (10 g)¹

A packet 3 times daily for up to 2 days

In general, other oral medications should be administered at least 2 hours before or 2 hours after taking LOKELMA.

Maintenance dose (10 g)¹

1 time daily

The recommended maintenance dose range is from 5 g every other day to 15 g daily.

Monitor serum K⁺ and adjust dose of LOKELMA based on the serum K⁺ level and desired target range
During maintenance treatment, up-titrate based on the serum K⁺ level at intervals of 1 week or longer and in increments of 5 g
Decrease the dose of LOKELMA or discontinue if serum K⁺ is below the desired target range

For patients across all settings,

LOKELMA is tasteless, odorless, and has hassle‑free
storage with no refrigeration required^1,3

LOKELMA offers straightforward administration: stir and drink¹

LOKELMA is a white to grey powder available as a 5 g or 10 g foil-lined packet for oral suspension¹

LOKELMA Dosing Sachet 10 g With Glass of Water

To administer LOKELMA

Fill a cup with at least 3 tablespoons of water¹

Empty the entire contents of the LOKELMA packet(s) into the cup¹

Stir well and drink immediately. If there is any powder left, add more water, stir, and drink again. Repeat until the powder is gone¹

Don’t forget!

LOKELMA can be taken with or without food¹
In general, other oral medications should be administered at least 2 hours before or 2 hours after taking LOKELMA. Advise patients to adjust dietary sodium, if appropriate¹

Non-dialysis patients were not required to make changes in potassium-lowering diets in clinical trials^3-6

Advise patients to adjust dietary sodium, if appropriate¹

Patients can take LOKELMA with or without food

DOWNLOAD THE DOSING GUIDE

Learn more about the access and affordability of LOKELMA

GO TO ACCESS AND SAVINGS

For patients on chronic hemodialysis,

LOKELMA should only be dosed on non-dialysis days¹

5 g

1x/DAY ON
NON-DIALYSIS DAYS

The recommended starting dose is 5 g once daily on non-dialysis days¹
Consider a starting dose of 10 g once daily on non-dialysis days in patients with serum K⁺ >6.5 mEq/L¹
Monitor serum K⁺ and adjust the dose of LOKELMA based on the predialysis serum K⁺ value after the LIDI and desired target range¹
During initiation and after a dose adjustment, assess serum K⁺ after 1 week¹
Recommended maintenance dose range is from 5 g to 15 g once daily, on non-dialysis days¹
Discontinue or decrease the dose of LOKELMA if¹:
- Serum K⁺ falls below the desired target range based on the predialysis value after the LIDI, or
- The patient develops clinically significant hypokalemia

For patients across all settings,

LOKELMA is tasteless, odorless, and hassle‑free
storage with no refrigeration required^1,3

LOKELMA offers straightforward administration: stir and drink¹

LOKELMA is a white to grey powder available as a 5 g or 10 g foil-lined packet for oral suspension¹

To administer LOKELMA

Fill a cup with at least 3 tablespoons of water¹

Empty the entire contents of the LOKELMA packet(s) into the cup¹

Stir well and drink immediately. If there is any powder left, add more water, stir, and drink again. Repeat until the powder is gone¹

Don’t forget!

LOKELMA can be taken with or without food¹
In general, other oral medications should be administered at least 2 hours before or 2 hours after taking LOKELMA. Advise patients to adjust dietary sodium, if appropriate¹

Advise patients to adjust dietary sodium, if appropriate¹

Patients can take LOKELMA with or without food

DOWNLOAD THE DOSING GUIDE

Learn more about the access and affordability of LOKELMA

GO TO ACCESS AND SAVINGS

IMPORTANT SAFETY INFORMATION FOR LOKELMA^® (sodium zirconium cyclosilicate)

WARNINGS AND PRECAUTIONS:

Gastrointestinal Adverse Events in Patients with Motility Disorders: Avoid LOKELMA in patients with severe constipation, bowel obstruction or impaction, including abnormal post-operative bowel motility disorders. LOKELMA has not been studied in patients with these conditions and it may be ineffective and may worsen gastrointestinal conditions
Edema: Each 5-g dose of LOKELMA contains approximately 400 mg of sodium, but the extent of absorption by the patient is unknown. In clinical trials of LOKELMA in patients who were not on dialysis, edema was observed and was generally mild to moderate in severity and was more commonly seen in patients treated with 15 g once daily. Monitor for signs of edema, particularly in patients who should restrict their sodium intake or are prone to fluid overload (eg, heart failure or renal disease). Advise patients to adjust dietary sodium, if appropriate. Increase the dose of diuretics as needed
In a clinical trial of LOKELMA in patients on chronic hemodialysis in which most patients were treated with doses of 5 g to 10 g once daily on non-dialysis days, there was no difference in the mean change from baseline in interdialytic weight gain (a measure of fluid retention) between the LOKELMA and placebo groups
Hypokalemia in Patients on Hemodialysis: Patients on hemodialysis may be prone to acute illness that can increase the risk of hypokalemia on LOKELMA (eg, illnesses associated with decreased oral intake, diarrhea). Consider adjusting LOKELMA dose based on potassium levels in these settings

Diagnostic Tests: LOKELMA has radio-opaque properties and, therefore, may give the appearance typical of an imaging agent during abdominal X-ray procedures

ADVERSE REACTIONS: The most common adverse reaction in non-dialysis patients with LOKELMA was mild to moderate edema. In placebo-controlled trials up to 28 days, edema was reported in 4.4%, 5.9%, 16.1% of non-dialysis patients treated with 5 g, 10 g, and 15 g of LOKELMA once daily, respectively vs 2.4% of non-dialysis patients receiving placebo.

DRUG INTERACTIONS: LOKELMA can transiently increase gastric pH. In general, oral medications with pH-dependent solubility should be administered at least 2 hours before or 2 hours after LOKELMA. Spacing is not needed if it has been determined the concomitant medication does not exhibit pH-dependent solubility.

INDICATION AND LIMITATION OF USE

LOKELMA is indicated for the treatment of hyperkalemia in adults.

LOKELMA should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.

PLEASE READ FULL PRESCRIBING INFORMATION for LOKELMA.

You may report side effects related to AstraZeneca products .

IMPORTANT SAFETY INFORMATION FOR LOKELMA^® (sodium zirconium cyclosilicate)

+

Ca²⁺=calcium; GI=gastrointestinal; HK=hyperkalemia; K⁺=potassium; Mg²⁺=magnesium; qod=every other day; SPS=sodium polystyrene sulfonate.

References: 1. LOKELMA^® (sodium zirconium cyclosilicate) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2024. 2. Stavros F, Yang A, Leon A, Nuttall M, Rasmussen HS. Characterization of structure and function of ZS-9, a K⁺ selective ion trap. PLoS One. 2014;9(12):e114686. 3. SPS^® Suspension [prescribing information]. Farmville, NC: CMP Pharma, Inc; 2021. 4. Palmer BF. Potassium binders for hyperkalemia in chronic kidney disease–diet, renin-angiotensin-aldosterone system inhibitor therapy, and hemodialysis. Mayo Clin Proc. 2020;95(2):339-354.

ACEi=angiotensin-converting enzyme inhibitor; ARB=angiotensin II receptor blocker; ARNI=angiotensin receptor-neprilysin inhibitor; CI=confidence interval; CKD=chronic kidney disease; DM=diabetes mellitus; ED=emergency department; eGFR=estimated glomerular filtration rate; EHR=electronic health record; ESKD=end-stage kidney disease; HD=hemodialysis; HF=heart failure; HFrEF=heart failure with reduced ejection fraction; HK=hyperkalemia; HR=hazard ratio; HTN=hypertension; ICD=International Classification of Diseases; IDN=integrated delivery network; K⁺=potassium; MACE=major adverse cardiovascular event; MACE+=major adverse cardiovascular event plus hospitalization for unstable angina; MRA=mineralocorticoid receptor antagonist; RAASi=renin‐angiotensin‐aldosterone system inhibitor; RWE=real-world evidence; US=United States.

References: 1. Collins AJ, Pitt B, Reaven N, et al. Association of serum potassium with all-cause mortality in patients with and without heart failure, chronic kidney disease, and/or diabetes. Am J Nephrol. 2017;46(3):213-221. 2. Collins AJ, Pitt B, Reaven N, et al. Association of serum potassium with all-cause mortality in patients with and without heart failure, chronic kidney disease, and/or diabetes. Am J Nephrol. 2017;46(3 Suppl):S1-S13. 3. Bakris G, Agiro A, Mu F, et al. Consequences of recurrent hyperkalemia on cardiovascular outcomes and mortality. JACC Adv. 2024;3(11):101331. 4. Data on File, REF-197797, AZPLP. 5. Data on File, REF-196652, AZPLP. 6. Rastogi A, Pollack CV Jr, Lesén E, et al. Association between reduced RAASi therapy and progression to ESKD in hyperkalemic CKD patients. Presented at: American Society of Nephrology (ASN) Kidney Week 2023; November 2-5, 2023; Philadelphia, PA. Poster TH-PO1028. 7. Kanda E, Rastogi A, Murohara T, et al. Clinical impact of suboptimal RAASi therapy following an episode of hyperkalemia. BMC Nephrol. 2023;24(1):18.

ACEi=angiotensin-converting enzyme inhibitor; ARB=angiotensin II receptor blocker; ARNI=angiotensin receptor-neprilysin inhibitor; ATLAS=Advanced Mapping Tactics for Learning Analysis; eLAAD=electronic longitudinal access and adjudication data; GDMT=guideline-directed medical therapy; HK=hyperkalemia; K⁺=potassium; MRA=mineralocorticoid receptor antagonist; RAASi=renin-angiotensin-aldosterone system inhibitor; US=United States.

ACEi=angiotensin-converting enzyme inhibitor; ARB=angiotensin II receptor blocker; K⁺=potassium; MRA=mineralocorticoid receptor antagonist; qd=once daily; qod=every other day; RAASi=renin-angiotensin-aldosterone system inhibitor; tid=three times a day.

References: 1. LOKELMA^® (sodium zirconium cyclosilicate) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2024. 2. Data on File, US-108426, AZPLP. 3. Packham DK, Rasmussen HS, Lavin PT, et al. Sodium zirconium cyclosilicate in hyperkalemia [article and supplementary material]. N Engl J Med. 2015;372(3):222-231. 4. SPS^® Suspension [prescribing information]. Farmville, NC: CMP Pharma, Inc; 2021. 5. Veltassa^® (patiromer) [package insert]. Redwood City, CA: Vifor Pharma, Inc; 2023. 6. Kosiborod M, Rasmussen HS, Lavin P, et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA. 2014;312(21):2223-2233. 7. Roger SD, Spinowitz BS, Lerma EV, et al. Efficacy and safety of sodium zirconium cyclosilicate for treatment of hyperkalemia: an 11-month open-label extension of HARMONIZE. Am J Nephrol. 2019;50(6):473-480. 8. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4S):S117-S314. 9. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. 10. Spinowitz BS, Fishbane S, Pergola PE, et al. Sodium zirconium cyclosilicate among individuals with hyperkalemia: a 12-month phase 3 study. Clin J Am Soc Nephrol. 2019;14(6):798-809.

K⁺=potassium; LIDI=long interdialytic interval; qd=once daily; SIDI=short interdialytic interval.

References: 1. LOKELMA^® (sodium zirconium cyclosilicate) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2024. 2. Data on File, US-108426, AZPLP. 3. Fishbane S, Ford M, Fukagawa M, et al. A phase 3b, randomized, double-blind, placebo-controlled study of sodium zirconium cyclosilicate for reducing the incidence of predialysis hyperkalemia. J Am Soc Nephrol. 2019;30(9):1723-1733.

CKD=chronic kidney disease; DM=diabetes mellitus; HF=heart failure; HTN=hypertension; qd=once daily.

References: 1. LOKELMA^® (sodium zirconium cyclosilicate) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2024. 2. Data on File, US-108426, AZPLP. 3. Spinowitz BS, Fishbane S, Pergola PE, et al. Sodium zirconium cyclosilicate among individuals with hyperkalemia: a 12-month phase 3 study. Clin J Am Soc Nephrol. 2019;14(6):798-809. 4. U.S. Food & Drug Administration. Drug Approval Package: LOKELMA (sodium zirconium cyclosilicate) Medical Review(s). Accessed January 28, 2026. https://www.accessdata.fda.gov/drugsatfda_docs/nda/2018/207078Orig1s000MedR.pdf

GI=gastrointestinal; K⁺=potassium; SAEs=serious adverse events.

References: 1. LOKELMA^® (sodium zirconium cyclosilicate) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2024. 2. Data on File, US-108426, AZPLP. 3. Fishbane S, Ford M, Fukagawa M, et al. A phase 3b, randomized, double-blind, placebo-controlled study of sodium zirconium cyclosilicate for reducing the incidence of predialysis hyperkalemia. J Am Soc Nephrol. 2019;30(9):1723-1733.

K⁺=potassium; qd=once daily; tid=three times a day.

References: 1. LOKELMA^® (sodium zirconium cyclosilicate) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2024. 2. Data on File, US-108426, AZPLP. 3. Kosiborod M, Rasmussen HS, Lavin P, et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA. 2014;312(21):2223-2233. 4. Packham DK, Rasmussen HS, Lavin PT, et al. Sodium zirconium cyclosilicate in hyperkalemia [article and supplementary material]. N Engl J Med. 2015;372(3):222-231. 5. Spinowitz BS, Fishbane S, Pergola PE, et al; ZS-005 Study Investigators. Sodium zirconium cyclosilicate among individuals with hyperkalemia: a 12-month phase 3 study. Clin J Am Soc Nephrol. 2019;14(6):798-809. 6. Roger SD, Spinowitz BS, Lerma EV, et al. Efficacy and safety of sodium zirconium cyclosilicate for treatment of hyperkalemia: an 11-month open-label extension of HARMONIZE. Am J Nephrol. 2019;50(6):473-480.

K⁺=potassium; LIDI=long interdialytic interval.

References: 1. LOKELMA^® (sodium zirconium cyclosilicate) [prescribing information]. Wilmington, DE: AstraZeneca Pharmaceuticals LP; 2024. 2. Data on File, US-108426, AZPLP. 3. Kosiborod M, Rasmussen HS, Lavin P, et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA. 2014;312(21):2223-2233.

EGWP=Employer Group Waiver Plans; FEHBP=Federal Employees Health Benefits Program; HCP=healthcare professional; K⁺=potassium; MA=Medicare Advantage; PACE=Program of All-Inclusive Care for the Elderly; PBM=Pharmacy Benefit Manager; PCP=primary care physician; PDP=prescription drug plan; SN=special needs.

References: 1. Data on File, US-108426, AZPLP. 2. Formulary Data are provided by Fingertip Formulary^® and are current as of 3/13/2025.

Reference: 1. Data on File, US-108426, AZPLP.

ACEi=angiotensin-converting enzyme inhibitor; ARB=angiotensin II receptor blocker; ARNI=angiotensin receptor-neprilysin inhibitor; CI=confidence interval; CKD=chronic kidney disease; CV=cardiovascular; ED=emergency department; eGFR=estimated glomerular filtration rate; EHR=electronic health records; ESKD=end-stage kidney disease; HD=hemodialysis; HF=heart failure; HK=hyperkalemia; HR=hazard ratio; HTN=hypertension; ICD=International Classification of Diseases; K⁺=potassium; MACE=major adverse cardiovascular event; MACE+=major adverse cardiovascular event plus hospitalization for unstable angina; MNT=medical nutrition therapy; MRA=mineralocorticoid receptor antagonist; RAASi=renin‐angiotensin‐aldosterone system inhibitor; RWE=real-world evidence; SD=standard deviation; US=United States.

References: 1. Rowan CG, Agiro A, Chan KA, et al. Hyperkalemia recurrence following medical nutrition therapy in patients with Stage 3-4 chronic kidney disease: The REVOLUTIONIZE I Real-World Study. Adv Ther. 2024;41(6):2381-2398. 2. Bakris G, Agiro A, Greatsinger A, et al. Economic burden of recurrent hyperkalemia in patients with chronic kidney disease. J Manag Care Spec Pharm. 2024;30(11):1261-1275. 3. Data on File, REF-197797, AZPLP. 4. Rastogi A, Pollack CV Jr, Lesén E, et al. Association between reduced RAASi therapy and progression to ESKD in hyperkalemic CKD patients. Presented at: American Society of Nephrology (ASN) Kidney Week 2023; November 2-5, 2023; Philadelphia, PA. Poster TH-PO1028. 5. Kanda E, Rastogi A, Murohara T, et al. Clinical impact of suboptimal RAASi therapy following an episode of hyperkalemia. BMC Nephrol. 2023;24(1):18. 6. Trevisan M, de Deco P, Xu H, et al. Incidence, predictors and clinical management of hyperkalaemia in new users of mineralocorticoid receptor antagonists. Eur J Heart Fail. 2018;20(8):1217-1226.

CI=confidence interval; CKD=chronic kidney disease; ED=emergency department; ESKD=end-stage kidney disease; HD=hemodialysis; HK=hyperkalemia; IRR=inter-rater reliability; K⁺=potassium; SD=standard deviation; US=United States.

References: 1. Data on File, REF-217791, AZPLP. 2. Data on File, US-108426, AZPLP. 3. Data on File, US-63248, AZPLP.

Start and maintain hyperkalemia treatment1

Choose LOKELMA for dosing and administration that is tasteless and odorless

LOKELMA is tasteless, odorless, and has hassle‑free storage with no refrigeration required1,3

LOKELMA offers straightforward administration: stir and drink1

To administer LOKELMA

Don’t forget!

Non-dialysis patients were not required to make changes in potassium-lowering diets in clinical trials3-6

IMPORTANT SAFETY INFORMATION FOR LOKELMA® (sodium zirconium cyclosilicate)

IMPORTANT SAFETY INFORMATION FOR LOKELMA® (sodium zirconium cyclosilicate) +

Start and maintain hyperkalemia treatment¹

LOKELMA is tasteless, odorless, and has hassle‑free
storage with no refrigeration required^1,3

LOKELMA offers straightforward administration: stir and drink¹

Non-dialysis patients were not required to make changes in potassium-lowering diets in clinical trials^3-6

IMPORTANT SAFETY INFORMATION FOR LOKELMA^® (sodium zirconium cyclosilicate)

IMPORTANT SAFETY INFORMATION FOR LOKELMA^® (sodium zirconium cyclosilicate)

+