Dr. Ahmed Lokelma Vs Veltassa is a comparison of the two novel potassium-binding resins, Sodium Zirconium Cyclosilicate and Patiromer.
Unlike Kayexalate, both these drugs are very effective and highly specific in the long-term management of hyperkalemia.
They have predictable potassium-lowering effects and are very safe with minimal side effects, unlike Kayexalate.
However, both Lokelma and Veltassa are costly and not readily available in most countries.
What is Lokelma?
Lokelma is the brand name of Sodium Zirconium Cyclosilicate. It is a newly approved potassium-binding resin marketed by AstraZeneca.
It got FDA approval in 2018. It is a non-absorbable inorganic compound that exchanges sodium and hydrogen ions for potassium.
Lokelma is highly effective and has a very rapid onset of action compared to all the other potassium-binding resins.
However, because of its sodium content, it is associated with fluid retention and may cause edema. Also, it impairs the absorption of drugs that have a PH-dependent absorption.
What is Veltassa?
Veltassa is the brand name of Patiromer. It has been developed by Vifor Fresenius Medical Care Renal Pharma (VFMCRP) and approved by the FDA in 2015 for the long-term maintenance treatment of hyperkalemia.
Veltassa (Patiromer Sorbitex Calcium or simply Patriomer) is also a non-absorbable cation-exchange resin, like Lokelma.
It exchanges calcium for potassium and magnesium. Thus, in addition to inhibiting potassium absorption, it may also inhibit the absorption of magnesium.
Hypomagnesemia is one of the common side effects of Veltassa. However, because it does not contain sodium, unlike Lokelma, it is not associated with fluid overload.
Lokelma Vs Veltassa (Sodium Zirconium Cyclosilicate Vs Patiromer):
Both Lokelma and Veltassa are effective and safer alternatives to Kayexalate. However, there are some differences and similarities between the two which are summarized in the table below:
Features | Lokelma | Veltassa |
| Drug Name | Sodium Zirconium Cyclosilicate | Patiromer Sorbitex Calcium |
| Manufacturer | AstraZeneca | Vifor Fresenius Medical Care Renal Pharma (VFMCRP) |
| FDA approval | FDA approved in 2018 | FDA approved in 2015 |
| MOA | Sodium hydrogen potassium exchange resin | Calcium potassium cation exchange resin |
| Formulation | Available as 5 and 10 g packets for oral suspension | Available as 8.4, 16.8, and 25.2 g sachets for oral suspension |
| Onset of action | One hour | 7 hours |
| Dose | Initial loading dose of 10 g three times a day, followed by a maintenance dose of 5 to 15 gm once daily | 8.4 g once daily, followed by dose titration to a maximum of 25.2 g once daily. |
| Contraindications | None | Allergic reactions |
| Common side effects |
|
|
| Cost comparison | $25 per sachet | $20 to $45 per sachet |
Which drug is more effective? Lokelma Vs Veltassa?
Both Lokelma and Veltassa have proven potassium-lowering effects compared to a placebo drug.
The effect of Lokelma can be seen as early as one hour after its administration while Veltassa takes about 7 hours.
This effect could also be due to the fact that Lokelma is designed in a way that it is administered as a loading dose of 10 gm three times a day for the first three days after which it is given in a maintenance daily dose of 5 to 15 gm once daily.
On the other hand, Veltassa is given in a once-daily dose from the start. It is administered starting from a low dose and then titrated upwards until the desired dose is achieved.
Lokelma seems to be more effective than Veltassa. In clinical trials, Lokelma lowered serum potassium to normal levels in 99% of the patients within 72 hours [Ref].
On the other hand, Veltassa (Patiromer) normalized serum potassium levels in 76% of the patients after four weeks of treatment [Ref].
Lokelma | Veltassa | |
| Onset of action | One hour | 7 hours |
| Efficacy | 99% of the patients achieve normal serum potassium levels after 72 hours | 76% of the patients achieve normal serum potassium levels after 4 weeks |
Which drug is safer? Lokelma Vs Veltassa?
Both Lokelma and Veltassa are very safe compared to Kayexalate. Because they are not absorbed into the systemic circulation, they have minimal systemic side effects.
However, Veltassa is associated with hypersensitivity reactions and is contraindicated in patients who are allergic to it. There aren’t any contraindications to Lokelma as per the manufacturer.
Both Lokelma and Veltassa have gastrointestinal side effects and should be avoided in patients with intestinal obstruction, severe constipation, inflammatory bowel diseases, and post-operative GI motility disorders.
Lokelma is associated with edema and fluid overload, and hence it should be avoided in patients with fluid-overloaded states like congestive heart failure.
On the other hand, Veltassa is associated with hypomagnesemia, and frequent monitoring of serum magnesium levels is recommended.
Which drug has the fewest interactions? Lokelma Or Veltassa?
Both drugs affect the absorption of medications to some extent. If a person has to take any other medicine along with Lokelma or Veltassa, it is recommended to take it at least 2 to 3 hours before or after these two potassium-binding resins.
The manufacturer of Lokelma recommends a gap of at least 2 hours, while the manufacturer of Veltassa (Patiromer) recommends a gap of at least 3 hours between the drug and the concomitant medication.
9 drugs have been tested in humans to study the Lokelma-drug interactions. 12 drugs have been tested in humans to study Veltassa drug interactions.
Lokelma-drug interactions:
Among the 9 drugs tested in humans, 3 drugs were found safe and their absorption was not affected when administered with Lokelma.
- No drug interactions detected:
- Losartan,
- Glipizide, and
- Levothyroxine.
6 drugs were affected by Lokelma. The absorption of two drugs was impaired while the absorption of 4 drugs was increased.
- Absorption decreased:
- Dabigatran
- Clopidogrel
- Absorption increased:
- Furosemide
- Atorvastatin
- Warfarin
- Amlodipine
Veltassa-drug interactions:
Among the twelve drugs that were tested, only three drugs showed significant drug-Veltassa interactions. Absorption of the rest of the 9 drugs tested did not show any interactions. Furthermore, all the drugs when given three hours apart did not show any interactions.
- Veltassa-drug interactions significant:
- ciprofloxacin,
- levothyroxine and
- metformin
- No drug interactions detected:
- amlodipine,
- cinacalcet,
- clopidogrel,
- furosemide,
- lithium,
- metoprolol,
- trimethoprim,
- verapamil or
- warfarin
It is important that levothyroxine had no significant interactions with Lokelma but with Patiromer (Veltassa), it had significant drug interactions.
Thus, before choosing a potassium-binding resin, it is best to check for any significant interactions. For example, if you are taking Levothyroxine, you should choose Lokelma rather than Veltassa.
Lokelma Vs Veltassa cost?
A single sachet of Lokelma 5 gm or 10 gm is roughly about $ 25 USD.
A single sachet of Veltassa (Patiromer) 8.4, 16.8, or 25.2 gm is in the range of $20 to $45 USD.
The cost of both drugs is dependent on the location, pharmacies, and the number of sachets you buy.
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