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Kayexalate is indicated for the treatment of hyperkalemia. Kayexalate is the brand of sodium polystyrene sulfonate is a benzene, diethenyl-polymer, with ethenylbenzene, sulfonated, sodium salt (FDA, 2019).

Mechanism of action: kayexalate is a non-absorbed, cation exchange polymer that contains a sodium counter ion. Kayexalate increases fecal potassium excretion through binding of potassium in the lumen of the gastrointestinal tract (Malone, 2015).

Monitoring: Caution is advised when kayexalate is administered to patients who cannot tolerate even a small increase in sodium loads, such as severe congestive heart failure, severe hypertension, or marked edema. In such instances compensatory restriction of sodium intake from other sources may be indicated (FDA, 2019).In the event of clinically significant constipation, treatment with kayexalate should be discontinued until normal bowel motion is resumed. Magnesium-containing laxatives or sorbitol should not be used (FDA, 2019).

Drug Interactions:Antacids: The simultaneous oral administration of kayexalate with nonabsorbable cation-donating antacids and laxatives may reduce the resins potassium exchange capability (FDA, 2019).

Non-absorbable cation-donating antacids and laxatives: Systemic alkalosis has been reported after cation-exchange resins were administered orally in combination with nonabsorbable cation-donating antacids and laxatives such as magnesium hydroxide and aluminum carbonate. Magnesium hydroxide should not be administered with kayexalate. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given kayexalate with magnesium hydroxide as a laxative Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with kayexalate has been reported (FDA, 2019).

Digitalis: The toxic effects of digitalis on the heart, especially various ventricular arrhythmias and A-V nodal dissociation, are likely to be exaggerated by hypokalemia, even in the face of serum digoxin concentrations in the normal range (Malone,2015).

Sorbitol: Concomitant use of Sorbitol with kayexalate has been implicated in cases of colonic necrosis. Therefore, concomitant administration is not recommended. Lithium: kayexalate may decrease absorption of lithium (FDA, 2019).Thyroxine: kayexalate may decrease absorption of thyroxine (FDA, 2019).

Side effects: Kayexalate may cause some degree of gastric irritation. Anorexia, nausea, vomiting, and constipation may occur especially if high doses are given. Also, hypokalemia, hypocalcemia, and significant sodium retention, and their related clinical manifestations, may occur .Occasionally diarrhea develops. Large doses in elderly individuals may cause fecal impaction. Rare instances of colonic necrosis have been reported. Intestinal obstruction due to concretions of aluminum hydroxide, when used in combination with kayexalate has been reported (FDA, 2019).