Lokelma, made simple.
Lokelma is a powder you mix with water to lower high potassium in your blood. It works a little faster than some potassium medicines, and it has its own timing rule. This guide explains how it works, how to take it, and what to watch for. A Mississippi pharmacist wrote it for you.
This guide is here to teach you. It is not medical advice, and it does not replace your doctor or pharmacist. Always do what your doctor tells you, and ask a pharmacist before you change how you take any medicine.
Print this guide for your fridgeWhat Lokelma is and why your doctor gave it to you
Lokelma is a medicine that lowers high potassium in your blood. Its full name is sodium zirconium cyclosilicate. It comes as a powder you mix with water and drink.
Potassium is a mineral your body needs, but too much is hard on the heart. High potassium, called hyperkalemia, is common with kidney disease, heart failure, and some blood pressure medicines.
Lokelma lowers potassium steadily. It starts working within about an hour, a bit faster than some other potassium binders. But like them, it is not a fast emergency treatment. Dangerously high potassium needs emergency care.
The simple version: Lokelma is a powder that traps extra potassium in your gut so it leaves your body in your bowel movements, keeping your potassium in a safer range for your heart.
How Lokelma works
Lokelma stays in your gut and is not absorbed into your blood.
Its structure is built to trap potassium specifically. As things move through your intestine, Lokelma captures extra potassium and holds it.
That captured potassium then leaves your body in your bowel movements instead of building up in your blood. As part of how it does this, Lokelma releases a small amount of sodium, which is a point worth knowing if you have heart failure or are on a low-salt diet. More on that below.
Your dose, and how to mix it
Lokelma comes in packets. Your doctor decides your dose and your pharmacist checks it. This page will not tell you what dose to take. Often there is a short starting phase of three times a day to bring potassium down, then a once a day maintenance dose.
To prepare it, empty the packet into a glass with about 3 tablespoons or more of water. Stir well, the powder does not dissolve, and drink it right away. If powder is left in the glass, add more water, stir, and drink again, until the glass is clear.
If you are on dialysis, there is one specific rule, covered in the special situations section: Lokelma is taken only on your non-dialysis days.
The timing rule, and what to do if you miss a dose
Lokelma briefly changes the acid level in your stomach as it works, and that can affect how some other medicines are absorbed.
The rule: take all your other oral medicines at least 2 hours before, or at least 2 hours after, Lokelma. Note that this is a 2 hour gap. Veltassa, a similar medicine, uses a 3 hour gap. They are different, so do not mix the two rules up. Ask your pharmacist to map your day.
If you miss a dose:
- If you miss a dose, take it as soon as you remember.
- If it is almost time for your next dose, skip the one you missed and take the next one on schedule.
- Never take two doses at once to catch up.
- During the early three times a day phase, keeping to the timing helps bring your potassium down on schedule, so call your pharmacist if you are unsure.
Side effects, what is normal and what is not
Common.
- Swelling, often in the legs or ankles, from holding a little extra fluid. This is the most common one and is linked to the sodium in Lokelma.
- Potassium dropping low, especially in the first days of the three times a day phase.
Call your doctor if you notice:
- New or worsening swelling in your legs, ankles, or feet.
- Muscle weakness, tiredness, cramps, or a fluttering heartbeat, which can mean potassium has dropped too low.
- Shortness of breath or trouble keeping to your fluid or salt limits, if you have heart failure.
Seek urgent care if:
- You have symptoms of very high potassium, such as a slow or irregular heartbeat, severe muscle weakness, or numbness. Lokelma is not an emergency treatment. Dangerously high potassium needs care right away.
What to be careful with
The first thing to be careful with is the 2 hour timing rule above. Keep all your other oral medicines at least 2 hours before or after Lokelma.
The second is sodium. Each dose of Lokelma carries a small amount of sodium, the same thing as salt. For most people that is fine. But if you have heart failure, or you are on a low-salt or fluid-restricted diet, that sodium matters. Make sure your doctor knows your heart and diet situation.
Do not take potassium supplements, or potassium-based salt substitutes, unless your doctor specifically says to. They work against what Lokelma is doing.
The simple rule: before you start or stop any medicine or supplement, tell your pharmacist you take Lokelma. Every single time.
What it costs
The cost is different for every person, because every insurance plan is different.
Here is the honest way to find your price. If you pay cash, call Fairview and we will give you a price for your situation. If you have private insurance, there may be a coupon or a savings program from the maker of the drug that helps lower your cost, and we will check if one is available for you. The best step is to let a pharmacist look at your plan. We do this for every patient.
Do not let cost make you skip doses. Call us first. There is almost always something we can do.
There is also a generic version of many medicines. The generic is the same medicine. Ask your pharmacist if a generic is a good fit for you.
What should be checked
Lokelma works best alongside regular blood tests, especially early on.
Your doctor should check:
- Your potassium level, often about a week after starting and after any dose change.
- Whether you are holding extra fluid, especially if you have heart failure.
- Your blood pressure and any swelling.
Your pharmacist should:
- Help you build a schedule that keeps the 2 hour rule simple.
- Check every new medicine for the timing separation.
- Remind you of the non-dialysis-day rule if you are on dialysis.
- Help with cost and assistance programs.
At Fairview, we keep an eye on our Lokelma patients. If a refill is running late, we call you, and if a new medicine is added, we check the timing.
Special situations
If you are on dialysis.
If you are on dialysis, take Lokelma only on the days you do not have dialysis. Taking it on a dialysis day can drop your potassium too low. Your care team will tell you exactly which days are yours.
If you have heart failure.
Lokelma carries a small amount of sodium with each dose. For someone with heart failure, or on a salt-restricted or fluid-restricted diet, that can add up and may worsen swelling. This does not always rule Lokelma out, but your doctor should weigh it. Tell them about your heart and your diet limits.
If you also take Veltassa.
Veltassa is another potassium-lowering medicine. Some people switch between the two. One key difference: Lokelma needs a 2 hour separation from other medicines, while Veltassa needs 3 hours. Do not assume the rule carries over. Ask your pharmacist which one applies.
It is not for emergencies.
Lokelma starts working within about an hour, but that is still not fast enough for an emergency. Dangerously high potassium needs immediate medical treatment.
Cost should never be the reason you stop.
Lokelma is brand only and can be expensive at full price, but there is a manufacturer savings program and an assistance program for people with limited income. If cost is a worry, call Fairview before you ever skip a dose.
How Fairview helps Lokelma patients
When you fill Lokelma at Fairview, here is what you get. This is normal care for us, not something extra.
At your first fill:
- We map your daily medicine schedule around the 2 hour rule.
- We show you how to mix Lokelma.
- We explain the dialysis-day rule if it applies to you.
- We talk through cost and help you find any program you qualify for.
At every refill:
- We check your file for any new medicines.
- We check that you are refilling on time.
- We answer any new questions before you leave.
On our own, without being asked:
- If a refill is late, we call you.
- If a new medicine needs the timing separation, we tell you.
- We check your cost at every fill to keep it as low as possible.
Questions people ask about Lokelma
Both lower high potassium, but they work a little differently. Lokelma starts working within about an hour, faster than Veltassa, and it uses a 2 hour separation from other medicines, where Veltassa uses 3 hours.
Related guides
Have a question about your Lokelma? Ask a pharmacist who knows it well.
Lokelma becomes simple once the 2 hour timing rule is a habit. A good pharmacist makes that easy and keeps an eye on the details. If something made you wonder, ask us. Moving your prescription to Fairview takes one phone call.