sodium polystyrene sulfonate: clinical use

Prescribing considerations

• Confirm hyperkalaemia and use regular biochemical assessment to guide continued treatment.
• Review gastrointestinal motility, recent surgery, constipation and aspiration risk before administration.
• Account for sodium load in heart failure, hypertension, renal damage, oedema or sodium restriction.
• Review oral medicines for binding interactions and ensure suitable separation.
• Avoid concurrent sorbitol and stop treatment if clinically significant constipation develops until bowel function recovers.

Contraindications and cautions

• Hypersensitivity to sodium polystyrene sulfonate, its excipients or polystyrene sulfonate resins.
• Potassium below the product's specified treatment threshold.
• Obstructive bowel disease.
• Oral administration to neonates.
• Use in neonates with reduced postoperative or drug-induced gut motility.

Monitoring

• Serum potassium, with vigilance for excessive potassium depletion.
• Calcium and magnesium.
• Sodium and fluid status where increased sodium load may be harmful.
• Bowel function and symptoms of obstruction, ischaemia or perforation.
• Clinical and, where appropriate, cardiac assessment in patients receiving digitalis medicines.

Clinical pharmacology

A non-absorbed cation-exchange resin that binds intestinal potassium in exchange for sodium and is excreted in faeces.

Formulation and product differences

• The selected product is a buff-coloured powder for oral or rectal suspension.
• It contains sodium, saccharin and vanillin and is considered high in sodium.
• The calcium form of polystyrene sulfonate may avoid some sodium-loading concerns, but it is a different active ingredient and product.