Kalimate® [Calcium polystyrene sulfonate]
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Clinical Pharmacology
Indications
Hyperkalemia caused by acute or chronic renal failure.
Composition
1 g of powder contains:
Active substance
calcium polystyrenesulfonate - 1 g
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Dosage and Administration
The standard daily dose is 15-30 g, which should be divided into 2-3 doses. The drug is diluted in a small amount of water (30-50 ml) or 3-4 ml of sweet food or liquid (except for juice rich in potassium - orange, pineapple, grape, tomato) for 1 g of powder. If necessary, the prepared suspension can be introduced using a gastric probe with a thickness of 2-3 mm. When preparing the suspension, inhalation of the drug should be avoided due to the risk of developing acute bronchitis (see the “Adverse Effects” section).
The above dose is average, and can be individually adjusted depending on the levels of electrolytes in a particular patient. The use of calcium polystyrenesulfonate should be discontinued with a decrease in the level of potassium below 5 mmol / l.
Elderly patients (over 65 years)
Since elderly patients often have a decrease in the activity of physiological processes, when prescribing calcium polystyrene sulfonate, elderly patients are advised to perform more careful medical observation and use lower doses of the drug.
Adverse reactions
The frequency of side effects is indicated according to the classification of indicators recommended by the World Health Organization (WHO):
Very often:> 1/10;Often: 1/100; Infrequently: 1/1000; Seldom: 1/10000; Very rarely:
Metabolic and nutritional disorders
Often: hypokalemia, anorexia
Infrequently: hypercalcemia
Rarely: hypomagnesemia
Disorders of the gastrointestinal tract
Often: constipation, nausea, stomach discomfort, anorexia
Infrequently: vomiting, diarrhea.
Rarely: intestinal perforation, ischemic colitis or intestinal necrosis, intestinal obstruction. It was reported about the formation of calculus (bezoar) in the gastrointestinal tract after the use of the drug.
Disorders of the respiratory system, organs of the chest and mediastinum
Seldom: cases of the development of acute bronchitis and / or bronchopneumonia associated with the inhalation of polystyrenesulfonate calcium particles have been reported.
Violations of the skin and subcutaneous tissue
Seldom: rash
Contraindications
When aggravation of these side effects or the emergence of new, not described in the instructions, the patient should inform the doctor.
1) Intestinal obstruction;
2) Hypersensitivity to polystyrene sulfonate in history;
3) Conditions associated with hypercalcemia (for example, hyperparathyroidism, multiple myeloma, sarcoidosis, metastatic carcinoma);
4) The level of potassium in the plasma is below 5 mmol / l;
5) Kalimate® is not recommended for use in children under the age of 18 years due to insufficient data on efficacy and safety;
6) Combined use with sorbitol.
Carefully:
1) In patients prone to constipation (risk of intestinal obstruction or perforation);
2) In patients with intestinal stenosis (intestinal obstruction or perforation is possible);
3) In patients with gastrointestinal ulcers (possibly exacerbation of symptoms).
Drug interactions
Combined use of the drug with sorbitol is not recommended, as cases of intestinal necrosis have been reported with this use.
Cation exchange drugs can reduce the efficiency of potassium ion binding with Kalimeit.
With the combined use of cation-exchange resins and cation-containing antacid and laxative preparations (magnesium hydroxide, aluminum hydroxide, calcium carbonate, etc.), systemic alkalosis can develop and concretions of aluminum hydroxide are formed.
When used together with digitalis preparations (eg, digoxin), in the case of hypokalemia and / or hypercalcemia, the toxic effect of digitalis preparations on the heart may increase, especially the onset of ventricular arrhythmias and oppression of the atrioventricular node.
When combined with lithium preparations, a decrease in lithium absorption is possible.
When combined with thyroxine may decrease the absorption of thyroxin.
Calcium polystyrenesulfonate may impair the absorption of fat-soluble vitamins.
Pregnancy and Lactation
Special studies of the safety of calcium polystyrenesulfonate during pregnancy have not been conducted. The drug is not used in newborns, so its use in patients with hyperkalemia during lactation is not recommended.
Special instructions
Cases of intestinal obstruction and perforation of the intestine have been reported with the use of sodium and calcium polystyrenesulfonates. In the event of such phenomena as severe constipation, prolonged abdominal pain, vomiting, you must stop using the drug and take appropriate therapeutic measures. Patients should be advised to consult a doctor if abdominal pain, abdominal distention, vomiting and other symptoms characteristic of intestinal obstruction / perforation of the intestine occur.
Like other cation exchange resins, calcium polystyrenesulfonate is not selective for potassium cations. The development of hypomagnesemia and / or hypercalcemia is possible. Accordingly, during drug therapy, the levels of all electrolytes available for determination should be monitored. Calcium levels should be assessed weekly for early diagnosis of possible hypercalcemia and correction of the dose of polystyrene sulfonate calcium to levels that do not cause hypercalcemia and hypokalemia.
In the case of clinically significant constipation, treatment should be interrupted until normal intestinal motility is restored. Do not use magnesium-containing laxatives to treat constipation in these patients.
Since elderly patients often have a decrease in the activity of physiological processes, when prescribing calcium polystyrene sulfonate, elderly patients are advised to perform more careful medical observation and use lower doses of the drug.
Influence on ability to drive vehicles and work with mechanisms:
Studies of the effect of the drug on the ability to drive and work with mechanisms were not conducted.
Overdosage
Biochemical disorders in overdose can be the cause of clinical manifestations of symptoms of hypokalemia (irritability, confusion, slowed thinking, muscle weakness, hyporeflexia, paralysis). With the progression of the condition, respiratory arrest may develop. Electrocardiographic changes may correspond to those characteristic of hypokalemia or hypercalcemia, arrhythmias may develop. Adequate measures should be taken to correct plasma electrolyte levels and remove the drug from the digestive tract with laxatives and enemas.
- Brand name: Kalimate®
- Active ingredient: Calcium polystyrene sulfonate
Studies and clinical trials of Calcium polystyrene sulfonate (Click to expand)
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- Intestinal Necrosis Associated with Orally Administered Calcium Polystyrene Sulfonate Without Sorbitol (February)
- Development of Colonic Perforation during Calcium Polystyrene Sulfonate Administration: A Case Report
- Colonic necrosis and perforation due to calcium polystyrene sulfonate in a uraemic patient: a case report
- ISMP Adverse Drug Reactions - Metformin-Associated Lactic Acidosis; Escitalopram-Related Rhabdomyolysis; Adalimumab-Induced Disseminated Superficial Porokeratosis; Nephrotic Syndrome Associated With Adalimumab; Methotrexate-Induced Periorbital Radiation Recall; Micturition Difficulty Associated With Aripiprazole; Aripiprazole-Related Acute Transient Myopia and Diplopia; Intestinal Necrosis Associated With Calcium Polystyrene Sulfonate
- Calcium polystyrene sulfonate bezoar in the ileum: diagnosis and treatment with double-balloon endoscopy
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- A Case of Ileus due to Ileal Stenosis caused by Oral Intake of Calcium Polystyrene Sulfonate
- Compared effects of calcium and sodium polystyrene sulfonate on mineral and bone metabolism and volume overload in pre-dialysis patients with hyperkalemia