Table 1:

Overview of potassium binders

Characteristic	Sodium polystyrene sulfonate23	Sodium zirconium cyclosilicate25	Patiromer24^,29
Mechanism	Nonabsorbed cation-exchange resin	Inorganic cation exchanger with a crystalline structure that entraps K+	Nonabsorbed cation-exchanger polymer that binds K+
Site	Colon	Entire GI tract	Colon
Exchange ion for potassium	Sodium	Sodium	Calcium
Onset of action	Hours to days	1 hour	4 to 7 hours
Enablement of RAAS inhibitors	Not on label or shown	Not on label About 70% of patients in phase 2 and 3 studies were receiving RAAS inhibitors at baseline	On label 99.4% of patients in phase 2 and 3 studies were receiving RAAS inhibitors at baseline
Adverse events	GI stenosis, intestinal ischemia, ischemic colitis, rectal hemorrhage, GI necrosis, intestinal perforation with fatal outcomes, hypomagnesemia, hypokalemia, hypocalcemia	Mild-to-moderate GI effects, edema, hypokalemia (0%–11%, dose-dependent effect)	Mild-to-moderate GI effects, hypomagnesemia, hypokalemia (3%–5.6%)
Recommended dose	Oral: 15 g, 1–4 times daily Rectal: 30–50 g, 1–2 times daily	10 g 3 times daily for up to 48 hours, then 5–10 g once a day. No more than 10 g once a day for maintenance therapy	8.4 g once a day. Dose can be titrated at ≥ 1-wk intervals in 8.4 g increments to a maximum of 25.2 g once a day
Daily list price and funding	Generic	$12.50 (5 g), $25 (10 g); negative CADTH recommendation^*	$13 (flat); positive CADTH recommendation^*

Note: CADTH = Canadian Agency for Drugs and Technologies in Health, GI = gastrointestinal, K+ = potassium, RAAS = renin–angiotensin–aldosterone system.
↵* CADTH is a government agency that undertakes an evaluation of the clinical and cost-effectiveness evidence on a drug, and provides recommendations on reimbursement. A positive recommendation means that CADTH supports reimbursement. A negative recommendation means that it does not support reimbursement. The recommendations are nonbinding.