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

The following events have been reported from worldwide post marketing experience:

• Fecal impaction following rectal administration, particularly in children;
• Gastrointestinal concretions (bezoars) following oral administration;
• Ischemic colitis, gastrointestinal tract ulceration or necrosis which could lead to intestinal perforation; and,
• Rare cases of acute bronchitis and/or broncho-pneumonia associated with inhalation of particles of polystyrene sulfonate.

Antacids

The simultaneous oral administration of Kayexalate (sodium polystyrene) with nonabsorbable cation-donating antacids and laxatives may reduce the resin's potassium exchange capability.

Non-absorbable cation-donating antacids and laxatives

Systemic alkalosis has been repotted 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 (sodium polystyrene) . One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given Kayexalate (sodium polystyrene) with magnesium hydroxide as a laxative.

Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with Kayexalate (sodium polystyrene) has been reported.

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" (See WARNINGS).

Sorbitol: Concomitant use of Sorbitol with Kayexalate (sodium polystyrene) has been implicated in cases of intestinal necrosis, which may be fatal. Therefore, concomitant administration is not recommended (See WARNINGS).

Lithium

Kayexalate (sodium polystyrene) may decrease absorption of lithium.

Thyroxine

Kayexalate (sodium polystyrene) may decrease absorption of thyroxine.

Last reviewed on RxList: 2/28/2011
This monograph has been modified to include the generic and brand name in many instances.