Kionex® brand of sodium polystyrene sulfonate is a benzene, diethenyl- polymer with ethenylbenzene, sulfonated, sodium salt and has the following structural formula:

The drug is a cream to light brown finely ground, powdered form of sodium polystyrene sulfonate, a cation-exchange resin prepared in the sodium phase with an in vitro exchange capacity of approximately 3.1 mEq (in vivo approximately 1 mEq) of potassium per gram. The sodium content is approximately 100 mg (4.1 mEq) per gram of the drug. It can be administered orally or in an enema.

Last updated on RxList: 10/8/2007

Kionex® is indicated for the treatment of hyperkalemia.

Suspension of this drug should be freshly prepared and not stored beyond 24 hours.

The average daily adult dose of the resin is 15 g to 60 g. This is best provided by administering 15 grams (approximately 4 level teaspoons) of Kionex® one to four times daily. One gram of Kionex® contains 4.1 mEq of sodium; one level teaspoon contains approximately 3.5 grams of Kionex® and 15 mEq of sodium. (A heaping teaspoon may contain as much as 10 to 12 grams of Kionex®.) Since the in vivo efficiency of sodium-potassium exchange resins is approximately 33 percent, about one third of the resin's actual sodium content is being delivered to the body.

In smaller children and infants, lower doses should be employed by using as a guide a rate of 1 mEq of potassium per gram of resin as the basis for calculation.

Each dose should be given as a suspension in a small quantity of water or, for greater palatability, in syrup. The amount of fluid usually ranges from 20 to 100mL, depending on the dose, or may be simply determined by allowing 3 to 4 mL per gram resin.

The resin may be introduced into the stomach through a plastic tube and, if desired, mixed with a diet appropriate for a patient in renal failure.

The resin may also be given, although with less effective results, in an enema consisting (for adults) of 30 g to 50 g every six hours. Each dose is administered as a warm emulsion (at body temperature) in 100 mL of aqueous vehicle, such as sorbitol. The emulsion should be agitated gently during administration. The enema should be retained as long as possible and followed by a cleansing enema.

After an initial cleansing enema, a soft, large size (French 28) rubber tube is inserted into the rectum for a distance of about 20 cm, with the tip well into the sigmoid colon, and taped in place. The resin is then suspended in the appropriate amount of aqueous vehicle at body temperature and introduced by gravity, while the particles are kept in suspension by stirring. The suspension is flushed with 50 mL or 100 mL of fluid, following which the tube is clamped and left in place. If back leakage occurs, the hips are elevated on pillows or a knee-chest position is taken temporarily. A somewhat thicker suspension may be used, but care should be taken that no paste is formed, because the latter has a greatly reduced exchange surface and will be particularly ineffective if deposited in the rectal ampulla. The suspension is kept in the sigmoid colon for several hours, if possible. Then the colon is irrigated with nonsodium containing solution at body temperature in order to remove the resin. Two quarts of flushing solution may be necessary. The returns are drained constantly through a Y tube connection. Particular attention should be paid to this cleansing enema when sorbitol has been used.

The intensity and duration of therapy depend upon the severity and resistance of hyperkalemia.

Kionex® should not be heated for to do so may alter the exchange properties of the resin.

Kionex® is available as a cream to light brown, finely ground powder in jars of 1 pound.

Store at 20°-25°C (68°-77°F); excursions permitted to 15°-30°C (59°-86°F) [see USP ControlledRoom Temperature].

Dispense in a tight, light-resistant container as defined in the USP.

Kionex® (Sodium Polystyrene Sulfonate, USP) is available as a powder in containers of: 454 grams (One Pound)

NDC 0574-2004-16

Packaged by: Paddock Laboratories, Inc.Minneapolis, MN 55427. FDA rev date: 9/17/2007

Last updated on RxList: 10/8/2007

Kionex® Sodium Polystyrene Sulfonate may cause some degree of gastric irritation. Anorexia, nausea, vomiting, and constipation may occur especially if high doses are given. Also, hypokalemia, hypocalcemia, 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 colonic necrosis have been reported. Intestinal obstruction due to concretions of aluminum hydroxide, when used in combination with sodium polystyrene sulfonate, 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;
• Gastrointestinal tract ulceration of necrosis which could lead to intestinal perforation; and,
• Rare cases of acute bronchitis and/or bronchopneumonia associated with inhalation of particles of polystyrene sulfonate.

Antacids: The simultaneous oral administration of Kionex® 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 reported 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 Kionex®. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene sulfonate with magnesium hydroxide as a laxative.

Intestinal obstruction due to concretions of aluminum hydroxide when used in combination with sodium polystyrene sulfonate 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 Kionex® has been implicated in cases of chronic necrosis. Therefore, concomitant administration is not recommended.

Lithium: Kionex® may decrease absorption of lithium.

Thyroxine: Kionex® may decrease absorption of thyroxine.

Last updated on RxList: 10/8/2007

AlternativeTherapy in Severe Hyperkalemia: Since effective lowering of serum potassium with this product may take hours to days, treatment with this drug alone may be insufficient to rapidly correct severe hyperkalemia associated with states of rapid tissue breakdown (e.g., burns and renal failure) or hyperkalemia so marked as to constitute a medical emergency. Therefore, other definitive measures, including dialysis, should always be considered and may be imperative.

Hypokalemia: Serious potassium deficiency can occur from therapy with Kionex®. The effect must be carefully controlled by frequent serum potassium determinations within each 24 hour period. Since intracellular potassium deficiency is not always reflected by serum potassium levels, the level at which treatment with Kionex® should be discontinued must be determined individually for each patient. Important aids in making this determination are the patient's clinical condition and electro cardiogram. Early clinical signs of severe hypokalemia include a pattern of irritable confusion and delayed thought processes.

Electrocardiographically, severe hypokalemia is often associated with a lengthened Q-T interval, widening, flattening, or inversion of the T wave, and prominent U waves. Also, cardiac arrhythmias may occur, such as premature atrial, nodal, and ventricular contractions, and supraventricular and ventricular tachycardias. The toxic effects of digitalis are likely to be exaggerated. Marked hypokalemia can also be manifested by severe muscle weakness, at times extending into frank paralysis.

Electrolyte Disturbances: Like all cation-exchange resins, Kionex® Sodium Polystyrene Sulfonate is not totally selective (for potassium) in its actions, and small amounts of other cations such as calcium and magnesium can also be lost during treatment. Accordingly, patients receiving Kionex® should be monitored for all applicable electrolyte disturbances.

Systemic Alkalosis:Systemic alkalosis has been reported 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 Kionex®. One case of grand mal seizure has been reported in a patient with chronic hypocalcemia of renal failure who was given sodium polystyrene sulfonate with magnesium hydroxide as laxative. (See PRECAUTIONS: DRUG INTERACTIONS.)

Caution is advised when Kionex® is administered to patients who cannot tolerate even a small increase in sodium loads (i.e., severe congestive heart failure, severe hypertension, or marked edema). In such instances compensatory restriction of sodium intake from other sources may be indicated.

In the event of clinically significant constipation, treatment with Kionex® should be discontinued until normal bowel motion is resumed. Magnesium-containing laxatives or sorbitol should not be used (see PRECAUTIONS: DRUG INTERACTIONS).

Carcinogenesis, Mutagenesis, Impairment of Fertility

Studies have not been performed.

Pregnancy Category C

Animal reproduction studies have not been conducted with Kionex® (Sodium Polystyrene Sulfonate, USP). It is also not known whether Kionex® can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Kionex® should be given to a pregnant woman only if clearly needed.

Nursing Mothers

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Kionex® is administered to a nursing woman.

Pediatric Use: The effectiveness of Kionex® in pediatric patients has not been established. In neonates, Kionex® should not be given by the oral route. In both children and neonates, particular care should be observed with rectal administration, as excessive dosage or inadequate dilution could result in impaction of the resin.

Due to the risk of digestive hemorrhage or colonic necrosis, particular care should be observed in premature infants or low birth weight infants.

Last updated on RxList: 10/8/2007

Biochemical disturbances resulting from overdosage may give rise to clinical signs and symptoms of hypokalemia, including: irritability, confusion, delayed thought processes, muscle weakness, hyporeflexia, which may progress to frank paralysis and/or apnea. Electrocardiographic changes may be consistent with hypokalemia or hypercalcemia; cardiac arrhythmias may occur. Appropriate measures should be taken to correct serum electrolytes (potassium, calcium), and the resin should be removed from the alimentary tract by appropriate use of laxatives or enemas.

Kionex® is contraindicated in the following conditions: patients with hypokalemia, patients with a history of hypersensitivity to polystyrene sulfonate resins, obstructive bowel disease, neonates with reduced gut motility (postoperatively or drug induced) and oral administration in neonates (see PRECAUTIONS).

Last updated on RxList: 10/8/2007

As the resin passes along the intestine or is retained in the colon after administration by enema, the sodium ions are partially released and are replaced by potassium ions. For the most part, this action occurs in the large intestine, which excretes potassium ions to a greater degree than does the small intestine. The efficiency of this process is limited and unpredictably variable. It commonly approximates the order of 33 percent but the range is so large that definitive indices of electrolyte balance must be clearly monitored. Metabolic data are unavailable.

Last updated on RxList: 10/8/2007

No information provided. Please refer to the WARNINGS and PRECAUTIONS sections.

Last updated on RxList: 10/8/2007

IMPORTANT NOTE: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your health care professional. Always seek the advice of your health care professional if you have any questions about this product or your medical condition. This information is not intended as individual medical advice and does not substitute for the knowledge and judgment of your health care professional. This information does not contain any assurances that this product is safe, effective, or appropriate for you.

SODIUM POLYSTYRENE SULFONATE - POWDER

(SO-dee-um pah-lee-STYE-reen SULL-fon-ate)

COMMON BRAND NAME(S): Kayexalate, Kionex, Marlexate

USES: This medication is used to treat high levels of potassium in the body (hyperkalemia).

HOW TO USE: To prepare the oral liquid suspension, follow the directions provided by your doctor or pharmacist. Measure out the correct dose of the powder and mix with the correctly measured amount of water or syrup exactly as directed. In some cases, sorbitol liquid may be prescribed to mix with the medication powder instead of water or syrup. Sorbitol acts as a laxative to relieve constipation. The oral suspension should be used soon after mixing. Do not store for more than 24 hours.

This medication may also be given rectally as an enema. Consult your doctor or pharmacist for specific directions on how to prepare the medication and use the enema (including the use of cleansing enemas before and after the actual medication enema).

Dosage is based on your medical condition and response to therapy.

Do not heat the medication; heat may cause the medication to be less effective.

Do not use salt substitutes without consulting your doctor.

SIDE EFFECTS: Nausea, stomach pain, loss of appetite, constipation or diarrhea may occur. If these effects persist or worsen, notify your doctor.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Unlikely but report promptly: swelling, muscle cramps, dizziness, mental or mood changes.

Very unlikely but report promptly: fast/slow/irregular pulse, muscle weakness, muscle spasm.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Contact your doctor for medical advice about side effects. The following numbers do not provide medical advice, but in the US you may report side effects to the Food and Drug Administration (FDA) at 1-800-FDA-1088. In Canada, you may call Health Canada at 1-866-234-2345.

PRECAUTIONS: Tell your doctor your medical history, including: allergies, heart disease, kidney disease, high blood pressure, swelling (edema).

This medication contains significant amounts of salt (sodium). If you are on a salt-restricted diet, or have any of the medical conditions noted above, consult your doctor or pharmacist before using this product.

This medication should be used only when clearly needed during pregnancy. Discuss the risks and benefits with your doctor.

It is not known whether this drug is excreted into breast milk. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Tell your doctor of all nonprescription and prescription medication you use, especially of: calcium or aluminum or magnesium-containing antacids or laxatives, certain "water pills" (potassium sparing diuretics such as amiloride), digoxin.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly.

NOTES: Do not share this medication with others.

Laboratory and/or medical tests may be performed to monitor your progress.

MISSED DOSE: If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not "double-up" the dose to catch up.

STORAGE: Store the powder at room temperature at 77 degrees F (25 degrees C) away from light and moisture. Brief storage between 59-86 degrees F (15-30 degrees C) is permitted. After mixing, use the oral liquid suspension within 24 hours. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).

Information last revised July 2008 Copyright(c) 2008 First DataBank, Inc.