Medical Editor: John P. Cunha, DO, FACOEP Last updated on RxList: 8/23/2022

Drug Summary

What Is Kionex?

Kionex (sodium polystyrene sulfonate) is a cation-exchange resin that works by helping your body get rid of extra potassium and is used to treat high levels of potassium in the blood, also called hyperkalemia. Kionex is available in generic form.

What Are Side Effects of Kionex?

Common side effects of Kionex include:

  • loss of appetite,
  • nausea,
  • vomiting,
  • upset stomach,
  • constipation, or
  • diarrhea.

Tell your doctor if you have serious side effects of Kionex including:

  • muscle weakness or spasms,
  • fast or irregular heartbeat,
  • mental/mood changes (such as irritability, confusion, slowed thinking), or
  • swelling hands/ankles/feet.

Kionex may cause serious side effects including:

  • hives,
  • difficulty breathing,
  • swelling of your face, lips, tongue, or throat,
  • stomach pain,
  • rectal pain,
  • severe constipation,
  • severe stomach pain,
  • bloating,
  • fever,
  • chills,
  • vomiting,
  • confusion,
  • thinking problems,
  • feeling irritable,
  • leg cramps,
  • constipation,
  • irregular heartbeats,
  • fluttering in your chest,
  • increased thirst or urination,
  • numbness or tingling,
  • muscle weakness,
  • limp feeling,
  • muscle spasms or contractions,
  • numbness or tingly feeling (around your mouth, or in your fingers and toes),
  • bloody or tarry stools,
  • coughing up blood, and
  • vomit that looks like coffee grounds

Seek medical care or call 911 at once if you have the following serious side effects:

  • Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
  • Serious heart symptoms such as fast, irregular, or pounding heartbeats; fluttering in your chest; shortness of breath; and sudden dizziness, lightheartedness, or passing out;
  • Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors.

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

Dosage for Kionex

The average daily adult dose of Kionex 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.

What Drugs, Substances, or Supplements Interact with Kionex?

Kionex may interact with digoxin, lithium, thyroxine, or diuretics (water pills). Tell your doctor all medications and supplements you use.

Kionex During Pregnancy and Breastfeeding

During pregnancy, Kionex should be used only when prescribed. It is unknown if this drug passes into breast milk, and the effect on a nursing infant is unknown. Consult your doctor before breastfeeding.

Additional Information

Our Kionex (sodium polystyrene sulfonate) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

Drug Description


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

Kionex® Sodium Polystyrene Sulfonate, Structural Formula Illustration

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 vivoapproximately 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.

Indications & Dosage


Kionex® Suspension is indicated for the treatment of hyperkalemia.


The average daily adult dose is 15 g (60 mL) to 60 g (240 mL) of suspension. This is best provided by administering 15 g (60 mL) of Kionex® Suspension one to four times daily. Each 60 mL of Kionex® Suspension contains 1500 mg (65 mEq) of sodium. Since the in vivo efficiency of sodium-potassium exchange resins is approximately 33%, 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.

Kionex® Suspension may be introduced into the stomach through a plastic tube and, if desired, given with a diet appropriate for a patient in renal failure.

Kionex® Suspension may also be given, although with less effective results, as an enema consisting (for adults) of 30 g (120 mL) to 50 g (200 mL) every six hours. 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 into place. The suspension is introduced at body temperature by gravity. The suspension is flushed with 50 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 kneechest position is taken temporarily. The suspension is kept in the sigmoid colon for several hours, if possible. Then the colon is irrigated with a sodium-free cleansing enema 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 the cleansing enema, because sorbitol is present in the vehicle.

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

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


Kionex® Suspension is a light brown, raspberry-flavored suspension supplied in pint (473 mL) bottles (NDC 0574-2002-16) and 60 mL unit dose bottles (NDC 0574-2002-02).

Dispense in a tight container, as defined in the USP. If repackaging into other containers, store in refrigerator and use within 14 days of packaging.


Store at 20° to 25° C (68° to 77° F) [see USP Controlled Room Temperature]

Manufactured By: Perrigo, Minneapolis, MN 55427. Revised: Nov 2018

Side Effects


Kionex® Suspension 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 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 with sodium polystyrene sulfonate powder:

  • fecal impaction following rectal administration, particularly in children;
  • gastrointestinal concretions (bezoars) following oral administration;
  • gastrointestinal tract ulceration or necrosis which could lead to intestinal perforation; and,
  • rare cases of acute bronchitis and/or bronchopneumonia associated with inhalation of particles of polystyrene sulfonate.
Drug Interactions



The simultaneous oral administration of sodium polystyrene sulfonate with non-absorbable cationdonating 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 sodium polystyrene sulfonate. 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.


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).


Concomitant use of additional sorbitol with Kionex® Suspension is not recommended.


Kionex® Suspension may decrease absorption of lithium.


Kionex® Suspension may decrease absorption of thyroxine.



Alternative Therapy In Severe Hyperkalemia

Since the effective lowering of serum potassium with sodium polystyrene sulfonate 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.


Serious potassium deficiency can occur from sodium polystyrene sulfonate therapy. 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 sodium polystyrene sulfonate should be discontinued must be determined individually for each patient. Important aids in making this determination are the patient's clinical condition and electrocardiogram. 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, sodium polystyrene sulfonate is not totally selective (for potassium) in its actions, and small amounts of other cations such as magnesium and calcium can also be lost during treatment. Accordingly, patients receiving sodium polystyrene sulfonate 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 sodium polystyrene sulfonate. 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. (See PRECAUTIONS, DRUG INTERACTIONS).



Caution is advised when sodium polystyrene sulfonate 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.

Caution is advised when Kionex® Suspension is administered to patients with end stage diabetic renal disease.

Kionex® Suspension should not be administered to patients following surgery until normal bowel function resumes.

Precautions should be taken to ensure the use of adequate volumes of sodium-free cleansing enemas after rectal administration.

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

Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment Of Fertility

Studies have not been performed.

Use In Specific Populations

Pregnancy Category C

Animal reproduction studies have not been conducted with sodium polystyrene sulfonate. It is also not known whether sodium polystyrene sulfonate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Sodium polystyrene sulfonate 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 sodium polystyrene sulfonate is administered to a nursing woman.

Pediatric Use

The effectiveness of Kionex® Suspension in pediatric patients has not been established. The use of Kionex® Suspension is contraindicated in neonates and especially in premature infants. In children, particular care should be observed with rectal administration, as excessive dosage or inadequate dilution could result in impaction of the resin. Precaution should be taken to ensure the use of adequate volumes of sodium-free cleansing enemas after rectal administration.

Overdose & Contraindications


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 into 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® Suspension is contraindicated in the following conditions: patients with hypokalemia, patients with a history of hypersensitivity to polystyrene sulfonate resins, obstructive bowel disease, oral or rectal administration in neonates (particularily in premature infants), and in any post-operative patient until normal bowel function resumes (see PRECAUTIONS).

Clinical Pharmacology


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%, but the range is so large that definitive indices of electrolyte balance must be clearly monitored.

Metabolic data are unavailable.

Medication Guide


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

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