Patiromer is a relatively new potassium binder and studies showed it is superior to Kayexalate which has been conventionally used to lower potassium in hyperkalemia due to various causes, especially renal failure.
Patiromer works by binding to free potassium available the intestine and prevent its absorption into the bloodstream. It releases positive calcium ions which are absorbed instead of potassium if needed. As free potassium readily combines to the Patiromer, thus less potassium is available for absorption, this results in a decrease in potassium blood potassium level.
Patiromer is not absorbed by the gut, thus it has no systemic side effects. The side effects are mainly related to the gut. Another advantage of Patiromer over Kayexalate is that it can be given in heart failure, hypertension, and CKD etc. Kayexalate has high sodium content and this can be potentially harmful in case of heart failure, hypertension and even in advanced chronic kidney disease.
Another advantage of Patiromer is that its dosage frequency is very less as compared to Kayexalate. Kayexalate is given 4 times a day per orally and two times a day per rectally. On the other hand, Patiromer is given in once or maybe twice weekly doses, which is very convenient and cost-effective and also compliance is easy. Moreover, Kayexalate has much interaction with other drugs, Patiromer, on the other hand, and has significantly lesser interaction (Interaction with Ciprofloxacin is being reported.) (12/23/17).
Patiromer is not yet available in Pakistan market. But hopefully, soon it will replace the conventional Kayexalate.