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SOLYSTAT is a brand name for Sodium Polystyrene Sulfonate, supplied as a powder for suspension. The medicine, its uses, side effects and dosage are the same regardless of brand.
Verbatim from this product's HC label. Tap a section to expand.
SOLYSTAT (sodium polystyrene sulfonate) is for oral or rectal administration only. The dosage recommendations given below are approximate. The precise requirements for each individual patient should be determined on the basis of regular clinical and biochemical assessments.
Powder for Suspension Suspensions of SOLYSTAT should be freshly prepared and not stored beyond 24 hours. SOLYSTAT powder should not be heated as heating may alter the exchange properties of the resin.
Adults, Including the Elderly Oral:
The average daily adult dose of SOLYSTAT is 15 to 60 grams. This is provided by administering 15 grams (approximately 4 level teaspoons) of SOLYSTAT one to four times daily. 5 grams of SOLYSTAT powder and 15 mmol of sodium. A heaping teaspoon may contain as much as 10-12 grams of SOLYSTAT powder.
Since the in vivo efficiency of sodium-potassium exchange resins is approximately 33 per cent, about one third of the resin’s actual sodium content is being delivered to the body. Each dose should be given as a suspension in a small quantity of water or, for greater palatability, in syrup, but not in orange juice or other fruit juices that are known to contain potassium.
The amount of fluid usually ranges from 20 to 100 mL, depending on the dose. It may be simply determined by allowing 3 to 4 mL per gram of resin. Administer SOLYSTAT at least 3 hours before or 3 hours after other oral medications. For patients with gastroparesis, a 6-hour separation should be considered (see WARNINGS AND PRECAUTIONS and DRUG INTERACTIONS).
The resin may be introduced into the stomach through a plastic tube. If desired, it may be mixed with a diet appropriate for a patient in renal failure.
Rectal:
For adults, SOLYSTAT may also be given, although with less effective results, in a daily enema. Thirty (30) to 50 g of resin is given once or twice daily (at intervals of six hours). Each dose is administered as a warm emulsion (at body temperature) in 150 to 200 mL of aqueous vehicle (such as plain water, 10 per cent dextrose in water or equal parts of water and 2 per cent methylcellulose suspension).
The emulsion should be agitated gently during administration. The enema should be retained for as long as possible and should be followed by a cleansing enema. After the initial cleansing enema, insert a soft, large size (French 28) rubber tube into the rectum for a distance of about 20 cm, with the tip well into the sigmoid colon.
Then tape the tube in place. Suspend the resin in the appropriate amount of water or 10 percent dextrose in water at body temperature. While constantly stirring to keep the particles in suspension, introduce the Prescribing Information - SOLYSTAT® Page 8 of 14 suspension into the colon by gravitational flow.
g. burns and renal failure). In such instances, some form of dialysis (peritoneal or hemo-) may be imperative. g. 5 mmol/liter), immediate treatment with intravenous glucose and insulin, or intravenous sodium bicarbonate may be necessary as a temporary measure to lower serum potassium, while other long-term potassium lowering therapy is initiated.
Binding to other orally administered medications:
When administered orally, SOLYSTAT may bind to other orally administered medications, which could decrease their gastrointestinal absorption and efficacy. Avoid co-administration of SOLYSTAT with other orally administered medications.
Administer SOLYSTAT at least 3 hours before or 3 hours after administration of other oral medications. For patients with gastroparesis, a 6-hour separation should be considered (see DRUG INTERACTIONS and DOSAGE AND ADMINISTRATION, Powder for Suspension).
Gastrointestinal injuries:
Cases of gastrointestinal stenosis, intestinal ischemia, ischemic colitis, peritonitis, gastro-intestinal tract ulceration, rectal haemorrhage, gastrointestinal necrosis and intestinal perforation with fatal outcomes have been reported in patients treated with sodium polystyrene sulfonate alone or in combination with sorbitol.
Although all patients are potentially susceptible, risk factors for gastrointestinal adverse events were present in many of the cases including prematurity, history of intestinal disease or surgery, hypovolemia, immunosuppressant therapy, severe burns, and renal insufficiency and failure.
Patients should be advised to seek prompt medical attention in case of newly developed severe abdominal pain, nausea and vomiting, stomach distension and rectal bleeding. Concomitant administration of sorbitol with SOLYSTAT is not recommended (see DRUG INTERACTIONS and ADVERSE REACTIONS).
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
Other brands of Sodium Polystyrene Sulfonate in Canada.
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The suspension should be flushed with 50 or 100 mL of saline solution, following which the tube is clamped and left in place. If back leakage occurs, the hips may be elevated on pillows or a temporary knee-chest position may be taken.
A somewhat thicker suspension may be used, but care should be taken that no paste is formed. Paste formation has a greatly reduced exchange surface and is particularly ineffective, if deposited in the rectal ampulla. If possible, keep the suspension in the sigmoid colon for several hours.
In order to remove the resin, irrigate the colon with non-sodium containing solution at body temperature. Two quarts of flushing solution may be necessary. The returns should be drained constantly through a Y tube connection. While the use of sorbitol is not recommended, particular attention should be paid to the cleansing enema whenever sorbitol has been used.
It should be noted that the rectal route of administration should be reserved for patients who are vomiting or who have upper gastrointestinal tract problems, including paralytic ileus. The rectal route may also be used simultaneously with oral administration in cases where more rapid initial results are desirable.
If both routes are used initially, it is probably unnecessary to continue rectal administration once the oral resin has reached the rectum. The intensity and duration of therapy depends upon the severity and resistance of hyperkalemia.
Children Oral:
In smaller children and infants, correspondingly lower doses should be employed. Calculation of the dose may be based upon the exchange rate of 1 mmol of potassium per gram of SOLYSTAT. An appropriate initial dose is 1 g/kg body weight daily in divided doses in acute hyperkalemia.
5 g/kg body weight daily.
Rectal:
When refused by mouth, SOLYSTAT may be given rectally using a dose at least as great as that which would have been given orally. SOLYSTAT should be suspended in a proportional amount of 10% dextrose in water. Following retention of the enema, the colon should be irrigated to ensure adequate removal of the resin (see WARNINGS AND PRECAUTIONS).
Neonates Rectal:
Since it is advised that the oral route should not be employed; only rectal administration should be considered. 5 to 1 g/kg of SOLYSTAT should be employed. The resultant suspension should be diluted as for adults. Following administration of SOLYSTAT, the colon should be adequately irrigated to ensure recovery of the resin (see WARNINGS AND PRECAUTIONS).
Oral Suspension Adults, Including the Elderly Oral Only:
The average daily adult dose of SOLYSTAT is 15 to 60 grams (60 to 240 mL). This is provided by administering 60 mL (15 grams) of SOLYSTAT one to four times daily. Since the in vivo efficiency of sodium-potassium exchange resins is approximately 33 per cent, about one third of the resin's actual sodium content is being delivered to the body.
Prescribing Information - SOLYSTAT® Page 9 of 14 SOLYSTAT may be introduced into the stomach through a plastic tube. If […]
Hypokalemia:
SOLYSTAT therapy can precipitate serious potassium deficiency and the possibility of severe potassium depletion should be considered. It is therefore imperative to determine serum potassium levels at least daily and more frequently when indicated.
Adequate clinical and biochemical control is essential during treatment especially in patients on digitalis. Therapy should be discontinued as soon as serum potassium falls below 5 mmol/L (see DRUG INTERACTIONS). Since intracellular potassium deficiency is not always reflected by serum potassium levels, the level at which treatment with SOLYSTAT should be discontinued must be determined individually for each patient.
The patient's clinical condition and electrocardiogram are important in making this determination. Early clinical signs of severe hypokalemia include a pattern of irritability, confusion and delayed thought processes. Severe hypokalemia is often associated with a lengthened Q-T interval, Prescribing Information - SOLYSTAT® Page 4 of 14 widening, flattening or inversion of the T wave, and the appearance of U waves on the electrocardiogram (ECG).
Cardiac arrhythmias such as premature atrial, nodal and ventricular contractions, and supraventricular and ventricular tachycardias may also occur. Marked hypokalemia can also be manifested by severe muscle weakness, at times extending into frank paralysis.
The toxic effects of digitalis on the heart, especially various ventricular arrhythmia and A-V nodal dissociation, are likely to be exaggerated by hypokalemia. These effects can occur even though serum digoxin concentration is within the ‘normal range’.
Other electrolytes 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. Patients receiving SOLYSTAT should be monitored for all applicable electrolyte disturbances.
Other risks:
In the event of clinically significant constipation, treatment with the resin should be discontinued until normal bowel motion is resumed. Magnesium-containing laxatives should not be used (see DRUG INTERACTIONS). The patient should be positioned carefully when ingesting the resin, in order to avoid aspiration, which could lead to bronchopulmonary complications.
Due to the risk of severe gastrointestinal disorders, the use of polystyrene sulfonate is not recommended in patients with compromised gastrointestinal motility (including immediate post- surgery or drugs that decrease gastrointestinal motility, such as anticholinergics or narcotic analgesics).
Special Populations Children and neonates:
In neonates, SOLYSTAT should not be given by the oral route. In both children and neonates, particular care should be observed with rectal administration. Excessive dosage or inadequate dilution could result in impaction of the resin.
Due to the risk of gastrointestinal tract hemorrhage, colonic necrosis, or sodium overload, particular care should be observed in premature infants or low birth weight infants.
Patients at risk from an increase in sodium load:
During the resin’s action in the intestinal tract, sodium is released mole for mole with potassium uptake. A single dose of sodium polystyrene sulfonate (15 grams) contains approximately 60 mmol of sodium. e. severe congestive heart failure, severe hypertension, marked edema or renal damage).
In such instances, compensatory restriction of sodium intake from other sources may be indicated and adequate clinical and […]