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{{Short description|Drug used for the treatment of hyperkalemia}}
{{Use dmy dates|date=February 2023}}
{{Infobox drug
{{Infobox drug
⚫
| drug_name =
| IUPAC_name = 2-Fluoropropenoic acid, cross-linked polymer with diethenylbenzene and 1,7-octadiene
| image = Patiromer skeletal.svg
| image = Patiromer skeletal.svg
| alt =
| alt =
| caption =
| caption =

<!-- Clinical data -->
<!-- Clinical data -->
| pronounce =
| pronounce =
| tradename = Veltassa
| tradename = Veltassa
| Drugs.com = {{Drugs.com|monograph|patiromer-sorbitex-calcium}}
| Drugs.com = {{Drugs.com|monograph|patiromer-sorbitex-calcium}}
| MedlinePlus =
| MedlinePlus = a616012
| DailyMedID = Patiromer
| pregnancy_AU = <!-- A / B1 / B2 / B3 / C / D / X -->
| pregnancy_AU = B1
| pregnancy_AU_comment =
| pregnancy_AU_comment =
| pregnancy_US = <!-- A / B / C / D / X / N -->
| pregnancy_category=
| pregnancy_category=
⚫
| routes_of_administration = [[Oral administration|By mouth]]
| legal_AU = <!-- S2, S3, S4, S5, S6, S7, S8, S9 or Unscheduled-->
⚫
| ATC_prefix = V03
| legal_AU_comment =
⚫
| ATC_suffix = AE09
| legal_CA = <!-- OTC, Rx-only, Schedule I, II, III, IV, V, VI, VII, VIII -->

| legal_AU = S4
| legal_AU_comment = <ref>{{cite web | title=Prescription medicines: registration of new chemical entities in Australia, 2017 | website=Therapeutic Goods Administration (TGA) | date=21 June 2022 | url=https://www.tga.gov.au/resources/publication/publications/prescription-medicines-registration-new-chemical-entities-australia-2017 | access-date=9 April 2023}}</ref><ref>{{cite web | title=Prescription medicines and biologicals: TGA annual summary 2017 | website=Therapeutic Goods Administration (TGA) | date=21 June 2022 | url=https://www.tga.gov.au/resources/publication/publications/prescription-medicines-and-biologicals-tga-annual-summary-2017 | access-date=31 March 2024}}</ref>
| legal_CA = Rx-only
| legal_CA_comment = <ref>{{cite web | title=Summary Basis of Decision (SBD) for Veltassa | website=[[Health Canada]] | date=23 October 2014 | url=https://hpr-rps.hres.ca/reg-content/summary-basis-decision-detailTwo.php?linkID=SBD00418&lang=en | access-date=29 May 2022 | archive-date=31 May 2022 | archive-url=https://web.archive.org/web/20220531065149/https://hpr-rps.hres.ca/reg-content/summary-basis-decision-detailTwo.php?linkID=SBD00418&lang=en | url-status=live }}</ref>
| legal_NZ = <!--Class A, B, C -->
| legal_NZ = <!--Class A, B, C -->
| legal_UK = <!-- GSL, P, POM, CD, CD Lic, CD POM, CD No Reg POM, CD (Benz) POM, CD (Anab) POM or CD Inv POM / Class A, B, C -->
| legal_UK = <!-- GSL, P, POM, CD, CD Lic, CD POM, CD No Reg POM, CD (Benz) POM, CD (Anab) POM or CD Inv POM / Class A, B, C -->
| legal_US = Rx-only
| legal_US = Rx-only
| legal_US_comment = <ref name="Veltassa FDA label" />
| legal_EU = Rx-only
| legal_EU_comment = <ref name="Veltassa EPAR" />
| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV-->
| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV-->
| legal_status =
| legal_status =

⚫
| routes_of_administration = By mouth ([[suspension (chemistry)|suspension]])
<!-- Pharmacokinetic data -->
<!-- Pharmacokinetic data -->
| bioavailability = Not absorbed
| bioavailability = Not absorbed
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| duration_of_action = 24 hrs
| duration_of_action = 24 hrs
| excretion = Feces
| excretion = Feces

<!-- Identifiers -->
<!-- Identifiers -->
| index2_label = Calcium salt
⚫
| CAS_number = 1260643-52-4
| CAS_number_Ref = {{cascite|correct|CAS}}
| CAS_supplemental = <br/>{{CAS|1208912-84-8}} (calcium salt)
⚫
| CAS_number = 1260643-52-4
⚫
| ATCvet =
| CAS_number2_Ref = {{cascite|correct|CAS}}
| ATC_prefix = V03
| CAS_number2 = 1208912-84-8
⚫
| ATC_suffix = AE09
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = 1FQ2RY5YHH
| PubChemSubstance = 135626866
| PubChemSubstance = 135626866
| DrugBank = DB09263
| DrugBank = DB09263
| UNII = 1FQ2RY5YHH
| ChemSpiderID = None
⚫
| ChEMBL = 2107875
| KEGG = D10148
| KEGG = D10148
⚫
| KEGG2 = D11037
⚫
| ChEMBL = 2107875
| synonyms = RLY5016
| synonyms = RLY5016

| ChemSpiderID = None
<!-- Chemical data -->
<!-- Chemical data -->
| chemical_formula = [(C<sub>3</sub>H<sub>3</sub>FO<sub>2</sub>)<sub>182</sub>·(C<sub>10</sub>H<sub>10</sub>)<sub>8</sub>·(C<sub>8</sub>H<sub>14</sub>)<sub>10</sub>]<sub>n</sub><br/>
| chemical_formula = [(C<sub>3</sub>H<sub>3</sub>FO<sub>2</sub>)<sub>182</sub>·(C<sub>10</sub>H<sub>10</sub>)<sub>8</sub>·(C<sub>8</sub>H<sub>14</sub>)<sub>10</sub>]<sub>n</sub><br />
[Ca<sub>91</sub>(C<sub>3</sub>H<sub>2</sub>FO<sub>2</sub>)<sub>182</sub>·(C<sub>10</sub>H<sub>10</sub>)<sub>8</sub>·(C<sub>8</sub>H<sub>14</sub>)<sub>10</sub>]<sub>n</sub> (calcium salt)
[Ca<sub>91</sub>(C<sub>3</sub>H<sub>2</sub>FO<sub>2</sub>)<sub>182</sub>·(C<sub>10</sub>H<sub>10</sub>)<sub>8</sub>·(C<sub>8</sub>H<sub>14</sub>)<sub>10</sub>]<sub>n</sub> (calcium salt)
| molecular_weight =
| molecular_weight =
}}
}}
⚫
'''Patiromer''', sold under the trade name '''Veltassa''', is a medication used to treat [[hyperkalemia|high blood potassium]].<ref name=AHSF2019>{{cite web |title=Patiromer Sorbitex Calcium Monograph for Professionals |url=https://www.drugs.com/monograph/patiromer-sorbitex-calcium.html |website=Drugs.com |accessdate=13 November 2019 |language=en |date=February 2017}}</ref> It is taken by mouth.<ref name=AHSF2019/>


⚫
'''Patiromer''', sold under the brand name '''Veltassa''', is a [[medication]] used to treat [[hyperkalemia|high blood potassium]].<ref name=AHSF2019>{{cite web |title=Patiromer Sorbitex Calcium Monograph for Professionals |url=https://www.drugs.com/monograph/patiromer-sorbitex-calcium.html |website=Drugs.com |access-date=13 November 2019 |date=February 2017 |archive-date=13 November 2019 |archive-url=https://web.archive.org/web/20191113062153/https://www.drugs.com/monograph/patiromer-sorbitex-calcium.html |url-status=live }}</ref> It is taken by mouth.<ref name=AHSF2019/> It works by [[potassium binder|binding potassium]] in the gut.<ref name="Henneman" /><ref name="Veltassa FDA label" />
Common side effects include [[constipation]], [[low blood magnesium]], and abdominal pain.<ref name=AHSF2019/> It works by [[potassium binder|binding potassium]] in the gut.<ref name="Henneman" /><ref name="Drugs.com" /> It was approved for medical use in the United States in 2015.<ref name=AHSF2019/>

Common side effects include [[constipation]], [[low blood magnesium]], and abdominal pain.<ref name=AHSF2019/>

It was approved for medical use in the United States in October 2015,<ref name="Veltassa FDA label" /><ref>{{cite web | title=Veltassa (Patiromer) Powder for Oral Suspension | publisher=U.S. [[Food and Drug Administration]] (FDA) | date=25 November 2015 | url=https://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/205739Orig1s000TOC.cfm | access-date=24 February 2023 | archive-date=4 May 2022 | archive-url=https://web.archive.org/web/20220504130422/https://www.accessdata.fda.gov/drugsatfda_docs/nda/2015/205739Orig1s000TOC.cfm | url-status=live }}</ref><ref name=AHSF2019/><ref name="FDAPress" /> and in the European Union in July 2017.<ref name="Veltassa EPAR" />


==Medical uses==
==Medical uses==
Patiromer is used for the treatment of hyperkalemia, but not as an emergency treatment for life-threatening hyperkalemia, as it acts relatively slowly.<ref name="Drugs.com" /> Such a condition needs [[Hyperkalemia#Treatment|other kinds of treatment]], for example [[calcium]] infusions, [[insulin]] plus [[glucose]] infusions, [[salbutamol]] inhalation, and [[hemodialysis]].<ref name="AHA2010" />
Patiromer is used for the treatment of hyperkalemia, but not as an emergency treatment for life-threatening hyperkalemia, as it acts relatively slowly.<ref name="Veltassa FDA label" /> Such a condition needs [[Hyperkalemia#Treatment|other kinds of treatment]], for example [[calcium]] infusions, [[insulin]] plus [[glucose]] infusions, [[salbutamol]] inhalation, and [[hemodialysis]].<ref name="AHA2010" />


Typical reasons for hyperkalemia are [[chronic kidney disease]] and application of drugs that inhibit the [[renin–angiotensin–aldosterone system]] (RAAS) – e.g. [[ACE inhibitor]]s, [[angiotensin II receptor antagonist]]s, or [[potassium-sparing diuretic]]s – or that interfere with [[kidney|renal]] function in general, such as [[nonsteroidal anti-inflammatory drug]]s (NSAIDs).<ref name="Esteras" /><ref name="Rastegar" />
Typical reasons for hyperkalemia are [[chronic kidney disease]] and application of drugs that inhibit the [[renin–angiotensin–aldosterone system]] (RAAS) – e.g. [[ACE inhibitor]]s, [[angiotensin II receptor antagonist]]s, or [[potassium-sparing diuretic]]s – or that interfere with [[kidney]] function in general, such as [[nonsteroidal anti-inflammatory drug]]s (NSAIDs).<ref name="Esteras" /><ref name="Rastegar" />


==Adverse effects==
==Adverse effects==
Patiromer was generally well tolerated in studies. Side effects that occurred in more than 2% of patients included in [[clinical trial]]s were mainly [[gastro-intestinal]] problems such as constipation, diarrhea, nausea, and [[flatulence]], and also [[hypomagnesemia]] (low levels of [[magnesium]] in the blood) in 5% of patients, because patiromer binds magnesium in the gut as well.<ref name="Drugs.com" /><ref name="Tamargo" />
Patiromer was generally well tolerated in studies. Side effects that occurred in more than 2% of patients included in [[clinical trial]]s were mainly [[gastro-intestinal]] problems such as constipation, diarrhea, nausea, and [[flatulence]], and also [[hypomagnesemia]] (low levels of [[magnesium]] in the blood) in 5% of patients, because patiromer binds magnesium in the gut as well.<ref name="Veltassa FDA label" /><ref name="Tamargo" />


==Interactions==
== Interactions ==
⚫
Patiromer was tested for drug-drug interactions with 28 drugs and showed binding or interaction with 14 of these drugs. This could reduce their availability and thus effectiveness,<ref name="Drugs.com" /> wherefore patiromer has received a [[boxed warning]] by the US [[Food and Drug Administration]] (FDA), telling patients to wait for at least six hours between taking patiromer and any other oral drugs.<ref name="FDAPress" />


⚫
Patiromer was tested for drug-drug interactions with 28 drugs and showed binding or interaction with 14 of these drugs. This could reduce their availability and thus effectiveness,<ref name="Veltassa FDA label" /> wherefore patiromer has received a [[boxed warning]] by the US [[Food and Drug Administration]] (FDA), telling patients to wait for at least six hours between taking patiromer and any other oral drugs.<ref name="FDAPress" />
⚫
Of the 14 drugs that did show an interaction in vitro, 12 were selected for further testing in phase 1 studies in healthy volunteers to assess whether the results seen in vitro translated into an effect in people. These studies showed patiromer did not alter the absorption of nine of the 12 drugs when co-administered. Patiromer reduced absorption of three drugs when co-administered, however, there was no interaction when patiromer and these three drugs were taken 3 hours apart.<ref name="Pharmabiz" />


⚫
Of the 14 drugs that did show an interaction in vitro, 12 were selected for further testing in phase 1 studies in healthy volunteers to assess whether the results seen in vitro translated into an effect in people. These studies showed patiromer did not alter the absorption of nine of the 12 drugs when co-administered. Patiromer reduced absorption of three drugs when co-administered, however, there was no interaction when patiromer and these three drugs were taken 3 hours apart.<ref name="Pharmabiz" />
⚫
This information was submitted to the FDA in the form of a supplemental New Drug Application (sNDA) and as a result, in November 2016 the FDA approved the removal of the [[boxed warning]] regarding the separation of patiromer and other oral medications. The updated label recommends patients take patiromer at least 3 hours before or 3 hours after other oral medications.<ref name="FDA Package Insert" />

⚫
This information was submitted to the FDA in the form of a supplemental New Drug Application (sNDA) and as a result, in November 2016 the FDA approved the removal of the [[boxed warning]] regarding the separation of patiromer and other oral medications. The updated label recommends patients take patiromer at least three hours before or three hours after other oral medications.<ref name="Veltassa FDA label" />


==Pharmacology==
==Pharmacology==


===Mechanism of action===
===Mechanism of action===
Patiromer works by binding free potassium ions in the gastrointestinal tract and releasing calcium ions for exchange, thus lowering the amount of potassium available for absorption into the bloodstream and increasing the amount that is excreted via the [[feces]]. The net effect is a reduction of potassium levels in the [[blood serum]].<ref name="Drugs.com" /><ref name="Esteras" />
Patiromer works by binding free potassium ions in the gastrointestinal tract and releasing calcium ions for exchange, thus lowering the amount of potassium available for absorption into the bloodstream and increasing the amount that is excreted via the [[feces]]. The net effect is a reduction of potassium levels in the [[blood serum]].<ref name="Veltassa FDA label" /><ref name="Esteras" />


Lowering of potassium levels is detectable 7 hours after administration. Levels continue to decrease for at least 48 hours if treatment is continued, and remain stable for 24 hours after administration of the last dose. After this, potassium levels start to rise again over a period of at least four days.<ref name="Drugs.com" />
Lowering of potassium levels is detectable seven hours after administration. Levels continue to decrease for at least 48 hours if treatment is continued, and remain stable for 24 hours after administration of the last dose. After this, potassium levels start to rise again over a period of at least four days.<ref name="Veltassa FDA label" />


===Pharmacokinetics===
===Pharmacokinetics===
Patiromer is not absorbed from the gut, is not [[metabolize]]d, and is excreted in unchanged form with the feces.<ref name="Drugs.com" />
Patiromer is not absorbed from the gut, is not [[metabolize]]d, and is excreted in unchanged form with the feces.<ref name="Veltassa FDA label" />


==Chemistry==
==Chemistry==
The substance is a cross-linked [[polymer]] of 2-fluoro[[acrylic acid]] with [[divinylbenzene]]s and 1,7-[[octadiene]]. It is used in form of its [[calcium]] salt (ratio 2:1) and with [[sorbitol]] (one molecule per two calcium ions or four fluoroacrylic acid units), a combination called ''patiromer sorbitex calcium''.<ref name="rxlist" />
The substance is a cross-linked [[polymer]] of 2-fluoro[[acrylic acid]] with [[divinylbenzene]]s and 1,7-[[octadiene]]. It is used in form of its [[calcium]] salt (ratio 2:1) and with [[sorbitol]] (one molecule per two calcium ions or four fluoroacrylic acid units), a combination called ''patiromer sorbitex calcium''.<ref name="Veltassa FDA label" />
<gallery>
<gallery>
File:2-Fluoroacrylic acid.svg|2-fluoroacrylic acid
File:2-Fluoroacrylic acid.svg|2-fluoroacrylic acid
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</gallery>
</gallery>


Patiromer sorbitex calcium is an off-white to light brown, amorphous, free-flowing powder. It is insoluble in water, 0.1&nbsp;[[molar concentration|M]] [[hydrochloric acid]], [[heptane]], and [[methanol]].<ref name="Drugs.com" /><ref name="rxlist" />
Patiromer sorbitex calcium is an off-white to light brown, amorphous, free-flowing powder. It is insoluble in water, 0.1&nbsp;[[molar concentration|M]] [[hydrochloric acid]], [[heptane]], and [[methanol]].<ref name="Veltassa FDA label" />


==History==
==History==

===Studies===
In a Phase III [[Multicenter trial|multicenter]] clinical trial including 237 patients with hyperkalemia under RAAS inhibitor treatment, 76% of participants reached normal serum potassium levels within four weeks. After subsequent [[randomized experiment|randomization]] of 107 responders into a group receiving continued patiromer treatment and a [[placebo]] group, re-occurrence of hyperkalemia was 15% versus 60%, respectively.<ref name="Weir" />
In a Phase III [[Multicenter trial|multicenter]] clinical trial including 237 patients with hyperkalemia under RAAS inhibitor treatment, 76% of participants reached normal serum potassium levels within four weeks. After subsequent [[randomized experiment|randomization]] of 107 responders into a group receiving continued patiromer treatment and a [[placebo]] group, re-occurrence of hyperkalemia was 15% versus 60%, respectively.<ref name="Weir" />


== Society and culture ==
===Approval===
=== Legal status ===
The US FDA approved patiromer in October 2015.<ref name="FDAPress" /> It was approved in Europe in 2017.
The US FDA approved patiromer in October 2015.<ref name="FDAPress" /> It was approved for use in the European Union in July 2017.<ref name="Veltassa EPAR">{{cite web | title=Veltassa EPAR | website=[[European Medicines Agency]] (EMA) | date=17 September 2018 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/veltassa | access-date=18 October 2020 | archive-date=21 October 2020 | archive-url=https://web.archive.org/web/20201021163527/https://www.ema.europa.eu/en/medicines/human/EPAR/veltassa | url-status=live }}</ref>

==See also==
* [[Sodium zirconium cyclosilicate]], another potassium binder

⚫
==References==
⚫
{{reflist|30em|refs=
<ref name="Drugs.com">{{drugs.com|pro|veltassa}} for Veltassa.</ref>
⚫
<ref name="Esteras">{{cite journal|doi=10.1177/2042098615589905|pmid=26301070|title=Combination use of medicines from two classes of renin-angiotensin system blocking agents: Risk of hyperkalemia, hypotension, and impaired renal function|journal=Therapeutic Advances in Drug Safety|volume=6|issue=4|pages=166–76|year=2015|last1=Esteras|first1=R.|last2=Perez-Gomez|first2=M. V.|last3=Rodriguez-Osorio|first3=L.|last4=Ortiz|first4=A.|last5=Fernandez-Fernandez|first5=B.|pmc=4530349}}</ref>
⚫
<ref name="Henneman">{{cite journal|pmid=26721532|year=2016|last1=Henneman|first1=A|title=Emerging therapies for the management of chronic hyperkalemia in the ambulatory care setting|journal=American Journal of Health-System Pharmacy|volume=73|issue=2|pages=33–44|last2=Guirguis|first2=E|last3=Grace|first3=Y|last4=Patel|first4=D|last5=Shah|first5=B|doi=10.2146/ajhp150457}}</ref>
⚫
<ref name="AHA2010">{{cite journal | author = Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, Gabrielli A | title = Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | journal = Circulation | volume = 122 | issue = 18 Suppl 3 | pages = S829–61 | date = 2010-11-02 | pmid = 20956228 | doi = 10.1161/CIRCULATIONAHA.110.971069 | last2 = Morrison | last3 = Shuster | last4 = Donnino | last5 = Sinz | last6 = Lavonas | last7 = Jeejeebhoy | last8 = Gabrielli }}</ref>
⚫
<ref name="Rastegar">{{cite journal|doi=10.1136/pmj.77.914.759|pmid=11723313|pmc=1742191|title=Hypokalaemia and hyperkalaemia|journal=Postgraduate Medical Journal|volume=77|issue=914|pages=759–64|year=2001|last1=Rastegar|first1=A|last2=Soleimani|first2=M}}</ref>
⚫
<ref name="FDAPress">{{cite news|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm468546.htm|title=FDA approves new drug to treat hyperkalemia|publisher=FDA|date=21 October 2015}}</ref>
<ref name="rxlist">RxList: [http://www.rxlist.com/veltassa-drug.htm Veltassa].</ref>
⚫
<ref name="Tamargo">{{cite journal|pmid=25425465|year=2014|last1=Tamargo|first1=J|title=New drugs for the treatment of hyperkalemia in patients treated with renin-angiotensin-aldosterone system inhibitors -- hype or hope?|journal=Discovery Medicine|volume=18|issue=100|pages=249–54|last2=Caballero|first2=R|last3=Delpón|first3=E}}</ref>
<ref name="Weir">{{cite journal|doi=10.1056/NEJMoa1410853|pmid=25415805|title=Patiromer in Patients with Kidney Disease and Hyperkalemia Receiving RAAS Inhibitors|journal=New England Journal of Medicine|volume=372|issue=3|pages=211–21|year=2015|last1=Weir|first1=Matthew R.|last2=Bakris|first2=George L.|last3=Bushinsky|first3=David A.|last4=Mayo|first4=Martha R.|last5=Garza|first5=Dahlia|last6=Stasiv|first6=Yuri|last7=Wittes|first7=Janet|author7-link=Janet Wittes|last8=Christ-Schmidt|first8=Heidi|last9=Berman|first9=Lance|last10=Pitt|first10=Bertram|url=https://semanticscholar.org/paper/691d0913e0cc89b0b62fe3bbb6729790176532dc}}</ref>
⚫
<ref name="Pharmabiz">Pharmabiz: [http://www.pharmabiz.com/NewsDetails.aspx?aid=98980&sid=2 US FDA approves removal of boxed warning on Relypsa's hyperkalemia drug, Veltassa].</ref>
<ref name="FDA Package Insert">FDA Package Insert: [http://www.accessdata.fda.gov/drugsatfda_docs/label/2016/205739s009lbl.pdf VELTASSA (patiromer) for oral suspension].</ref>


⚫
== References ==
⚫
{{reflist|refs=
⚫
<ref name="Esteras">{{cite journal | vauthors = Esteras R, Perez-Gomez MV, Rodriguez-Osorio L, Ortiz A, Fernandez-Fernandez B | title = Combination use of medicines from two classes of renin-angiotensin system blocking agents: risk of hyperkalemia, hypotension, and impaired renal function | journal = Therapeutic Advances in Drug Safety | volume = 6 | issue = 4 | pages = 166–176 | date = August 2015 | pmid = 26301070 | pmc = 4530349 | doi = 10.1177/2042098615589905 }}</ref>
⚫
<ref name="Henneman">{{cite journal | vauthors = Henneman A, Guirguis E, Grace Y, Patel D, Shah B | title = Emerging therapies for the management of chronic hyperkalemia in the ambulatory care setting | journal = American Journal of Health-System Pharmacy | volume = 73 | issue = 2 | pages = 33–44 | date = January 2016 | pmid = 26721532 | doi = 10.2146/ajhp150457 }}</ref>
⚫
<ref name="AHA2010">{{cite journal | vauthors = Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, Jeejeebhoy FM, Gabrielli A | display-authors = 6 | title = Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care | journal = Circulation | volume = 122 | issue = 18 Suppl 3 | pages = S829-861 | date = November 2010 | pmid = 20956228 | doi = 10.1161/CIRCULATIONAHA.110.971069 | doi-access = free | title-link = doi }}</ref>
⚫
<ref name="Rastegar">{{cite journal | vauthors = Rastegar A, Soleimani M, Rastergar A | title = Hypokalaemia and hyperkalaemia | journal = Postgraduate Medical Journal | volume = 77 | issue = 914 | pages = 759–764 | date = December 2001 | pmid = 11723313 | pmc = 1742191 | doi = 10.1136/pmj.77.914.759 }}</ref>
⚫
<ref name="FDAPress">{{cite press release|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm468546.htm|title=FDA approves new drug to treat hyperkalemia|publisher=U.S. [[Food and Drug Administration]] (FDA)|date=21 October 2015|access-date=24 February 2023|archive-date=7 November 2015|archive-url=https://web.archive.org/web/20151107235654/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm468546.htm|url-status=dead}}</ref>
⚫
<ref name="Tamargo">{{cite journal | vauthors = Tamargo J, Caballero R, Delpón E | title = New drugs for the treatment of hyperkalemia in patients treated with renin-angiotensin-aldosterone system inhibitors -- hype or hope? | journal = Discovery Medicine | volume = 18 | issue = 100 | pages = 249–254 | date = November 2014 | pmid = 25425465 }}</ref>
<ref name="Weir">{{cite journal | vauthors = Weir MR, Bakris GL, Bushinsky DA, Mayo MR, Garza D, Stasiv Y, Wittes J, Christ-Schmidt H, Berman L, Pitt B | s2cid = 205097243 | display-authors = 6 | title = Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors | journal = The New England Journal of Medicine | volume = 372 | issue = 3 | pages = 211–221 | date = January 2015 | pmid = 25415805 | doi = 10.1056/NEJMoa1410853 | author7-link = Janet Wittes | doi-access = free | title-link = doi }}</ref>
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<ref name="Pharmabiz">Pharmabiz: [http://www.pharmabiz.com/NewsDetails.aspx?aid=98980&sid=2 US FDA approves removal of boxed warning on Relypsa's hyperkalemia drug, Veltassa] {{Webarchive|url=https://web.archive.org/web/20161221154155/http://www.pharmabiz.com/NewsDetails.aspx?aid=98980&sid=2 |date=21 December 2016 }}.</ref>
<ref name="Veltassa FDA label">{{cite web | title=Veltassa- patiromer powder, for suspension | website=DailyMed | date=23 October 2019 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bf002984-d6c9-46df-aecb-a07733f763c1 | access-date=18 October 2020 | archive-date=20 October 2020 | archive-url=https://web.archive.org/web/20201020144519/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=bf002984-d6c9-46df-aecb-a07733f763c1 | url-status=live }}</ref>
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{{Drugs for treatment of hyperkalemia and hyperphosphatemia}}
{{Drugs for treatment of hyperkalemia and hyperphosphatemia}}
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[[Category:Nephrology procedures]]
[[Category:Nephrology procedures]]

Latest revision as of 03:18, 31 March 2024

Patiromer
Clinical data
Trade namesVeltassa
Other namesRLY5016
AHFS/Drugs.comMonograph
MedlinePlusa616012
License data
Pregnancy
category
  • AU: B1
Routes of
administration		By mouth
ATC code
Legal status
Legal status
Pharmacokinetic data
BioavailabilityNot absorbed
MetabolismNone
Onset of action7 hrs
Duration of action24 hrs
ExcretionFeces
Identifiers
CAS Number
PubChem SID
DrugBank
ChemSpider
  • None
UNII
KEGG
ChEMBL
Chemical and physical data
Formula[(C3H3FO2)182·(C10H10)8·(C8H14)10]n
[Ca91(C3H2FO2)182·(C10H10)8·(C8H14)10]n (calcium salt)

Patiromer, sold under the brand name Veltassa, is a medication used to treat high blood potassium.[6] It is taken by mouth.[6] It works by binding potassium in the gut.[7][4]

Common side effects include constipation, low blood magnesium, and abdominal pain.[6]

It was approved for medical use in the United States in October 2015,[4][8][6][9] and in the European Union in July 2017.[5]

Medical uses[edit]

Patiromer is used for the treatment of hyperkalemia, but not as an emergency treatment for life-threatening hyperkalemia, as it acts relatively slowly.[4] Such a condition needs other kinds of treatment, for example calcium infusions, insulin plus glucose infusions, salbutamol inhalation, and hemodialysis.[10]

Typical reasons for hyperkalemia are chronic kidney disease and application of drugs that inhibit the renin–angiotensin–aldosterone system (RAAS) – e.g. ACE inhibitors, angiotensin II receptor antagonists, or potassium-sparing diuretics – or that interfere with kidney function in general, such as nonsteroidal anti-inflammatory drugs (NSAIDs).[11][12]

Adverse effects[edit]

Patiromer was generally well tolerated in studies. Side effects that occurred in more than 2% of patients included in clinical trials were mainly gastro-intestinal problems such as constipation, diarrhea, nausea, and flatulence, and also hypomagnesemia (low levels of magnesium in the blood) in 5% of patients, because patiromer binds magnesium in the gut as well.[4][13]

Interactions[edit]

Patiromer was tested for drug-drug interactions with 28 drugs and showed binding or interaction with 14 of these drugs. This could reduce their availability and thus effectiveness,[4] wherefore patiromer has received a boxed warning by the US Food and Drug Administration (FDA), telling patients to wait for at least six hours between taking patiromer and any other oral drugs.[9]

Of the 14 drugs that did show an interaction in vitro, 12 were selected for further testing in phase 1 studies in healthy volunteers to assess whether the results seen in vitro translated into an effect in people. These studies showed patiromer did not alter the absorption of nine of the 12 drugs when co-administered. Patiromer reduced absorption of three drugs when co-administered, however, there was no interaction when patiromer and these three drugs were taken 3 hours apart.[14]

This information was submitted to the FDA in the form of a supplemental New Drug Application (sNDA) and as a result, in November 2016 the FDA approved the removal of the boxed warning regarding the separation of patiromer and other oral medications. The updated label recommends patients take patiromer at least three hours before or three hours after other oral medications.[4]

Pharmacology[edit]

Mechanism of action[edit]

Patiromer works by binding free potassium ions in the gastrointestinal tract and releasing calcium ions for exchange, thus lowering the amount of potassium available for absorption into the bloodstream and increasing the amount that is excreted via the feces. The net effect is a reduction of potassium levels in the blood serum.[4][11]

Lowering of potassium levels is detectable seven hours after administration. Levels continue to decrease for at least 48 hours if treatment is continued, and remain stable for 24 hours after administration of the last dose. After this, potassium levels start to rise again over a period of at least four days.[4]

Pharmacokinetics[edit]

Patiromer is not absorbed from the gut, is not metabolized, and is excreted in unchanged form with the feces.[4]

Chemistry[edit]

The substance is a cross-linked polymer of 2-fluoroacrylic acid with divinylbenzenes and 1,7-octadiene. It is used in form of its calcium salt (ratio 2:1) and with sorbitol (one molecule per two calcium ions or four fluoroacrylic acid units), a combination called patiromer sorbitex calcium.[4]

  • 2-fluoroacrylic acid
    2-fluoroacrylic acid
  • o-divinylbenzene
    o-divinylbenzene
  • p-divinylbenzene
    p-divinylbenzene
  • 1,7-octadiene
    1,7-octadiene

Patiromer sorbitex calcium is an off-white to light brown, amorphous, free-flowing powder. It is insoluble in water, 0.1 M hydrochloric acid, heptane, and methanol.[4]

History[edit]

In a Phase III multicenter clinical trial including 237 patients with hyperkalemia under RAAS inhibitor treatment, 76% of participants reached normal serum potassium levels within four weeks. After subsequent randomization of 107 responders into a group receiving continued patiromer treatment and a placebo group, re-occurrence of hyperkalemia was 15% versus 60%, respectively.[15]

Society and culture[edit]

Legal status[edit]

The US FDA approved patiromer in October 2015.[9] It was approved for use in the European Union in July 2017.[5]

References[edit]

  1. ^ "Prescription medicines: registration of new chemical entities in Australia, 2017". Therapeutic Goods Administration (TGA). 21 June 2022. Retrieved 9 April 2023.
  2. ^ "Prescription medicines and biologicals: TGA annual summary 2017". Therapeutic Goods Administration (TGA). 21 June 2022. Retrieved 31 March 2024.
  3. ^ "Summary Basis of Decision (SBD) for Veltassa". Health Canada. 23 October 2014. Archived from the original on 31 May 2022. Retrieved 29 May 2022.
  4. ^ a b c d e f g h i j k l "Veltassa- patiromer powder, for suspension". DailyMed. 23 October 2019. Archived from the original on 20 October 2020. Retrieved 18 October 2020.
  5. ^ a b c "Veltassa EPAR". European Medicines Agency (EMA). 17 September 2018. Archived from the original on 21 October 2020. Retrieved 18 October 2020.
  6. ^ a b c d "Patiromer Sorbitex Calcium Monograph for Professionals". Drugs.com. February 2017. Archived from the original on 13 November 2019. Retrieved 13 November 2019.
  7. ^ Henneman A, Guirguis E, Grace Y, Patel D, Shah B (January 2016). "Emerging therapies for the management of chronic hyperkalemia in the ambulatory care setting". American Journal of Health-System Pharmacy. 73 (2): 33–44. doi:10.2146/ajhp150457. PMID 26721532.
  8. ^ "Veltassa (Patiromer) Powder for Oral Suspension". U.S. Food and Drug Administration (FDA). 25 November 2015. Archived from the original on 4 May 2022. Retrieved 24 February 2023.
  9. ^ a b c "FDA approves new drug to treat hyperkalemia" (Press release). U.S. Food and Drug Administration (FDA). 21 October 2015. Archived from the original on 7 November 2015. Retrieved 24 February 2023.
  10. ^ Vanden Hoek TL, Morrison LJ, Shuster M, Donnino M, Sinz E, Lavonas EJ, et al. (November 2010). "Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S829-861. doi:10.1161/CIRCULATIONAHA.110.971069. PMID 20956228.
  11. ^ a b Esteras R, Perez-Gomez MV, Rodriguez-Osorio L, Ortiz A, Fernandez-Fernandez B (August 2015). "Combination use of medicines from two classes of renin-angiotensin system blocking agents: risk of hyperkalemia, hypotension, and impaired renal function". Therapeutic Advances in Drug Safety. 6 (4): 166–176. doi:10.1177/2042098615589905. PMC 4530349. PMID 26301070.
  12. ^ Rastegar A, Soleimani M, Rastergar A (December 2001). "Hypokalaemia and hyperkalaemia". Postgraduate Medical Journal. 77 (914): 759–764. doi:10.1136/pmj.77.914.759. PMC 1742191. PMID 11723313.
  13. ^ Tamargo J, Caballero R, Delpón E (November 2014). "New drugs for the treatment of hyperkalemia in patients treated with renin-angiotensin-aldosterone system inhibitors -- hype or hope?". Discovery Medicine. 18 (100): 249–254. PMID 25425465.
  14. ^ Pharmabiz: US FDA approves removal of boxed warning on Relypsa's hyperkalemia drug, Veltassa Archived 21 December 2016 at the Wayback Machine.
  15. ^ Weir MR, Bakris GL, Bushinsky DA, Mayo MR, Garza D, Stasiv Y, et al. (January 2015). "Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors". The New England Journal of Medicine. 372 (3): 211–221. doi:10.1056/NEJMoa1410853. PMID 25415805. S2CID 205097243.
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