with nonabsorbable cation-donating antacids and laxatives may reduce the resin's potassium exchange capability. nonabsorbable 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. 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 sodium polystyrene sulfonate has been implicated in cases of intestinal necrosis, which may be fatal (see warnings ). lithium sps ® suspension may decrease absorption of lithium. thyroxine sps ® suspension may decrease absorption of thyroxine.

resection, or bowel obstruction). • discontinue use in patients who develop constipation. 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. hypokalemia 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 ). risk of aspiration cases of acute bronchitis or bronchopneumonia caused by inhalation of sodium polystyrene sulfonate particles has been reported. patients with impaired gag reflex, altered level of consciousness, or patients prone to regurgitation may be at increased risk. administer sodium polystyrene sulfonate suspension with the patient in an upright position. binding to other orally administered medications sodium polystyrene sulfonate suspension may bind orally administered medications, which could decrease their gastrointestinal absorption and lead to reduced efficacy. administer other oral medications at least 3 hours before or 3 hours after sodium polystyrene sulfonate suspension. patients with gastroparesis may require a 6 hour separation (see dosage and administration and precautions, drug interactions ).

with a diet appropriate for a patient in renal failure. sps ® 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 knee-chest 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 this cleansing enema, because sorbitol is present in the vehicle. the intensity and duration of therapy depend upon the severity and resistance of hyperkalemia. sps ® suspension should not be heated for to do so may alter the exchange properties of the resin.

• rare cases of acute bronchitis and/or bronchopneumonia associated with inhalation of particles of polystyrene sulfonate (see warnings ). to report suspected adverse reactions, contact cmp pharma, inc., toll free at 1-844-321-1443 or the fda at 1-800-fda-1088 or www.fda.gov/medwatch.

with nonabsorbable cation-donating antacids and laxatives may reduce the resin's potassium exchange capability. nonabsorbable 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. 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 sodium polystyrene sulfonate has been implicated in cases of intestinal necrosis, which may be fatal (see warnings ). lithium sps ® suspension may decrease absorption of lithium. thyroxine sps ® suspension may decrease absorption of thyroxine.