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Sodium polystyrene sulfonate

Classification: B

Drug products: Resonium

ATC code: V03AE01

Substances: sodium polystyrene sulfonate


Published controlled studies on differences between men and women regarding the efficacy, safety and pharmacokinetics of sodium polystyrene sulfonate are lacking.

Additional information

Sodium polystyrene sulfonate was approved by the FDA in the 1950s and the required documentation regarding effect and safety, not to mention sex differences, at that time was limited [1].

Pharmacokinetics and dosing

No studies on sex differences in pharmacokinetic properties have been identified. The dosing of sodium polystyrene sulfonate is based on levels of elevated S-potassium.


Although participants of both sexes have been included in most studies on sodium polystyrene sulfonate [2, 3], few report sex divided results and we have not identified any studies providing sex divided analysis. Re-analysis of data reported from two retrospective studies do not indicate any obvious sex-differences [4, 5]. In a retrospective cohort study of successful treatment of lithium toxicity (6 men, 6 women) potassium and lithium were found to be lowered after administration of sodium polystyrene sulfonate in both the men and women included in the study. Potassium was lowered 0.8±0.6 and 0.4±0.6 mmol/L in men and women, respectively and percentage estimated total body lithium was lowered with 15.9±8.5% and 14.8±10.1% in men and women, respectively [4]. In another retrospective cohort study of infants with hyperkalemia (10 boys, 3 girls) potassium was lowered with 1.4±0.5 mEq/L and 1.7±0.3 mEq/L in boys and girls, respectively [5].

Adverse effects

In a systematic review of case series and case reports of possible severe gastrointestinal adverse events associated with sodium polystyrene sulfonate, with and without sorbitol use, 58 cases were identified (29 men, 29 women). The study found chronic dose and cardiovascular morbidity to be associated with an increased risk. No difference in risk of gastrointestinal adverse events between men and women was found [6].

Reproductive health issues

Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).

Updated: 2020-08-28

Date of litterature search: 2016-12-16


  1. Sterns RH, Grieff M, Bernstein PL. Treatment of hyperkalemia: something old, something new. Kidney Int. 2016;89:546-54. PubMed
  2. Lepage L, Dufour AC, Doiron J, Handfield K, Desforges K, Bell R et al. Randomized Clinical Trial of Sodium Polystyrene Sulfonate for the Treatment of Mild Hyperkalemia in CKD. Clin J Am Soc Nephrol. 2015;10:2136-42. PubMed
  3. Chernin G, Gal-Oz A, Ben-Assa E, Schwartz IF, Weinstein T, Schwartz D et al. Secondary prevention of hyperkalemia with sodium polystyrene sulfonate in cardiac and kidney patients on renin-angiotensin-aldosterone system inhibition therapy. Clin Cardiol. 2012;35:32-6. PubMed
  4. Ghannoum M, Lavergne V, Yue CS, Ayoub P, Perreault MM, Roy L. Successful treatment of lithium toxicity with sodium polystyrene sulfonate: a retrospective cohort study. Clin Toxicol (Phila). 2010;48:34-41. PubMed
  5. Thompson K, Flynn J, Okamura D, Zhou L. Pretreatment of formula or expressed breast milk with sodium polystyrene sulfonate (Kayexalate(®)) as a treatment for hyperkalemia in infants with acute or chronic renal insufficiency. J Ren Nutr. 2013;23:333-9. PubMed
  6. Harel Z, Harel S, Shah PS, Wald R, Perl J, Bell CM. Gastrointestinal adverse events with sodium polystyrene sulfonate (Kayexalate) use: a systematic review. Am J Med. 2013;126:264e9-24. PubMed
  7. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2015 [cited 2016-12-19.] Socialstyrelsens statistikdatabas

Authors: Mia von Euler, Linnéa Karlsson Lind

Reviewed by: Mia von Euler

Approved by: Karin Schenck-Gustafsson