K-Nor99.934% w/w

K-Nor is a cation-exchange resin indicated for the treatment of hyperkalemia (elevated blood potassium levels), most commonly in patients with chronic kidney disease, including those on dialysis, and in other conditions associated with potassium retention (e.g., certain drug-induced hyperkalemia).

• Established use: Management of hyperkalemia, particularly in patients where sodium restriction is important (e.g., fluid overload, hypertension, heart failure), since K-Nor exchanges calcium rather than sodium for potassium.
• Important limitation: K-Nor has a delayed onset of action and is not suitable as sole therapy for severe or life-threatening hyperkalemia requiring emergency correction (e.g., with ECG changes); it is used as an adjunct once acute measures (insulin/glucose, calcium gluconate, dialysis) have been considered.
• Chronic/maintenance use: May be used for longer-term outpatient control of mild-to-moderate hyperkalemia under physician supervision.

Each unit dose contains Calcium Polystyrene Sulfonate as the active ingredient, available as a powder for oral or rectal suspension.

K-Nor is a synthetic cation-exchange resin that binds potassium ions in the gastrointestinal tract in exchange for calcium ions. It works similarly to sodium polystyrene sulfonate but avoids an added sodium load, which can be advantageous in patients who need to limit sodium intake. It is used to lower elevated serum potassium levels, particularly in patients with chronic kidney disease.

Potassium-binding (cation-exchange) resin; anti-hyperkalemic agent

Calcium Polystyrene Sulfonate is an insoluble ion-exchange resin. As it passes through the gastrointestinal tract, principally in the large intestine, it releases calcium ions and binds potassium ions present in the gut lumen (from dietary intake and gastrointestinal secretions). The potassium-bound resin is then excreted in the feces, resulting in a net reduction of total body and serum potassium.

The exchange capacity is partial and depends on transit time and the presence of other cations. The onset of potassium-lowering effect is gradual (typically hours to a day or more), which distinguishes it from rapid-acting emergency treatments for hyperkalemia.

For oral use, mix the powder with a small amount of water immediately before use (avoid fruit juice). For rectal use, prepare as a suspension for a retention enema, administered by or under the guidance of a healthcare professional. Do not co-administer with sorbitol, or with magnesium/aluminum-containing antacids or laxatives.

K-Nor has clinically significant interactions with the following:

• Sorbitol-containing products: Concurrent use markedly increases the risk of serious, sometimes fatal, intestinal necrosis; sorbitol-containing formulations or co-administration should be avoided, especially in postoperative patients or those with reduced bowel motility.
• Magnesium- or aluminum-containing antacids and laxatives: These can reduce the potassium-binding capacity of K-Nor and lower its efficacy; avoid co-administration or separate dosing as advised by a physician.
• Other oral medications: Because it is a non-selective binding resin, K-Nor may theoretically reduce absorption of other orally administered drugs; when possible, other oral medicines should be given at a different time from K-Nor.
• Calcium-containing products or vitamin D: May increase the risk of hypercalcemia when used together with K-Nor; monitor calcium levels.

Common and serious adverse effects associated with K-Nor include:

• Gastrointestinal: Constipation (common), nausea, vomiting, anorexia, and gastric irritation.
• Serious (rare but important): Intestinal necrosis and gastrointestinal bleeding/perforation, particularly when used with sorbitol or in patients with reduced bowel motility (see Contraindications and Precautions).
• Electrolyte disturbances: Hypercalcemia (due to the calcium-exchange mechanism), hypokalemia (with overcorrection), and hypomagnesemia may occur; regular monitoring is required.
• Other: Fecal impaction, particularly in patients with reduced gastrointestinal motility or dehydration.

Data on the use of K-Nor in pregnancy and lactation are limited. As a resin that acts locally in the gastrointestinal tract with minimal systemic absorption, risk to the fetus or infant is expected to be low; however, K-Nor should be used during pregnancy or breastfeeding only if clearly needed and if the potential benefit justifies the potential risk. A physician should be consulted before use in pregnant or breastfeeding women.

K-Nor should be used with the following precautions:

• Intestinal necrosis: A rare but serious, sometimes fatal, adverse event has been reported, especially with concurrent sorbitol use. Avoid sorbitol-containing formulations, particularly in postoperative patients and those with dysmotility, ileus, or bowel obstruction risk factors.
• Not for emergency correction: Onset of action is not immediate; K-Nor should not be relied upon as sole therapy for severe or life-threatening hyperkalemia requiring urgent treatment.
• Electrolyte monitoring: Regular monitoring of serum potassium, calcium, and other electrolytes is recommended, given the risk of hypokalemia (with overcorrection) and hypercalcemia.
• Bowel function: Ensure adequate bowel function before administration; avoid use in patients at risk of gastrointestinal obstruction and manage constipation promptly if it occurs.
• Drug administration timing: Do not administer with magnesium- or aluminum-containing antacids/laxatives (reduces efficacy); separate timing from other oral drugs where possible.

Overdose or excessive use of K-Nor may result in hypokalemia, hypercalcemia, and severe constipation or intestinal obstruction. If overdose is suspected, seek immediate medical attention or contact emergency services/poison control. Management should be supportive and guided by a healthcare professional, with correction of electrolyte abnormalities and assessment of bowel function as clinically indicated.

Store at room temperature (below 30°C), away from light and moisture. Keep out of reach of children.

Renal impairment: K-Nor is commonly used in patients with renal impairment, including those on dialysis, as this population is at highest risk of hyperkalemia; electrolyte monitoring is essential.

Hepatic impairment: No specific dose adjustment is established; use with routine clinical monitoring.

Elderly: Use with caution due to a higher likelihood of reduced bowel motility and constipation; ensure adequate bowel function is maintained.

Pediatric use: See Pediatric Uses.

Cation-exchange resins; Potassium-binding agents

The safety and efficacy of K-Nor in the pediatric population, other than neonates, have not been well established, and it should be used with caution and physician supervision if considered necessary in children. K-Nor is contraindicated in neonates, particularly premature infants, because of an increased risk of intestinal necrosis, especially when given with sorbitol-containing formulations. Any pediatric use requires careful weight-based dosing, close monitoring of bowel function and electrolytes, and should only be undertaken under specialist medical supervision.