Compatibility study of patiromer with juices/liquids and soft foods

Patiromer powder for oral suspension (patiromer o.s.) is a once-daily, potassium (K + ) binder approved for the treatment of hyperkalemia. It is known that patiromer o.s. can be mixed with water, apple juice, or cranberry juice. This in vitro study assessed whether mixing patiromer o.s. with a variety of other liquids and soft foods would affect the total K + -exchange capacity (TKEC) of patiromer. Juices (grape, orange, pear, or pineapple), nectars (apricot or peach), and other liquids/soft foods (milk, thickener, apple sauce, chocolate pudding, vanilla pudding, or yoghurt) were assessed for compatibility with patiromer o.s. at low and high ratio levels, equivalent to patiromer active moiety doses of 8.4 g and 25.2 g per 80 mL (1/3 cup), respectively. Mixtures were stirred, rested for 45 min, diluted with water, and centrifuged. Residues were washed, vacuum filtered, and dried. TKEC of the residue was evaluated; the prespecified acceptance criterion for patiromer was 8.4–10.0 mmol/g. Mean TKECs of the patiromer in juices/nectars were 8.7–8.9 mmol/g for the low ratio and 8.5–8.6 mmol/g for the high ratio. For other liquids/soft foods, the mean TKEC for patiromer at low and high ratios was 8.5–8.7 mmol/g. All tested vehicles were within the prespecified range. Mixing of patiromer o.s. with juices/liquids and soft foods does not adversely affect the K + -binding capability of patiromer. Use of different vehicles for suspending patiromer o.s. may help with its palatability, enhance patient experience, and reduce nonadherence. Graphical Abstract The potassium binder, patiromer powder for oral suspension, can be mixed with water, juices (apple, cranberry, grape, orange, pear, or pineapple), nectar (apricot or peach), other liquids (milk or thickener), and soft foods (apple sauce, chocolate or vanilla pudding, or yoghurt) for the treatment of hyperkalemia.