Sodium Polystyrene Sulfonate and Breastfeeding

Summary of use during lactation

Because sodium polystyrene sulfonate is not orally absorbed, it is unlikely to reach the breastmilk or adversely affect the breastfed infant after maternal administration. No special precautions are required. A suspension of sodium polystyrene sulfonate has been added directly to breastmilk to lower the potassium concentration of milk for use in infants with renal impairment. In addition to lowering average potassium content by 65%, the calcium content of breastmilk was reduced by 84%.[1] Infants given either expressed breastmilk, formula or a combination of both had their average serum potassium levels decreased by 24% from 6.3 to 4.8 mEq/L. Serum calcium and creatinine also decreased slightly. The infants had no clinically noticeable side effects.[2] Addition of large amounts of sodium polystyrene sulfonate to artificial formula also lowers the calcium, copper, manganese, phosphorus, sulfur and zinc concentrations; whereas the iron, sodium and sulfur content of formulas are increased.[3] Similar changes might occur with breastmilk.

Drug levels in milk and infant serum

### Summary of Use during Lactation Because sodium polystyrene sulfonate is not orally absorbed, it is unlikely to reach the breastmilk or adversely affect the breastfed infant after maternal administration. No special precautions are required. A suspension of sodium polystyrene sulfonate has been added directly to breastmilk to lower the potassium concentration of milk for use in infants with renal impairment. In addition to lowering average potassium content by 65%, the calcium content of breastmilk was reduced by 84%.[1] Infants given either expressed breastmilk, formula or a combination of both had their average serum potassium levels decreased by 24% from 6.3 to 4.8 mEq/L. Serum calcium and creatinine also decreased slightly. The infants had no clinically noticeable side effects.[2] Addition of large amounts of sodium polystyrene sulfonate to artificial formula also lowers the calcium, copper, manganese, phosphorus, sulfur and zinc concentrations; whereas the iron, sodium and sulfur content of formulas are increased.[3] Similar changes might occur with breastmilk. ### Effects in Breastfed Infants Relevant published information was not found as of the revision date. ### Effects on Lactation and Breastmilk Relevant published information was not found as of the revision date. ### Alternate Drugs to Consider Patiromer ### References

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

Alternative drugs to consider

Patiromer

References

1. BonnetL GoudableJ AccominottiM [Effect of polystyrene sulfonate resins on milk ionic concentration] Nephrologie 1997 18 287 9 9496569 PubMed
2. ThompsonK FlynnJ OkamuraD Pretreatment of formula or expressed breast milk with sodium polystyrene sulfonate (Kayexalate(R)) as a treatment for hyperkalemia in infants with acute or chronic renal insufficiency. J Ren Nutr 2013 23 333 9 23707305 PubMed
3. TaylorJM OladitanL CarlsonS Renal formulas pretreated with medications alters the nutrient profile. Pediatr Nephrol 2015 30 1815 23 25930981 PubMed