The US FDA has approved the cation chelator sodium zirconium cyclosilicate (ZS-9, Lokelma®) for the treatment of hyperkalemia.

Sodium Zirconium Cyclosilicate

  • Oral potassium cation-exchange agent, not systemically absorbed
  • Onset of action 1 hour, median 2.2 hours until normokalemic
  • Not approved for life-threatening potassium elevations at this time
  • Daily dosing for 1 year twice as likely as placebo to maintain normokalemia
  • Most common adverse effects: GI distress, hypokalemia, UTI, edema
  • Adverse effects less frequent than patiromer (alternative chelating agent for hyperkalemia)

The US FDA has approved the alpha-adrenergic agonist lofexidine HCl (Lucemyra®) for the treatment of opioid withdrawal symptoms.

Key Points

  • First non-opioid approved for treating opioid withdrawal symptoms
  • Approved for up to 14 days after discontinuation of opioids
  • Alpha-2 adrenergic agonist, suppresses sympathetic outflow
  • Originally developed in 1980s for management of hypertension
  • Most common side effects: hypotension, bradycardia, sedation and dizziness
  • Alternative treatments for opioid withdrawal: gradual opioid dose taper, switch to less addictive opioids (e.g., methadone, buprenorphine), use opioid receptor antagonists (naltrexone)


Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used in the treatment of hypertension and congestive heart failure.  It acts by inhibiting the conversion of angiotensin I to angiotensin II, lowering serum levels of the vasopressor hormone angiotenin II.  Decreased angiotensin II receptor stimulation also decreases adrenal secretion of aldosterone. 


Key Points

  • Clopidogrel + aspirin lower risk of major ischemic events (stroke, MI, vascular) relative to aspirin alone following minor stroke or high-risk TIA
  • Most risk reduction during first 30 days
  • More frequent serious bleeding events on dual therapy, although primarily gastrointestinal/systemic rather than intracerebral
  • Dual therapy benefit may outweigh risks in first 30 days after minor stroke/TIA

The US FDA has approved the first epoetin alfa biosimilar drug, Retacrit, (epoetin alfa – epbx) for the treatment of anemia.

Key Points

  • First biosimilar drug approved for epoetin alfa (Epogen/Procrit), a recombinant human erythropoetin
  • Approved to treat anemia due to CKD, chemotherapy, zidovudine use, or surgical hemorrhage
  • Epogen/Procrit currently accounts for significant % of Medicare spending, weekly treatments can cost $2,000