Your Patients Can't Find Sodium Polystyrene Sulfonate — Here's How You Can Help

You've prescribed Sodium Polystyrene Sulfonate (Kayexalate, SPS) for a patient with hyperkalemia, and now your office is fielding calls: "My pharmacy doesn't have it." "They said it's on backorder." "They don't know when it's coming back."

This scenario is playing out in nephrology clinics, emergency departments, and primary care offices across the country. The Sodium Polystyrene Sulfonate suspension has experienced ongoing shortages, and even the powder form can be difficult to locate at certain pharmacies.

This guide provides practical steps your team can take to help patients access their medication — and reduce the administrative burden on your practice in the process.

Current Availability Snapshot

Understanding what's available helps you set patient expectations and choose the right prescribing strategy.

• Powder form (generic): Generally available from manufacturers including ECI Pharmaceuticals, Amneal, and Carolina Medical Products. This is the most reliably stocked formulation.
• Pre-mixed suspension: Limited availability. Hikma Pharmaceuticals is no longer marketing the suspension. Other generic suppliers may produce limited quantities intermittently.
• Brand Kayexalate: Available as a powder but priced higher ($47-$100 vs. $6-$20 generic).

Bottom line: prescribing the powder formulation gives your patients the best chance of finding it in stock.

Why Patients Can't Find It

Several factors converge to make Sodium Polystyrene Sulfonate harder to locate than you might expect for a decades-old generic:

• Manufacturer consolidation: Fewer companies producing SPS means less supply resilience
• Low profit margins: Generic SPS is inexpensive ($6-$20), providing little incentive for new manufacturers to enter the market
• Formulation-specific shortages: Patients prescribed the suspension may not realize the powder is available and equivalent
• Pharmacy ordering patterns: Some pharmacies don't stock SPS routinely because they fill it infrequently — they rely on just-in-time ordering, which fails when supply is tight
• Patient awareness gaps: Many patients don't know they can check multiple pharmacies or switch formulations

What Providers Can Do: 5 Actionable Steps

Step 1: Prescribe the Powder Form by Default

Unless there's a clinical reason for the suspension (e.g., patient cannot prepare the powder at home, rectal administration needed in a non-institutional setting), prescribe Sodium Polystyrene Sulfonate powder as your default. It's more widely available, less expensive, and functionally equivalent.

Ensure your prescription specifies:

• Generic name: Sodium Polystyrene Sulfonate powder for suspension
• Quantity: typically 454 g (a standard container)
• Dosing instructions: e.g., "Mix 15 g (approximately 4 level teaspoons) in water, take by mouth 1-4 times daily as directed"
• "Substitution permitted" to allow any generic manufacturer

Step 2: Direct Patients to Medfinder

Medfinder for Providers is a free tool that lets patients search pharmacy inventory by medication and location. Instead of your staff calling pharmacies on behalf of patients, you can direct them to medfinder.com to check which pharmacies near them have SPS in stock.

Consider adding this to your patient handouts or discharge instructions for any patient prescribed a shortage-affected medication.

Step 3: Educate Patients on Formulation Flexibility

Many patients don't realize that the powder and suspension are the same active medication. When prescribing, take 30 seconds to explain:

• "The powder form is the same medicine — you just mix it with water at home."
• "It may be easier to find and is usually cheaper."
• "Don't mix it with hot liquids or orange juice."

This simple counseling step can prevent a week of phone calls and frustrated patients.

Step 4: Have an Alternatives Strategy Ready

For patients who cannot find any form of SPS, be prepared to prescribe an alternative:

• Patiromer (Veltassa): Calcium-based binder, no risk of colonic necrosis, $600-$900/month. Manufacturer copay card available for commercially insured patients.
• Sodium Zirconium Cyclosilicate (Lokelma): Faster onset, selective for potassium, $500-$800/month. AstraZeneca patient support available.
• Loop diuretics (Furosemide): Adjunctive option for patients with adequate renal function, very affordable ($4-$10/month).

Document SPS unavailability in the patient chart — this supports prior authorization requests for the more expensive alternatives. For a detailed comparison, refer to our clinical overview: Sodium Polystyrene Sulfonate Shortage: What Prescribers Need to Know.

Step 5: Engage Your Pharmacy Network

Build relationships with pharmacies that reliably stock SPS:

• Identify 2-3 pharmacies in your area that carry the powder consistently
• Include independent pharmacies — they often have better access to certain generics
• For institutional settings, work with your pharmacy department to maintain adequate stock and identify backup suppliers
• Encourage pharmacies to use allocation wisely and order proactively for known patients

Alternatives at a Glance

Here's a quick-reference comparison to share with your team:

• SPS Powder: $6-$20 | Onset 2-24 hrs | Non-selective | GI risks including colonic necrosis (rare) | No PA typically needed
• Patiromer (Veltassa): $600-$900/mo | Onset 4-7 hrs | Calcium-based | Better GI profile | PA often required
• Lokelma: $500-$800/mo | Onset ~1 hr | Highly selective | Contains sodium | PA often required

For patient-facing information on alternatives: Alternatives to Sodium Polystyrene Sulfonate.

Workflow Tips for Your Practice

• Template your EHR: Create a dot phrase or smart text for SPS prescribing that includes powder-specific mixing instructions and the Medfinder link
• Proactive refills: For chronic hyperkalemia patients, flag SPS refills 2 weeks early to allow time to locate stock
• Staff training: Ensure your MA/nursing team knows to recommend the powder form and share Medfinder when patients call about availability
• Document shortage encounters: Track how often patients report difficulty finding SPS — this data supports formulary discussions and prior authorization appeals

Final Thoughts

The Sodium Polystyrene Sulfonate shortage is an inconvenience for providers and a genuine barrier for patients. By prescribing the powder form, directing patients to Medfinder, and having an alternatives playbook ready, you can minimize the impact on your patients and your practice.

For provider tools and resources, visit medfinder.com/providers. For cost-saving strategies to share with patients, see: How to Help Patients Save Money on Sodium Polystyrene Sulfonate.