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Background and Importance Sodium zirconium cyclosilicate (SZC) is a fast-acting potassium ion-exchange agent, indicated for treating hyperkalaemia in adults. The recommended dosage is 10 g three times a day (correction phase) for up to 72 hours. Normokalaemia is usually achieved within 24–48 hours. If serum potassium remains elevated after 72 hours, alternative therapies should be considered, due to the increased risk of electrolyte disturbances. 1 The recommended maintenance therapy dosage is between 5 g and 10 g daily. Adverse effects include peripheral oedema and gastrointestinal symptoms. Close monitoring of serum potassium is recommended throughout treatment1.Aim and Objectives To assess the appropriateness and guideline compliance of SZC prescriptions, considering the patients’ clinical status.Material and Methods Retrospective observational study including patients treated with SZC between June 2024 and September 2025. Demographic and clinical data, dosing regimen, duration of the correction/maintenance phases, and serum potassium monitoring were analysed. Prescription compliance was defined based on the duration of the treatment phases, guidelines adherence and frequency of potassium monitoring 1.Results A total of 87 patients were included, predominantly elderly, with 79% over 65 years old and 46% over 80.After 24 hours of treatment, potassium levels decreased in 60 patients. Hyperkalaemia persisted in 45 patients at 24 hours and in only 15 at 48 hours.Prescription analysis revealed that 40% were not compliant with the guidelines1. Among these, seven patients were eligible for therapy switching and two should have initiated treatment with a correction dose. Potassium levels were not measured in 8, 10, and 25 patients at 24, 48, and 72 hours, respectively.Conclusion and Relevance These results are align with published data, which indicate normokalaemia is typically achieved within 24 to 48 hours, and highlight the importance of aligning SZC prescribing with the current guidelines to reduce deviations in the correction phase, optimise transition to maintenance therapy, and improve safety and effecacy 1.Hospital pharmacists can play a key role, assisting the clinical team by ensuring adherence to dosing and monitoring recommendations, enhancing both safety and therapeutic outcomes.References and/or Acknowledgements 1. National Institute for Health and Care Excellence (NICE). Sodium zirconium cyclosilicate for treating hyperkalaemia. NICE Technology Appraisal Guidance. London: 2022.Conflict of Interest No conflict of interest