sucroferric oxyhydroxide

Therapeutic Classification: electrolyte modifiers

Pharmacologic Classification: phosphate binders

Indications ⬆ ⬇

REMS

Hyperphosphatemia in patients with chronic renal disease currently on dialysis.

Action ⬆ ⬇

Binds dietary phosphorus in the GI tract via ligand exchange.

Therapeutic effects:

Decreased serum phosphorus levels and sequelae of hyperphosphatemia.

Pharmacokinetics ⬆ ⬇

Absorption: Phosphate binding is local with no systemic absorption. Minimal amounts of released iron may be absorbed.

Distribution: Unknown.

Metabolism/Excretion: Action is local, no metabolism. Bound phosphate is excreted in feces.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(phosphorus lowering)

ROUTE	ONSET	PEAK	DURATION
PO	within 4 wk	12–16 wk	length of treatment

Contraind./Precautions ⬆ ⬇

Contraindicated in:

None noted.

Use Cautiously in:

Peritonitis (from peritoneal dialysis), significant hepatic/gastric disorders, following major GI surgery, history of hemochromatosis/diseases of iron accumulation;
OB: Not systemically absorbed (minimal risk of fetal exposure);
Lactation: Not systemically absorbed (not likely to appear in breast milk);
Pedi: Children <9 yr (safety and effectiveness not established).

Adv. Reactions/Side Effects ⬆ ⬇

GI: discolored feces, diarrhea, nausea, unpleasant taste

Interactions ⬆ ⬇

Drug-drug:

Should not be used concurrently with levothyroxine due to interference with phosphorus homeostasis; administer ≥4 hr before sucroferric oxyhydroxide.
May ↓ absorption and effectiveness of aspirin, cephalexin, and doxycycline; administer ≥1 hr before sucroferric oxyhydroxide.

Route/Dosage ⬆ ⬇

PO (Adults and Children ≥12 yr): 500 mg 3 times daily (with meals) initially; may be titrated by 500 mg/day at weekly intervals depending on serum phosphorus; usual range is 1500–3000 mg/day in 3 divided doses.
PO (Children 9–<12 yr): 500 mg twice daily (with meals) initially; may be titrated by 500 mg/day at weekly intervals depending on serum phosphorus; usual range is 1500–3000 mg/day in 3 divided doses.

Availability ⬆ ⬇

Chewable tabletswild berry flavored: 500 mg

Assessment ⬆ ⬇

Monitor for abdominal pain or discomfort. Sucroferric oxyhydroxide causes discolored (black) stool and may mask GI bleeding. Medication does not effect guaiac-based (Hemoccult) or immunological-based (iColoRectal and Hexagon Opti) fecal occult blood tests.

Lab Test Considerations:

Monitor serum calcium, phosphorus, and PTH levels. Dose of sucroferric oxyhydroxide is titrated in increments of 500 mg (one tablet) per day as needed until acceptable serum phosphorus level (≤5.5 mg/dL) is reached. Monitor periodically thereafter. May begin titration 1 wk after start of therapy and adjust at weekly intervals.
- Monitor iron homeostasis in patients with peritonitis during peritoneal dialysis, significant hepatic or gastric disorders, following major GI surgery, or with a history of hemochromatosis or other diseases with iron accumulation.

Implementation ⬆ ⬇

PO: Administer 3 times daily with meals. Tablets must be chewed; do not swallow whole. Tablets may be crushed prior to swallowing. No additional fluid is required above usual amount taken.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient. Advise patient to read Patient Information before starting therapy. Instruct patient to take as directed. Omit missed doses; resume medication with next meal; do not double doses.
Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other medications.
Advise patient to take aspirin, cephalexin, and doxycycline ≥1 hr before and levothyroxine ≥4 hr before sucroferric oxyhydroxide.
Advise patient sucroferric oxyhydroxide may cause staining or discolored teeth.
Instruct patient to report any rash to a health care professional.
Rep: Advise female patients to notify health care professional if pregnancy is planned or suspected.

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Pronunciation ⬇

Classifications ⬆ ⬇