sevelamer

Therapeutic Classification: electrolyte modifiers

Pharmacologic Classification: phosphate binders

Indications ⬆ ⬇

REMS

Hyperphosphatemia associated with end-stage renal disease.

Action ⬆ ⬇

A polymer that binds phosphate in the GI tract, preventing its absorption.

Therapeutic effects:

Decreased serum phosphate levels and reduction in the consequences of hyperphosphatemia (ectopic calcification, secondary hyperparathyroidism with osteitis fibrosa).

Pharmacokinetics ⬆ ⬇

Absorption: Not absorbed; action is local (in GI tract).

Distribution: Unknown.

Metabolism/Excretion: Eliminated in feces.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(↓ in serum phosphate concentrations)

ROUTE	ONSET	PEAK	DURATION
PO	5 days	2 wk	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Hypophosphatemia;
Bowel obstruction.

Use Cautiously in:

Dysphagia, swallowing disorders, severe GI motility disorders, or major GI tract surgery (avoid use of tablets);
OB: Not systemically absorbed; no fetal exposure expected. May ↓ levels of folate and fat-soluble minerals; consider supplementation during pregnancy;
Lactation: Not systemically absorbed; no expected presence in breast milk. May ↓ levels of folate and fat-soluble minerals; consider supplementation while breastfeeding;
Pedi: Safety and effectiveness not established in children <18 yr (Renagel) and children <6 yr (Renvela).

Adv. Reactions/Side Effects ⬆ ⬇

GI: diarrhea, dyspepsia, vomiting, BLEEDING GI ULCER, BOWEL OBSTRUCTION/NECROSIS/PERFORATION, choking (tablet), colitis, constipation, dysphagia (tablet), ESOPHAGEAL OBSTRUCTION (TABLET), flatulence, nausea, ulceration

Interactions ⬆ ⬇

Drug-drug:

May ↓ absorption of other drugs and ↓ effectiveness, especially drugs whose efficacy is dependent on tightly controlled blood levels.
↓absorption of ciprofloxacin.

Route/Dosage ⬆ ⬇

PO (Adults ): 800–1600 mg 3 times daily with meals; may titrate by 800 mg every 2 wk to achieve target serum phosphorus levels.
PO (Children ≥6 yr and BSA ≥1.2 m²): Renvela: 1600 mg 3 times daily with meals; may titrate by 800 mg every 2 wk to achieve target serum phosphorus levels.
PO (Children ≥6 yr and BSA 0.75–<1.2 m²): Renvela: 800 mg 3 times daily with meals; may titrate by 400 mg every 2 wk to achieve target serum phosphorus levels.

Availability ⬆ ⬇

(Generic available)

Powder for oral suspension: 800 mg/pkt; 2400 mg/pkt
Tablets: 400 mg; 800 mg

Assessment ⬆ ⬇

Assess patient for GI side effects periodically during therapy.

Lab Test Considerations:

Monitor serum phosphorous, calcium, bicarbonate, and chloride levels periodically during therapy.

Implementation ⬆ ⬇

Do not confuse Renagel with Renvela.
Doses of concurrent medications, especially antiarrhythmics, should be spaced at least 1 hr before or 3 hr after sevelamer.
PO: Administer with meals. DNC: Do not break, chew, or crush tablets; contents expand in water.
- Use suspension for patients with swallowing disorders. Place contents of powder packet in a cup and mix thoroughly with at least 1 oz of water for the 800-mg dose or 2 oz of water for the 2400-mg dose packet. Stir mixture vigorously (it does not dissolve) and drink entire preparation within 30 min or resuspend the preparation right before drinking.

Patient/Family Teaching ⬆ ⬇

Instruct patient to take sevelamer with meals as directed and to adhere to prescribed diet.
Caution patient to space concurrent medications at least 1 hr before or 3 hr after sevelamer.
Advise patient to notify health care professional if GI effects (worsening of existing constipation, bloody stools) occur.
Rep: Advise patient to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. Sevelamer is not systemically absorbed, but may decrease serum levels of fat-soluble vitamins and folic acid in pregnant women. May consider supplementation.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇