Sevelamer
RENVELA, RENAGEL
Pronunciation: se-VEL-a-mer
What it isNon-absorbed phosphate-binding polymer; hyperphosphatemia in dialysis.
Why this oneIt binds phosphate without adding calcium or aluminum, so it avoids the vascular calcification that calcium binders promote.
What limits itLarge tablets three times daily with meals drive non-adherence. It binds other drugs — separate levothyroxine and quinolones.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Hyperphosphatemia in CKD on dialysis | Adults | 0.8 g TID (P >5.5-<7.5) or 1.6 g TID (P ≥7.5) with meals | per serum phosphorus | ~14 g/day (highest studied) |
| Hyperphosphatemia in CKD | Peds ≥6 yr (by BSA) | 0.8-1.6 g TID with meals | per serum phosphorus |
Titration Titrate at 2-week intervals
Renal Undefined
Hepatic Undefined
Instructions
- Take with meals
- Swallow tablets whole; consider suspension in patients with swallowing disorders
- May reduce fat-soluble vitamins (D, E, K) and folic acid — consider supplementation
Available strengths
- tab 800 mg
- susp 2.4 g/packet
- susp 800 mg/packet
Contraindications
- Bowel obstruction
Cautions
- Serious GI events: dysphagia, bowel obstruction, bleeding GI ulcers, colitis, ulceration, necrosis, perforation
- Reductions in vitamins D, E, K and folic acid
Adverse reactions
- Vomiting
- Nausea
- Diarrhea
- Dyspepsia
- Abdominal pain
- Flatulence
- Constipation
Pregnancy Not absorbed systemically; may decrease fat-soluble vitamins/folate — consider supplementation
Lactation Not absorbed systemically; not expected to expose the child
Cost
Generic entry2019
NO BOXED WARNINGS
Principal riskBinds other drugs in the gut; separate dosing
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityLocal irritation, sensitization or administration-site injury; negligible systemic toxicity at usual use.