Drug information of Sevelamer

Mechanism of effect

Sevelamer carbonate tablets and powder contain Sevelamer carbonate, a non-absorbed phosphate binding crosslinked polymer, free of metal and calcium. It contains multiple amines separated by one carbon from the polymer backbone. These amines exist in a protonated form in the intestine and interact with phosphate molecules through ionic and hydrogen bonding. By binding phosphate in the gastrointestinal tract and decreasing absorption, Sevelamer carbonate lowers the phosphate concentration in the serum (serum phosphorus)

Pharmacodynamic

In addition to effects on serum phosphorus levels, Sevelamer hydrochloride has been shown to bind bile acids. Sevelamer binds bile acids, it may interfere with normal fat absorption and thus may reduce absorption of fat soluble vitamins such as A, D and K.

Pharmacokinetics

A mass balance study using 14C-Sevelamer hydrochloride, in 16 healthy male and female volunteers showed that Sevelamer hydrochloride is not systemically absorbed. No absorption studies have been performed in patients with renal disease

Dosage

Usual Adult Dose for Hyperphosphatemia of Renal Failure Sevelamer carbonate: 800 mg to 1600 mg orally three times daily with each meal based on serum phosphorus level Sevelamer hydrochloride: Renagel(R): Phosphorus greater than 5.5 and less than 7.5 mg/dL = One 800 mg tablet or two 400 mg tablets orally 3 times daily with meals Phosphorus greater than or equal to 7.5 and less than 9.0 mg/dL = Two 800 mg tablets or three 400 mg tablets orally 3 times daily with meals Phosphorus greater than or equal to 9.0 mg/dL = Two 800 mg tablets or four 400 mg tablets orally 3 times daily with meals

Drug contraindications

hypersensitivity to drug or its components. , bowel obstruction

Side effects

nausea , constipation , abdominal pain , vomiting , rash , Diarrhea , dyspepsia , itching , flatulence , intestinal obstruction , intestinal perforation

Alerts

1- Cases of dysphagia and esophageal tablet retention have been reported in association with use of the tablet formulation of Sevelamer, some requiring hospitalization and intervention. Consider using Sevelamer suspension in patients with a history of swallowing disorders. 2- Cases of bowel obstruction and perforation have also been reported with Sevelamer use 3- Patients with dysphagia, swallowing disorders, severe gastrointestinal (GI) motility disorders including severe constipation, or major GI tract surgery were not included in the Sevelamer carbonate clinical studies

Points of recommendation

1- Bicarbonate and chloride levels should be monitored 2- Monitor for Reduced Vitamins D, E, K (clotting factors) and Folic Acid Levels 3-Inform patients to take Sevelamer carbonate as directed with meals and adhere to their prescribed diets

Pregnancy level