Sevelamer for High Phosphate Levels

Sevelamer, commonly known as Renvela, is a prescription medication used to lower high levels of phosphate in the blood (hyperphosphatemia). It's typically prescribed for adults and children aged 6 and older who have chronic kidney disease and are receiving dialysis.

Hyperphosphatemia

Hyperphosphatemia occurs when there's an excessive amount of phosphate in the bloodstream. Phosphate is a vital mineral crucial for bone strength, energy production, and various bodily functions. However, elevated phosphate levels can lead to complications like bone and heart issues, especially for individuals with kidney problems. This condition is common in those with chronic kidney disease because their kidneys struggle to eliminate excess phosphate effectively.

How Sevelamer Works

Sevelamer belongs to a class of medications called phosphate binders, which are designed to regulate phosphate levels in the body.

Sevelamer functions by attaching to phosphate in the stomach, particularly from the food you consume. By doing so, it prevents the absorption of phosphate in the intestine, subsequently reducing the amount of phosphate that enters the bloodstream. This action helps in maintaining optimal phosphate levels in your body, which is essential for managing complications such as bone disorders and cardiovascular issues.

Administration

Sevelamer is available in 800 mg tablets and should be taken with food. Sevelamer is also available as a powder that can be made into a liquid for those who have trouble swallowing pills.

If this medication is taken on an empty stomach, it will not be effective because there won't be any phosphate available from food to bind to.

Side Effects

Common side effects

• Nausea, vomiting, constipation or diarrhea
• Indigestion, stomach pain, bloating, or feeling gassy
• Fatigue
• Joint pain

If you are experiencing any of these side effects be sure to talk with your healthcare provider to determine whether a dose adjustment or switching to a different medication would be beneficial for you.

Serious side effects

• Stomach or intestine problems, including bleeding ulcers, severe stomach pain, blood in your stool, or bowel blockage, including stomach cramping, inability to have a bowel movement or gas, loss of appetite, or vomiting
• Severe stomach pain or constipation
• Symptoms of high phosphate levels, such as muscle weakness or bone pain
• Allergic reactions, including hives, difficulty breathing, or swelling of your face, lips, tongue, or throat

If you are experiencing any of these serious side effects, immediately call your doctor and stop taking this medication.

Contraindications

Sevelamer should not be taken by individuals who have experienced hypersensitivity or allergic reactions to sevelamer hydrochloride (Renagel), Sevelamer carbonate (Renvela), or any of its ingredients. Allergic reactions may include symptoms like hives, itching, difficulty breathing, or swelling of the face, lips, tongue, or throat.

Furthermore, sevelamer is not suitable for patients with confirmed bowel obstruction, as it could potentially exacerbate this condition. Bowel obstruction refers to a blockage that hinders the passage of food, fluids, or gas through the intestines, often caused by factors like bleeding ulcers or inflammation. Administering sevelamer to individuals with bowel obstruction might worsen the blockage and lead to severe complications.

Interactions

It is recommended to avoid using Sevelamer with medications that could increase your risk of certain side effects. Some of these medications include antibiotics, such as Ciprofloxacin, which should be taken at least 2 hours before or 6 hours after you take Sevelamer.

Warnings

Warnings associated with the use of sevelamer include the following:

• Gastrointestinal effects: Sevelamer may cause gastrointestinal side effects such as nausea, vomiting, diarrhea, constipation, and abdominal pain.
• Blockage of the digestive tract: Sevelamer may potentially cause blockage of the digestive tract, including blockage of the stomach or intestinal blockage, bleeding ulcers, and inflammation. Patients should be aware of symptoms such as severe abdominal pain, nausea, and vomiting, and receive immediate medical attention if such symptoms occur..
• Low levels of vitamins and folic acid: Long-term use of sevelamer may lead to low levels of certain vitamins, such as A, D, E, K, and folic acid due to decreased absorption. Monitoring of these vitamin levels and supplementation may be necessary to prevent deficiency-related complications.
• Hypersensitivity reactions: Sevelamer may cause hypersensitivity reactions, including angioedema and anaphylaxis. You should be monitored for signs of allergic reactions, and treatment should be discontinued if a hypersensitivity reaction occurs.

Patients should be informed about these warnings before starting sevelamer carbonate therapy, and healthcare professionals should closely monitor patients for any adverse effects or complications.

Pregnancy

Sevelamer is not recommended for use during pregnancy unless the potential benefits outweigh the risks. There is limited data on the use of sevelamer in pregnant women, and its safety during pregnancy has not been well-established.

The impact of sevelamer on the absorption of vitamins and other essential nutrients has not been studied in pregnant women. During pregnancy, there is an increased demand for vitamins and other nutrients.

Animal studies have shown adverse effects on fetal development, but there are no adequate and well-controlled studies in pregnant women. In pregnant rats that were administered sevelamer, there were instances of reduced or irregular bone formation of fetal bones. This effect is likely due to a diminished absorption of fat-soluble vitamin D.

Breastfeeding

Studies in women suggest that sevelamer shows minimal risk to the infant when used during breastfeeding. However, the decision to use sevelamer during breastfeeding should be made carefully, weighing the potential benefits against any possible risks. Consulting with a healthcare professional is important to assess individual circumstances and consider alternatives if necessary.

Speak with Your Doctor

You should speak with your doctor about taking sevelamer, as it has been shown to effectively reduce high levels of phosphate in the blood, particularly in patients with CKD undergoing dialysis.