Indications
Sevelamer Carbonate is a phosphate binder used to control high blood phosphate levels (hyperphosphataemia) in adults with chronic kidney disease, mainly those on dialysis. When the kidneys fail, phosphate builds up in the blood and can weaken bones and cause calcium deposits in blood vessels and the heart.
How It Works
Sevelamer is a polymer that is not absorbed into the body. In the gut it binds to phosphate from food, forming a compound that passes out in the stool. This stops the phosphate from being absorbed, lowering blood phosphate levels. Unlike some other binders, it contains no calcium or aluminium. It may also lower LDL cholesterol slightly.
Dosage and Administration
Take exactly as prescribed with meals. Usual starting dose in adults is 800 mg to 1.6 g three times daily with meals, depending on the phosphate level; the doctor then adjusts the dose every 2 to 4 weeks based on blood tests. Swallow tablets whole with water; do not crush or chew. Powder forms are mixed in water as directed. Follow the low-phosphate diet advised by your doctor or dietitian.
Interactions
Sevelamer can reduce the absorption of some medicines. Take Ciprofloxacin and similar antibiotics, Mycophenolate, Levothyroxine and other important medicines at least 1 hour before or 3 hours after Sevelamer, or as your doctor advises. It may reduce Ciclosporin and Tacrolimus levels in transplant patients and lower the absorption of fat-soluble vitamins (A, D, E, K) and Folic acid.
Contraindications
Do not use if you have low blood phosphate, bowel obstruction, or are allergic to Sevelamer.
Side Effects
Common side effects include nausea, vomiting, indigestion, stomach pain, constipation, diarrhoea and wind. Rarely, it can cause blockage or serious inflammation of the bowel, or tablets may become stuck in the food pipe.
Get urgent medical help if you have severe stomach pain, severe constipation, swelling of the abdomen, blood in your stools or black stools, difficulty or pain when swallowing, or signs of a severe allergic reaction.
Pregnancy and Lactation
Sevelamer is not absorbed, but it may lower vitamin and folic acid absorption needed in pregnancy. Use only if your doctor advises. It is not expected to enter breast milk; ask your doctor before breastfeeding.
Precautions and Warnings
Tell your doctor if you have swallowing problems, bowel motility disorders, severe constipation, inflammatory bowel disease or recent major bowel surgery. Blood phosphate, calcium, bicarbonate and vitamin levels will be checked regularly. Vitamin supplements may be needed.
Overdose
Since it is not absorbed, serious toxicity is unlikely, but large amounts may cause constipation or bowel blockage. Seek medical advice if much more than prescribed has been taken.
Therapeutic Class
Phosphate binder (non-calcium, non-aluminium).
Storage
Store below 30°C in the original container, tightly closed to protect from moisture, and out of the reach of children.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.