Indications
Sevelamer hydrochloride is used to control high blood phosphate levels (hyperphosphataemia) in adults with chronic kidney disease who are on haemodialysis or peritoneal dialysis. When the kidneys fail, phosphate builds up in the blood, which over time weakens bones and causes calcium deposits in blood vessels and the heart.
How It Works
Sevelamer is a phosphate binder. It is a polymer that stays in the gut and is not absorbed into the body. It binds phosphate from food in the intestine, so the phosphate passes out in the stool instead of being absorbed into the blood. It contains no calcium or aluminium and can also lower LDL cholesterol.
Dosage and Administration
The dose depends on blood phosphate levels and is adjusted by the doctor every few weeks, as prescribed. It must be taken with meals, usually three times a day with each main meal. Swallow tablets whole with water; do not crush, chew or break them. Follow the diet and fluid advice given by your kidney team.
- Blood phosphate, calcium and bicarbonate levels are checked regularly.
Interactions
Sevelamer can bind other medicines in the gut and reduce their absorption. Take Ciprofloxacin at least 2 hours before or 6 hours after it. Levothyroxine, Mycophenolate, Ciclosporin and Tacrolimus levels may fall; take them at a different time and have levels or thyroid tests checked. For any medicine where a reduced effect could be serious (for example antiarrhythmics or antiepileptics), take it at least 1 hour before or 3 hours after Sevelamer, or as your doctor advises.
Contraindications
- Allergy to Sevelamer or any ingredient.
- Low blood phosphate (hypophosphataemia).
- Bowel obstruction.
Side Effects
Common side effects include nausea, vomiting, indigestion, stomach pain, bloating, wind, constipation and diarrhoea. Itching and rash can occur. Long-term use may lower levels of fat-soluble vitamins and folic acid, and can make the blood more acidic.
Get urgent medical help if you have severe stomach pain, severe constipation with no bowel movement, a swollen hard abdomen, vomiting that will not stop, black or bloody stools, or difficulty swallowing.
Pregnancy and Lactation
There is limited information on use in pregnancy and breastfeeding. Because it is not absorbed, harm is unlikely, but it may reduce absorption of vitamins and folic acid, so use only if the doctor advises it and follow advice on supplements.
Precautions and Warnings
Use with care in people with swallowing problems, severe stomach or bowel motility disorders, recent major bowel surgery, or inflammatory bowel disease. Severe constipation and bowel blockage have been reported, so tell your doctor about constipation early. Vitamin and bicarbonate levels may need monitoring, and supplements may be prescribed.
Overdose
Sevelamer is not absorbed, so serious toxicity is unlikely. Large amounts may cause constipation or bowel upset; contact a doctor if a large amount has been taken.
Therapeutic Class
Phosphate binder (non-calcium, non-aluminium polymer).
Storage
Store below 30°C in a dry place, away from light, with the 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.