Sevelamer

Sevelamer is a prescription medication used for regulating serum phosphorus in patients with chronic kidney disease. 

• Sevelamer is available under the following different brand names: Renagel, Renvela.

Adult and pediatric dosage

Tablet

• 400mg (Renagel)
• 800mg (Renagel, Renvela)

Powder packet for oral suspension

• 800mg (Renvela)
• 2400mg (Renvela)

Serum Phosphorus Regulation

Adult dosage

Initial dose

Not taking phosphate binder

• Serum PO4 over 9 mg/dL [2.91 mmol/L]: 1600 mg orally every 8 hours with meals
• Serum PO4 7.5-9 mg/dL [2.42-2.91 mmol/L]: 1200-1600 mg orally every 8 hours with meals
• Serum PO4 5.5-7.5 mg/dL [1.78-2.42 mmol/L]: 800 mg orally every 8 hours with meals

Switching from calcium acetate

• Substitute 800 mg Renagel or Renvela for 667 mg of Ca-acetate
• Substitute 1600 mg Renvela or Renagel for 1334 mg of Ca-acetate
• Substitute 2400 mg Renvela or Renagel for 2001 mg of Ca-acetate

Maintenance dose

• Target goal is serum phosphorus less than 5.5 mg/dL
• Serum PO4 over 5.5 mg/dL [over 1.78 mmol/L]: increase dose by 400-800 mg per meal
• Serum PO4 3.5-5.5 mg/dL [1.13-1.78 mmol/L]: Maintain current dose
• Serum PO4 under 3.5 mg/dL [1.13 mmol/L] decrease by 400-800 mg per meal

Pediatric dosage

• Children younger than 6 years of age: Safety and efficacy not established

Initial dose (not taking phosphate binder)

• BSA 0.75 or over but less than 1.2m2: 800 mg per meal/snack; titrate up or down by 400 mg-increments
• BSA 1.2 m2 or over: 1600 mg per meal/snack; titrate up or down by 800 mg-increments

Dosage Considerations – Should be Given as Follows: 

• See “Dosages”.

Common side effects of Sevelamer include:

• nausea, 
• vomiting, 
• stomach pain, 
• loss of appetite, 
• upset stomach, 
• gas, 
• bloating, 
• diarrhea, 
• constipation, 
• tiredness, 
• itching, and 
• joint pain 

Serious side effects of Sevelamer include:

• hives, 
• difficulty breathing, 
• swelling of the face, lips, tongue, or throat, 
• choking, 
• black, bloody, or tarry stools, 
• severe constipation with stomach pain, and
• constipation that gets worse or doesn’t resolve

Rare side effects of Sevelamer include:

• none 

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Sevelamer has severe interactions with the following drugs:
  • potassium phosphates, IV
  • sodium phosphates, IV
• Sevelamer has serious interactions with the following drug:
  • erdafitinib
• Sevelamer has moderate interactions with at least 45 other drugs.
• Sevelamer has minor interactions with no other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist of all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Contraindications

• Hypersensitivity
• Bowel obstruction

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Sevelamer?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Sevelamer?”

Cautions

• Caution in dysphagia, GI motility disorders, GI surgery
• Cases of bowel obstruction, bleeding gastrointestinal ulcers, colitis, ulceration, necrosis, and perforation were reported; inflammatory disorders may resolve upon discontinuation; reevaluate treatment in patients who develop severe gastrointestinal symptoms
• Tablets should not be crushed, broken, or chewed (tablets rapidly expand and become a choking hazard)
• Dysphagia and esophageal tablet retention reported, in some cases requiring hospitalization and intervention; consider sevelamer oral suspension in patients with a history of swallowing disorders
• May decrease GI absorption of antiarrhythmic, fat-soluble vitamins, folic acid, and antiseizure medications; take medications 1 hour before or 3 hours after sevelamer dose
• Monitor serum bicarbonate and chloride levels
• Monitor fat-soluble vitamin and folic acid levels, especially in pregnancy
• Safety/efficacy with dialysis not studied

Pregnancy and Lactation

• Not absorbed systemically following oral administration and maternal use is not expected to result in fetal exposure to the drug. 
• May decrease serum levels of fat-soluble vitamins and folic acid in pregnant women; consider supplementation. 
• Not absorbed systemically by the mother following oral administration; breastfeeding is not expected to result in the exposure of the child to drugs.