Usual Adult Dose for Hyperphosphatemia of Renal Failure

Initial dose: 1500 mg orally per day in divided doses with meals
Titrate in increments of 750 mg/day every 2 to 3 weeks until an acceptable serum phosphate level is reached
Maintenance dose: Most patients require 1500 to 3000 mg/day to reduce plasma phosphate levels to less than 6 mg/dL
Maximum dose: 4500 mg/day

Comments:

• In addition to reduction of intestinal phosphate with phosphate binders, management of elevated serum phosphorus levels in ESRD requires reduction in dietary intake of phosphate and removal of phosphate by dialysis.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended

Precautions

CONTRAINDICATIONS:

• Bowel obstruction, including ileus and fecal impaction

Dialysis

This drug is indicated for patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis; therefore, no dosage adjustment is recommended.

Other Comments

Administration advice:
Take with or immediately after meals

• Chewable Tablets: Chew or crush tablets completely before swallowing; do not swallow intact tablets
• Oral powder: Sprinkle on a small quantity of applesauce (or similar food) and consume immediately; do not open until ready to use and do not store for future use once mixed with food; do not attempt to dissolve as powder is insoluble

• Patients should adhere to recommended diets in order to control phosphate and fluid intake.
• Patients with poor dentition or those who have difficulty chewing tablets should use the oral powder to avoid the risk of serious gastrointestinal events.

• Serum phosphate levels should be monitored as needed during dose titration and regularly thereafter.
• Thyroid stimulating hormone (TSH) levels should be checked in patients receiving thyroid hormone replacement.
• Hypocalcemia may develop in patients with renal dysfunction; periodic monitoring of serum calcium levels is recommended.
• Consider monitoring liver function in patients with marked reduction of bile flow.

• Patients should be instructed as to proper way to take this medication to avoid risk of serious gastrointestinal adverse events.
• Gastrointestinal events are common with initiation of therapy; taking this medication with food will minimize events and with continued dosing they tend to lessen.
• Antacids, thyroid medications, and antibiotic medications may need to be taken 1 to 2 hours before or 2 to 4 hours after taking this medication; check with a health care professional for specific timing.
• Patients should let their physician know they are taking this drug prior to an abdominal X-ray.