Usual Adult Dose for Hyperphosphatemia of Renal Failure

Initial Dosing for patients not on a phosphate binder: 800 mg to 1600 mg orally 3 times a day with meals
Based on serum phosphorus level:

• Phosphorus greater than 5.5 to less than 7.5 mg/dL: 800 mg 3 times a day with meals
• Phosphorus greater than or equal to 7.5 mg/dL: 1600 mg 3 times a day with meals
• Titrate in increments of 800 mg 3 times a day at 2-week intervals with the goal of controlling serum phosphorus within target range.

Average prescribed dose: 7.2 g/day (2.4 g with each meal)
Maximum studied dose: 14 g per day (carbonate); 13 g per day (hydrochloride)

Switching from the hydrochloride salt to carbonate: Use the same dose, however further titration may be necessary to achieve desired phosphorus levels.

Switching from calcium acetate: Substitute approximately mg for mg

Comment: Treatment of hyperphosphatemia includes reduction in dietary intake of phosphate, inhibition of intestinal phosphate absorption with phosphate binders, and removal of phosphate with dialysis.

Use: To control serum phosphorus levels in patients with chronic kidney disease on dialysis.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

Data not available

Dose Adjustments

Dosage should be adjusted based on the serum phosphorus level: Target serum phosphorus level should be 5.5 mg/dL or less:

• Levels greater than 5.5 mg/dL: Increase by 800 mg per meal at 2 week intervals.
• Levels between 3.5 and 5.5 mg/dL: Maintain current dose
• Levels less than 3.5 mg/dL: Decrease 1 tablet per meal

Precautions

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

No adjustment recommended

Other Comments

Administration advice:

• Take orally 3 times a day with meals

Concomitant administration of oral medications:

• Patients who are taking concomitant oral medications that may be clinically altered by a reduction in bioavailability should be advised to take these medications at least 1 hour before or 3 hours after taking sevelamer.

Storage requirements:

• Protect from moisture

Reconstitution/preparation techniques: Oral suspension:

• Place the entire contents of packet in a cup and mix with appropriate amount of water (i.e., 0.8 g packet with 30 mL; 2.4 g packet with 60 mL).
• Multiple packets may be mixed together with the appropriate amount of water.
• Stir vigorously before drinking; consume within 30 minutes
• Powder does not dissolve in water.

General:

• Treatment of hyperphosphatemia includes reduction in dietary intake of phosphate, inhibition of intestinal phosphate absorption with phosphate binders, and removal of phosphate with dialysis. This drug taken with meals has been shown to control serum phosphorus concentrations in patients with CKD who are on dialysis.

Monitoring:

• Monitor serum phosphorus levels for efficacy.
• Monitor for constipation.
• Monitor bicarbonate and chloride levels.
• Monitor for reduced folate and vitamin D, E, and K levels.
• Monitor clinical response and/or blood levels of concomitant oral medications that have narrow therapeutic ranges.

Patient advice:

• Instruct patients to take this medication with meals and adhere to their prescribed diets.
• If significant interactions are expected, patients may need to separate administration times of their concomitant medications.
• Instruct patients to report new onset or worsening of constipation promptly.