Phosphate Binder
Pregnancy: C
Sevelamer
Brand names: Renagel, Renvela
Adult dose
Dose: 800–1600mg three times daily with meals
Route: Oral
Frequency: Three times daily with meals
Dose titrated based on serum phosphate. Start 800mg TDS if phosphate 1.76–2.42 mmol/L, 1200–1600mg TDS if higher.
Clinical pearls
- Sevelamer carbonate (Renvela) preferred over hydrochloride (Renagel) to avoid metabolic acidosis
- Take WITH meals — binds dietary phosphate in GI tract
- Non-calcium, non-aluminium binder — preferred in hypercalcaemia or calcification risk
- Tablets must be swallowed whole — not crushed or chewed
Contraindications
- Bowel obstruction
- Hypophosphataemia
Side effects
- Nausea
- Vomiting
- Constipation
- Diarrhoea
- Metabolic acidosis (carbonate form reduces this)
Interactions
- Ciprofloxacin — reduces absorption (give 2h apart)
- Levothyroxine — reduces absorption
- Mycophenolate — reduces absorption
Monitoring
- Serum phosphate
- Serum calcium
- Serum bicarbonate
Reference: KDIGO CKD-MBD Guidelines 2017. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.