Iron-based phosphate binder Pregnancy: Not systemically absorbed following oral administration, and maternal use is not expected to result in fetal exposure to the drug. Animal data: no embryo-fetal developmental toxicity in rats at up to 800 mg/kg/day (16 times the maximum recommended clinical dose); in rabbits, increased incomplete/unossified epiphyses and metacarpals/phalanges at 200 mg/kg/day (4 times the recommended maximum clinical dose); in a rat pre-/post-natal study, lower offspring body-weight gain at 5-13 weeks and delayed neuromuscular function at 800 mg/kg/day.

Sucroferric oxyhydroxide

Brand names: Velphoro

Sucroferric oxyhydroxide is an iron-based, non-calcium phosphate binder used to control hyperphosphataemia in patients with chronic kidney disease on dialysis.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One 500 mg tablet three times daily with meals (starting dose). Each chewable tablet contains 500 mg iron, equivalent to 2,500 mg sucroferric oxyhydroxide

Route: Oral - chew or crush the tablet; do not swallow whole. Must be administered with meals

Frequency: Three times daily with meals

Max: Daily doses as high as 3,000 mg per day have been studied in adults and paediatric patients 9 years of age and older (no formal maximum dose is stated)

Indication in this label: control of serum phosphorus levels in patients with chronic kidney disease on dialysis. TITRATION: monitor serum phosphorus and titrate in decrements or increments of one 500 mg tablet per day as needed until an acceptable serum phosphorus level is reached, with regular monitoring afterwards; titrate as often as weekly. If the recommended daily dose cannot be divided equally among meals, administer the larger dose with the largest meal of the day. In clinical studies, on average, adult patients and paediatric patients 12 years of age and older required 1,500 mg to 2,000 mg (3 to 4 tablets) a day to control serum phosphorus. MISSED DOSE: if one or more doses are missed, resume with the next food intake. PAEDIATRIC (fixed tablet dosing, not per-kg, hence paedDose is null): patients 12 years of age and older - starting dose one 500 mg tablet three times daily with meals (same as adults); patients 9 to less than 12 years - starting dose one 500 mg tablet two times daily with meals, and on average required 1,500 mg (3 tablets) to control serum phosphorus. Safety and effectiveness have been established in patients 6 years to less than 9 years with CKD on dialysis, but the product is not approved in that age group because of the lack of an appropriate dosage strength; safety and effectiveness have not been established below 6 years of age, and it has not been studied below 2 years of age. Verify any under-18 use against a children's formulary. SOURCE: no UK SPC (eMC) record was retrieved in this bundle - the dose above is from US prescribing information (Velphoro, Fresenius Medical Care Renal Therapies Group, label date 2026-04-01, https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=4e6c954e-7710-efc7-e063-6394a90a6dc2) and must be verified against UK labelling.

Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

None (US label section 4 states 'None')

Side effects

Discoloured faeces (12%)
Diarrhoea (6%)

Interactions

Doxycycline, acetylsalicylic acid and cephalexin - take at least 1 hour before sucroferric oxyhydroxide (US label Table 1)
Levothyroxine - take at least 4 hours before sucroferric oxyhydroxide (US label Table 1)
Can be administered concomitantly with oral calcitriol, ciprofloxacin, digoxin, enalapril, furosemide, HMG-CoA reductase inhibitors, hydrochlorothiazide, losartan, metoprolol, nifedipine, omeprazole, quinidine and warfarin (US label Table 1)
Oral medications not listed in the label: no empirical interaction data; where reduced bioavailability of the concomitant drug would have a clinically significant effect on its safety or efficacy, consider separating the administration of the two drugs, and where possible monitor clinical response and/or blood levels of drugs with a narrow therapeutic range

Clinical monograph

How it works

Phosphate binds to the iron-oxyhydroxide complex in the gut and is excreted in the faeces, with minimal iron absorption.

Prescribing in practice

Take with meals so the binder coincides with dietary phosphate, and chew the tablets as directed for effective binding.
Discoloured (typically dark) stools are expected and harmless but can interfere with faecal occult blood testing.
Diarrhoea and other gastrointestinal effects are common, and the small amount of absorbed iron should be considered in patients with iron-overload conditions.

Monitoring

Monitor serum phosphate periodically to guide dose titration, alongside routine renal mineral parameters.

Counselling the patient

Chew the tablets and take them with your meals.
Your stools may turn dark while taking this medicine, which is normal.

Evidence & guidelines

Sucroferric oxyhydroxide is an established phosphate binder supported by randomised trials in dialysis patients and CKD-mineral and bone disorder guidance.

Reference: NICE NG203; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators