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sevelamer (Rx)Brand and Other Names:Renagel, Renvela

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 400mg
  • 800mg

packet

  • 800mg
  • 2400mg
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End-Stage Renal Disease

Hemodialysis; hyperphosphatemia

Initial dose

  • Serum PO4 >9 mg/dL [2.91 mmol/L]: 1600 mg PO q8hr with meals
  • Serum PO4 7.5-9 mg/dL [2.42-2.91 mmol/L]: 1200-1600 mg PO q8hr with meals
  • Serum PO4 5.5-7.5 mg/dL [1.78-2.42 mmol/L]: 800 mg PO q8hr with meals

Maintenance dose

  • Serum PO4 >5.5 mg/dL [>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 <3.5 mg/dL [1.13 mmol/L] decrease by 400-800 mg per meal

Dosing considerations

  • Titrate dose; increase by 400-800 mg per meal at 2-week intervals; no more than 4 g

Switching From Ca-Acetate

Substitute 800 mg Renagel or Renvela for 667 mg of Ca-acetate

Substitute 1600 Renvela or Renagel for 1334 mg of Ca-acetate

Substitute 2400 mg Renvela or Renagel for 2001 mg Ca-acetate

Dosing considerations

  • Renagel = Renvela on a per gram basis

Safety and efficacy not established

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Interactions

Interaction Checker

sevelamer and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            Vomiting (22%)

            Nausea (20%)

            Diarrhea (19%)

            Dyspepsia (16%)

            Nasopharyngitis (14%)

            Limb pain (13%)

            Pruritus (13%)

            Arthralgia (12%)

            Bronchitis (11%)

            Dyspnea (10%)

            Hypertension (10%)

            1-10%

            Abdominal pain (9%)

            Constipation (8%)

            Flatulence (8%)

            Peritonitis (during peritoneal dialysis: 8%)

            Hypercalcemia (5-7%)

            Frequency Not Defined

            Back pain

            Cough

            Headache

            Pyrexia

            Upper respiratory infection

            Pruritus

            Rash

            Intestinal perforation

            Fecal impaction

            Intestinal obstruction

            Postmarketing Reports

            Hypersensitivity

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            Warnings

            Contraindications

            Hypersensitivity

            Bowel obstruction

            Cautions

            Caution in dysphagia, GI motility disorders, GI surgery

            Bowel obstruction and perforation reported

            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 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 fat soluble vitamin and folic acid levels, especially in pregnancy

            Safety/efficacy with dialysis not studied

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Not absorbed systemically; not excreted in breast milk

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Polymeric phosphate binder; decreases serum phosphate concentrations without changing calcium, aluminum, or bicarbonate concentrations

            Absorption

            No intestinal absorption

            Elimination

            Excretion: Feces

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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