sevelamer (Rx)

Brand and Other Names:Renagel, Renvela
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 400mg (Renagel)
  • 800mg (Renagel, Renvela)

powder packet for oral suspension

  • 800mg (Renvela)
  • 2400mg (Renvela)

Serum Phosphorus Regulation

Indicated for the control of serum phosphorus in patients with chronic kidney disease (CKD) who are on dialysis

Initial dose

  • Not taking phosphate binder
    • 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
  • Switching from calcium 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

Maintenance dose

  • Target goal is serum phosphorus ≤5.5 mg/dL
  • 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

Dose titration

  • Titrate dose; increase by 400-800 mg per meal at 2-week intervals as necessary to achieve target serum phosphorus levels
  • Based on clinical studies, the average prescribed adult daily dose is ~7.2 g/day
  • Highest daily adult dose studied was 14 grams in CKD patients on dialysis

Dosing Considerations

Renagel = Renvela on a per gram basis

Dosage Forms & Strengths

tablet

  • 800mg (Renvela)

powder packet for oral suspension

  • 800mg (Renvela)
  • 2400mg (Renvela)

Serum Phosphorus Regulation

Indicated for the control of serum phosphorus in with chronic kidney disease (CKD) who are on dialysis in children aged ≥6 yr

<6 years: Safety and efficacy not established

See Administration for oral suspension preparation instructions

Initial dose (not taking phosphate binder)

  • BSA ≥0.75 to <1.2 m²: 800 mg per meal/snack; titrate up or down by 400 mg-increments
  • BSA ≥1.2 m²: 1600 mg per meal/snack; titrate up or down by 800 mg-increments
Next:

Interactions

Interaction Checker

and sevelamer

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (2)

            • potassium phosphates, IV

              sevelamer decreases effects of potassium phosphates, IV by cation binding in GI tract. Contraindicated. Sevelamer decreases serum phosphate concentration by binding dietary phosphate.

            • sodium phosphates, IV

              sevelamer decreases effects of sodium phosphates, IV by cation binding in GI tract. Contraindicated. Sevelamer decreases serum phosphate concentration by binding dietary phosphate.

            Serious - Use Alternative (1)

            • erdafitinib

              sevelamer, erdafitinib. Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid coadministration during initial dosing adjustment period (ie, first 21 days). Increases in serum phosphate levels are a pharmacodynamic effect of FGFR inhibition. Serum phosphate binders may obscure decisions regarding initial dosage increase.

            Monitor Closely (45)

            • acebutolol

              sevelamer decreases levels of acebutolol by increasing elimination. Use Caution/Monitor.

            • acetazolamide

              sevelamer decreases levels of acetazolamide by increasing elimination. Use Caution/Monitor.

            • adenosine

              sevelamer decreases levels of adenosine by increasing elimination. Use Caution/Monitor.

            • amiodarone

              sevelamer decreases levels of amiodarone by increasing elimination. Use Caution/Monitor.

            • carbamazepine

              sevelamer decreases levels of carbamazepine by increasing elimination. Use Caution/Monitor.

            • ciprofloxacin

              sevelamer decreases levels of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Administer oral quinolones at least 1 hour before or 3 hours after sevelamer. .

            • clonazepam

              sevelamer decreases levels of clonazepam by increasing elimination. Use Caution/Monitor.

            • diazepam

              sevelamer decreases levels of diazepam by increasing elimination. Use Caution/Monitor.

            • dichlorphenamide

              dichlorphenamide, sevelamer. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Both drugs can cause metabolic acidosis.

            • digoxin

              sevelamer decreases levels of digoxin by increasing elimination. Use Caution/Monitor.

            • disopyramide

              sevelamer decreases levels of disopyramide by increasing elimination. Use Caution/Monitor.

            • encainide

              sevelamer decreases levels of encainide by increasing elimination. Use Caution/Monitor.

            • eslicarbazepine acetate

              sevelamer decreases levels of eslicarbazepine acetate by increasing elimination. Modify Therapy/Monitor Closely.

            • esmolol

              sevelamer decreases levels of esmolol by increasing elimination. Use Caution/Monitor.

            • ethosuximide

              sevelamer decreases levels of ethosuximide by increasing elimination. Use Caution/Monitor.

            • felbamate

              sevelamer decreases levels of felbamate by increasing elimination. Use Caution/Monitor.

            • flecainide

              sevelamer decreases levels of flecainide by increasing elimination. Use Caution/Monitor.

            • fosphenytoin

              sevelamer decreases levels of fosphenytoin by increasing elimination. Use Caution/Monitor.

            • gabapentin

              sevelamer decreases levels of gabapentin by increasing elimination. Use Caution/Monitor.

            • gabapentin enacarbil

              sevelamer decreases levels of gabapentin enacarbil by increasing elimination. Use Caution/Monitor.

            • ibutilide

              sevelamer decreases levels of ibutilide by increasing elimination. Use Caution/Monitor.

            • lacosamide

              sevelamer decreases levels of lacosamide by increasing elimination. Use Caution/Monitor.

            • lamotrigine

              sevelamer decreases levels of lamotrigine by increasing elimination. Use Caution/Monitor.

            • levetiracetam

              sevelamer decreases levels of levetiracetam by increasing elimination. Use Caution/Monitor.

            • lidocaine

              sevelamer decreases levels of lidocaine by increasing elimination. Use Caution/Monitor.

            • lorazepam

              sevelamer decreases levels of lorazepam by increasing elimination. Use Caution/Monitor.

            • methsuximide

              sevelamer decreases levels of methsuximide by increasing elimination. Use Caution/Monitor.

            • mexiletine

              sevelamer decreases levels of mexiletine by increasing elimination. Use Caution/Monitor.

            • oxcarbazepine

              sevelamer decreases levels of oxcarbazepine by increasing elimination. Use Caution/Monitor.

            • phenobarbital

              sevelamer decreases levels of phenobarbital by increasing elimination. Use Caution/Monitor.

            • phenytoin

              sevelamer decreases levels of phenytoin by increasing elimination. Use Caution/Monitor.

            • primidone

              sevelamer decreases levels of primidone by increasing elimination. Use Caution/Monitor.

            • procainamide

              sevelamer decreases levels of procainamide by increasing elimination. Use Caution/Monitor.

            • propafenone

              sevelamer decreases levels of propafenone by increasing elimination. Use Caution/Monitor.

            • propranolol

              sevelamer decreases levels of propranolol by increasing elimination. Use Caution/Monitor.

            • quinidine

              sevelamer decreases levels of quinidine by increasing elimination. Use Caution/Monitor.

            • rufinamide

              sevelamer decreases levels of rufinamide by increasing elimination. Use Caution/Monitor.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of sevelamer by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of sevelamer by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

            • sotalol

              sevelamer decreases levels of sotalol by increasing elimination. Use Caution/Monitor.

            • tiagabine

              sevelamer decreases levels of tiagabine by increasing elimination. Use Caution/Monitor.

            • topiramate

              sevelamer decreases levels of topiramate by increasing elimination. Use Caution/Monitor.

            • valproic acid

              sevelamer decreases levels of valproic acid by increasing elimination. Use Caution/Monitor.

            • verapamil

              sevelamer decreases levels of verapamil by increasing elimination. Use Caution/Monitor.

            • zonisamide

              sevelamer decreases levels of zonisamide by increasing elimination. Use Caution/Monitor.

            Minor (0)

              Previous
              Next:

              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

              Bleeding gastrointestinal ulcers, colitis, ulceration, necrosis

              Previous
              Next:

              Warnings

              Contraindications

              Hypersensitivity

              Bowel obstruction

              Cautions

              Caution in dysphagia, GI motility disorders, GI surgery

              Cases of bowel obstruction, bleeding gastrointestinal ulcers, colitis, ulceration, necrosis, and perforation reported; inflammatory disorders may resolve upon discontinuation; reevaluate treatment in patients who develop severe gastrointestinal symptoms

              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 serum bicarbonate and chloride levels

              Monitor fat soluble vitamin and folic acid levels, especially in pregnancy

              Safety/efficacy with dialysis not studied

              Previous
              Next:

              Pregnancy & Lactation

              Pregnancy

              Not absorbed systemically following oral administration and maternal use not expected to result in fetal exposure to the drug

              May decrease serum levels of fat soluble vitamins and folic acid in pregnant women; consider supplementation

              Lactation

              Not absorbed systemically by mother following oral administration; breastfeeding is not expected to result in exposure of child to drug

              May decrease serum levels of fat soluble vitamins and folic acid in pregnant women; consider supplementation

              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.

              Previous
              Next:

              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

              Previous
              Next:

              Administration

              Oral Suspension Preparation

              Minimum amount of water for suspension

              • 400 mg (ie, one-half 800 mg packet): 30 mL
              • 800 mg: 30 mL
              • 2400 mg: 60 mL

              Instruct patients to stir the mixture vigorously (it does not dissolve), resuspend, if necessary, right before administration, and drink the entire preparation within 30 minutes

              As an alternative to water, the entire contents of the sachet may be premixed with a small amount of food or beverage and consumed immediately (within 30 minutes) as part of the meal

              Do not heat powder for oral suspension (eg, microwave) or add to heated foods or liquids

              Previous
              Next:

              Images

              BRAND FORM. UNIT PRICE PILL IMAGE
              sevelamer HCl oral
              -
              800 mg tablet
              sevelamer HCl oral
              -
              400 mg tablet
              sevelamer HCl oral
              -
              800 mg tablet
              Renagel oral
              -
              800 mg tablet

              Copyright © 2010 First DataBank, Inc.

              Previous
              Next:

              Patient Handout

              Patient Education
              sevelamer HCl oral

              SEVELAMER - ORAL

              (seh-VELL-uh-mer)

              COMMON BRAND NAME(S): Renagel, Renvela

              USES: Sevelamer is used to lower high blood phosphorus (phosphate) levels in patients who are on dialysis due to severe kidney disease. Dialysis removes some phosphate from your blood, but it is difficult to remove enough to keep your phosphate levels balanced. Decreasing blood phosphate levels can help keep your bones strong, prevent unsafe buildup of minerals in your body, and possibly decrease the risk of heart disease and strokes that can result from high phosphate levels. Sevelamer works by holding onto phosphate from the diet so that it can pass out of your body.

              HOW TO USE: Take this medication by mouth as directed by your doctor, usually 3 times daily with meals. Swallow the tablet whole. Do not crush, chew, or split the tablet. The dosage is based on your medical condition, any other medications you take to lower your phosphate levels, and your response to treatment. In children, the dosage is also based on body size.If you are taking the powder form of this medication, check the manufacturer package directions for mixing with water, beverage, or food and taking it within 30 minutes. Follow the directions for the proper amount of water to use for your dose. Stir the mixture well and drink all of it. If the powder settles to the bottom of the cup, stir again right before drinking. You may also mix the powder with a small amount of food or beverage to take as part of a meal. If mixing with food or beverage, do not heat the powder or add to heated foods or liquids.Take this medication regularly in order to get the most benefit from it. Remember to take it 3 times a day with meals, or on the schedule given to you by your doctor.

              SIDE EFFECTS: Headache, diarrhea, stomach upset, nausea, vomiting, cough, gas, or constipation may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: problems with your dialysis access site, severe constipation/inability to have a bowel movement, signs of stomach/intestinal bleeding or ulcers (such as black/bloody stools, vomit that looks like coffee grounds, stomach/abdominal pain, dizziness).Get medical help right away if you have any very serious side effects, including: trouble breathing, chest pain, pain/redness/swelling in the lower legs.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking sevelamer, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: low blood phosphorus levels, stomach/intestinal problems (such as blockage, colitis, constipation, ulcers), stomach/intestinal surgeries, swallowing problems (dysphagia).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this medication passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Sevelamer may interfere with the effectiveness of some drugs (including ciprofloxacin, mycophenolate, thyroid medications such as levothyroxine, among others) by making it more difficult for them to be absorbed by the stomach. Ask your pharmacist about the best times to take your other medications.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

              NOTES: Your doctor may direct you to follow a special diet to help lower your blood phosphate levels. Follow the diet closely.Do not share this medication with others.Laboratory and/or medical tests (such as blood phosphate, calcium, bicarbonate and chloride levels) should be performed regularly to monitor your progress or check for side effects. Consult your doctor for more details.

              MISSED DOSE: If you miss a dose, skip the missed dose unless you have just eaten. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

              Information last revised September 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

              Previous
              Next:

              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
              • Manage and view all your plans together – even plans in different states.
              • Compare formulary status to other drugs in the same class.
              • Access your plan list on any device – mobile or desktop.

              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.
              Additional Offers
              Email to Patient

              From:

              To:

              The recipient will receive more details and instructions to access this offer.

              By clicking send, you acknowledge that you have permission to email the recipient with this information.

              Email Forms to Patient

              From:

              To:

              The recipient will receive more details and instructions to access this offer.

              By clicking send, you acknowledge that you have permission to email the recipient with this information.

              Previous
              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.