Sevelamer

Sevelamer as a phosphate binder is indicated for treatment of hyperphosphatemia. There are two forms of hydrochloride (HCl) and carbonate sevelamer. Hydrochloride and carbonate sevelamer forms have equal efficacy and phosphate binding rate. Sevelamer hydrochloride (HCl) form decrease serum bicarbonate and cause acidosis. Sevelamer carbonate form has no effect on serum bicarbonate, so in metabolic acidosis carbonate sevelamer form should be used. Serum phosphate concentration decrease after 1-2 weeks of administration.


Pharmacokinetics:

Sevelamer is not systemically absorbed. No absorption studies have been performed in patients with renal disease.


Mechanism of action:

Sevelamer with binding to phosphate in gastrointestinal tract prevent phosphate absorption and eventually, decrease blood phosphate.


Adverse Reactions:

Nausea, Diarrhea, Vomiting, Abdominal pain, Flatulence


Drug interactions:

Concurrent administration of sevelamer with calcitriol, levothyroxine and fluoroquinolones antimicrobial drugs such as ciprofloxacin may cause the bioavailability reduction of calcitriol, levothyroxine and absorption of fluoroquinolones antimicrobial drugs, respectively. The mentioned drugs should be administered at least one hour before or three hours after sevelamer administration.

Contraindication:

Patients with hyperphosphatemia, Bowel obstruction, patients with hypersensitivity to sevelamer.


Pregnancy:

Category C.


Precautions:

Cases of dysphagia and esophageal tablet retention, bowel obstruction and perforation and reductions in vitamins D, E, K (clotting factors) and folic acid Levels have been reported.


Hyperphosphatemia causing agents:

Chronic Kidney Disease (CKD), pseudohypoparathyroidism, hypoparathyroidism, trauma, rhabdomyolysis, vitamin D intoxication and laxative administration can cause hyperphosphatemia.
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