Sevelamer

RENVELA, RENAGEL

What it isNon-absorbed phosphate-binding polymer; hyperphosphatemia in dialysis.

Why this oneIt binds phosphate without adding calcium or aluminum, so it avoids the vascular calcification that calcium binders promote.

What limits itLarge tablets three times daily with meals drive non-adherence. It binds other drugs — separate levothyroxine and quinolones.

FDA label

FDA dosing	Population	Start	Target	Max
Hyperphosphatemia in CKD on dialysis	Adults	0.8 g TID (P >5.5-<7.5) or 1.6 g TID (P ≥7.5) with meals	per serum phosphorus	~14 g/day (highest studied)
Hyperphosphatemia in CKD	Peds ≥6 yr (by BSA)	0.8-1.6 g TID with meals	per serum phosphorus

Titration Titrate at 2-week intervals

Renal Undefined

Hepatic Undefined

Take with meals
Swallow tablets whole; consider suspension in patients with swallowing disorders
May reduce fat-soluble vitamins (D, E, K) and folic acid — consider supplementation

Serious GI events: dysphagia, bowel obstruction, bleeding GI ulcers, colitis, ulceration, necrosis, perforation
Reductions in vitamins D, E, K and folic acid

Pregnancy Not absorbed systemically; may decrease fat-soluble vitamins/folate — consider supplementation

Lactation Not absorbed systemically; not expected to expose the child

NO BOXED WARNINGS

Principal riskBinds other drugs in the gut; separate dosing

Cost, est. cash$10–$300/month

Generic entry2019

Therapeutic safety burden0 / 4

Overdose danger0 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk0 / 4

Legacy pregnancy categoryUnknown / historical label unavailable

Defining liabilityLocal irritation, sensitization or administration-site injury; negligible systemic toxicity at usual use.