Sucroferric oxyhydroxide

VELPHORO

What it isChewable iron-based phosphate binder; hyperphosphatemia in dialysis.

Why this oneIt generally controls phosphate with a lower pill burden than sevelamer.

What limits itBlack stools and diarrhea are common; minimal iron absorption can still complicate interpretation of iron studies.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Control of serum phosphorus (CKD on dialysis)	Adults & pediatrics ≥12 yr	500 mg TID with meals	1500-2000 mg/day (typical)	3000 mg/day (studied)
Control of serum phosphorus (CKD on dialysis)	Pediatrics 9 to <12 yr	500 mg BID with meals	~1500 mg/day (typical)	3000 mg/day (studied)

Titration Adjust by one 500 mg tablet/day as needed, as often as weekly.

Renal Undefined

Hepatic Undefined

Each tablet contains 500 mg iron; average requirement 1500-2000 mg/day in adults.

Chew or crush tablets; do not swallow whole.
Take with meals.
If daily dose cannot be divided equally, give the larger dose with the largest meal.

Not studied in peritonitis during peritoneal dialysis, significant gastric/hepatic disorders, recent major GI surgery, or iron accumulation disorders (hemochromatosis) — monitor effect and iron homeostasis

Pregnancy Not systemically absorbed; fetal exposure not expected.

Lactation Not systemically absorbed; child exposure not expected.

NO BOXED WARNINGS

Principal riskBlack stools; interferes with iron studies

Cost, est. cash$300–$2,500/month

Generic entry2011

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.