Products
Sevelamer carbonate is commercially available in the form of film-coated tablets and powder. It was approved in many countries in 2011 (Renvela). The precursor sevelamer chloride (Renagel) has been available since 2004. Generics were registered in 2018.
Effects
Sevelamer carbonate (ATC V03AE02) is a polymer containing numerous amino groups that are protonated in the stomach and bind phosphate ions. Unlike other phosphate binders, it does not contain calcium and therefore cannot cause hypercalcemia and does not contain aluminum, which is controversial because of potential adverse effects. Inhibition of phosphate absorption lowers serum phosphate levels. Sevelamer carbonate acts locally in the intestine and is not absorbed into the body. It was developed as a successor to sevelamer chloride (Renagel). Compared to chloride, carbonate counteracts the development of acidosis and is said to be better tolerated in the intestine. It is also available as a powder and not just in tablet form.
Indications
For the treatment of hyperphosphatemia in hemodialysis or peritoneal dialysis patients and in patients with chronic renal failure.
Dosage
According to the SmPC. The drug is taken three times daily with meals.
Contraindications
- Hypersensitivity
- Hypophosphatemia
- Intestinal obstruction
Full precautions can be found in the drug label.
Interactions
Drug-drug interactions are possible with ciprofloxacin, ciclosporin, mycophenolate mofetil, tacrolimus, and levothyroxine. Sevelamer carbonate acts locally in the intestine and may affect the bioavailability of other drugs. If an interaction is possible, other drugs should be administered at least 1 hour before or 3 hours after sevelamer carbonate.
Adverse Effects
The most common possible adverse effects include nausea, vomiting, abdominal pain, constipation, diarrhea, dyspepsia, and flatulence.
