Sevelamer is a medication used to control phosphate levels, primarily in patients with chronic kidney disease (CKD).
Sevelamer is a phosphate binder used to reduce high blood phosphate levels (hyperphosphataemia).
It is most primarily used for patients with chronic kidney disease (CKD) who are on dialysis.
Unlike some other binders, sevelamer is calcium-free and metal-free, meaning it lowers phosphate without raising calcium or aluminum levels in the body.
By keeping phosphate levels in check, it helps protect your bones and reduces the risk of dangerous mineral deposits in your heart and blood vessels.
Note. Advantages: It is often chosen because it does not increase calcium levels (avoiding hypercalcaemia), making it safer for patients who cannot tolerate calcium-based binders – especially if they have had hypercalcaemia.
The mechanism of action of sevelamer involves ‘binding’ to phosphate in the digestive tract:
When taken with meals, sevelamer attaches to the phosphate found in your food.
This prevents the phosphate from being absorbed into your bloodstream.
Instead, the bound phosphate passes safely through your system and is eliminated in your stool.
The main uses of sevelamer include the treatment of:
Hyperphosphataemia (high blood phosphate) in adults with CKD, who are not on dialysis
Patients on dialysis (both haemodialysis and peritoneal dialysis).
By controlling phosphate, sevelamer helps prevent secondary hyperparathyroidism and metabolic bone disease.
Adults: The starting dose is usually 800 mg to 1600 mg taken three times a day with meals.
Titration: Your doctor will adjust the dose based on your blood phosphate levels.
Available as sevelamer carbonate (Renvela) or sevelamer hydrochloride (Renagel).
Note: Sevelamer must be taken with food to be effective. Tablets should be swallowed whole; do not crush, chew, or break them.
Most sevelamer side-effects are gastrointestinal, as the medicine stays within the digestive tract.
Nausea and vomiting
Diarrhea or constipation
Indigestion or stomach pain
Bloating and gas
Serious symptoms to report:
Severe constipation or worsening ‘blockage’ feelings.
Difficulty swallowing.
Severe abdominal pain.
Your doctor should monitor:
Blood Phosphate: To ensure the dose is effectively binding the phosphate from your diet.
Blood Calcium and Bicarbonate: To maintain a healthy mineral balance.
Vitamins: Because it binds substances in the gut, sevelamer can sometimes lower the absorption of vitamins D, E, K, and folic acid.
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