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Phosphate Binder

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Phosphate Binder, Phosphorus Binder, Sevelamer, Phosphate Chelating Agent, Lanthanum, Sucroferric oxyhydroxide, Phoslo, RenaGel, Renvela, Fosrenol, Velphoro, Auryxia

  • Technique
  1. Take Phosphate Binders with food
  2. Take other medications at least one hour before or 3 hours after Phosphate Binders
  • Preparations
  • Calcium based
  1. Calcium Carbonate (e.g. Tums)
    1. Effective and inexpensive, but increases Serum Calcium
    2. Starting dose: 3 tabs daily (increase up to 17 tabs/day in some cases)
  2. Calcium Acetate (e.g. Phoslo, phoslyra)
    1. Effective and inexpensive, but increases Serum Calcium (less than Calcium Carbonate)
    2. Starting dose: 3 tabs daily
  • Preparations
  • Non-Calcium based agents
  1. Sevelamer HCl (RenaGel)
    1. Less effective than calcium-based binders and expensive, but does not increase Serum Calcium
    2. Risk of Metabolic Acidosis
    3. Starting dose: 3-12 tabs daily (increase to 9 tabs/day or more in some cases)
  2. Sevelamer Carbonate (Renvela)
    1. Less effective than calcium-based binders and expensive (but less expensive than RenaGel)
      1. However, does not increase Serum Calcium, unlike calcium-based binders
      2. Does not cause Metabolic Acidosis unlike Sevelamer HCl (RenaGel)
    2. Starting dose: 3-6 tabs daily (increase to 9 tabs/day or more in some cases)
  3. Lanthanum Carbonate (Fosrenol)
    1. Effective and does not increase Serum Calcium, but expensive (more than Sevelamer)
    2. Starting dose: 3 tabs daily
  • Preparations
  • Iron Containing Phosphate Binders
  1. Sucroferric oxyhydroxide (Velphoro)
    1. Effective and does not increase Serum Calcium, but expensive
    2. Increases iron levels minimally (less than ferric citrate)
    3. Starting dose: 3 tabs daily
  2. Ferric Citrate (Auryxia)
    1. Effective and does not increase Serum Calcium, but expensive
    2. Increases iron levels and reduces need for IV iron requirements and Erythropoietin (e.g. Epogen)
    3. Starting dose: 6 tabs daily (maximum 12 tabs/day)
  • References
  1. (2019) Presc Lett 26(9):53
  2. (2015) Presc Lett 22(8)
  3. Hutchison (2009) Kidney Int 75:906-14 +PMID:19279554 [PubMed]