Phosphate Binder

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

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II. Indications

  1. Hyperphosphatemia
  2. Chronic Kidney Disease related Bone Disease (Renal Osteodystrophy)

III. Technique

  1. Take Phosphate Binders with food
  2. Take other medications at least one hour before or 3 hours after Phosphate Binders

IV. 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

V. 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

VI. 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)

VII. 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]

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Cost: Medications

renagel (on 12/21/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
RENAGEL 800 MG TABLET $6.79 each
renvela (on 12/21/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
RENVELA 0.8 GM POWDER PACKET $16.42 each
RENVELA 2.4 GM POWDER PACKET $16.58 each
RENVELA 800 MG TABLET $5.44 each
fosrenol (on 6/2/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
FOSRENOL 1,000 MG TABLET CHEW $11.52 each
FOSRENOL 500 MG TABLET CHEW $11.64 each
velphoro (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
VELPHORO 500 MG CHEWABLE TAB $11.12 each
auryxia (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
AURYXIA 210 MG TABLET $4.84 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Ontology: Lanthanum (C0023031)

Definition (NCI) A silvery white metallic element that belongs to period 6 of the lanthanoids family, with phosphate binding property. Lanthanum, when administered in a salt form, dissociates in acid to release lanthanum ions, which then bind dietary phosphate. This agent inhibits the absorption of phosphate by forming highly insoluble lanthanum-phosphate complexes that reduce concentrations of serum phosphate and calcium phosphate.
Definition (MSH) Lanthanum. The prototypical element in the rare earth family of metals. It has the atomic symbol La, atomic number 57, and atomic weight 138.91. Lanthanide ion is used in experimental biology as a calcium antagonist; lanthanum oxide improves the optical properties of glass.
Definition (CSP) rare metallic element, symbol La, atomic number 57.
Concepts Element, Ion, or Isotope (T196)
MSH D007811
SnomedCT 414568004
English Lanthanum, Lanthanum [Chemical/Ingredient], LANTHANUM, La element, lanthanum, La, Lanthanum (substance)
Swedish Lantan
Czech lanthan
Finnish Lantaani
Russian LANTAN, ЛАНТАН
Polish Lantan
Norwegian Lantan
French Lanthane
German Lanthan
Italian Lantanio
Spanish lantano (sustancia), lantano, Lantano
Portuguese Lantânio
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: RenaGel (C0526563)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C405346
English RenaGel, Renagel, renagel
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: sevelamer (C0718050)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH C405346
SnomedCT 329195003, 395871000
English sevelamer, sevelamer [Chemical/Ingredient], SEVELAMER, Sevelamer (product), Sevelamer (substance), Sevelamer, poly(allylamine-co-N,N'-diallyl-1,3-diamino-2-hydroxypropane)
Spanish sevelámero (producto), sevelámero (sustancia), sevelámero
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Phoslo (C0722621)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C120662
English Phoslo, PhosLo, phoslo
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Fosrenol (C1174767)

Concepts Pharmacologic Substance (T121) , Inorganic Chemical (T197)
MSH C119467
English Fosrenol
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Renvela (C1968327)

Concepts Organic Chemical (T109) , Pharmacologic Substance (T121)
English Renvela
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Phosphate Binder [EPC] (C2267031)

Concepts Pharmacologic Substance (T121)
English Phosphate Binder [EPC], Phosphate Binder
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Phosphate Chelating Activity [MoA] (C2267178)

Concepts Molecular Function (T044)
English Phosphate Binding Activity, Phosphate Chelating Activity [MoA], Phosphate Chelating Activity
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Velphoro (C3696395)

Concepts Pharmacologic Substance (T121)
English Velphoro
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: sucroferric oxyhydroxide (C3696416)

Concepts Pharmacologic Substance (T121)
English sucroferric oxyhydroxide, SUCROFERRIC OXYHYDROXIDE, iron (as sucroferric oxyhydroxide)
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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