#phosphate binder

[superflaminggayelmo]

I noticed something about renvela lately: it tastes kind of like beef O_O

(renvela's one of my medications)

[mission-to-dietitian]

Meds that need to be taken with food

-Creon

-Phosphate binders

[siglerprescriptiondrugcards]

Sevelamer Carbonate

Brand Name: Renvela

Generic Available

Common Dosage Forms:

Tablets, film coated

Powder for Suspension: 800 mg/packet, 2400/packet

FDA Indications/Dosages:

Indicated for the control of serum phosphorus in adults and children 6 years of age and alder with chronic kidney disease on dialysis: Based on serum phosphate levels, start with 800-1600 mg given 3 times a day with meals. Serum phosphate levels between 5.50-7.5 mg/dL start at 800 mg 3 times a day and serum phosphate levels over 7.6 mg/dL start at 1600 mg 3 times a day. Titrate at two weeks intervals in 800 mg per meal increments until the target serum phosphate level is reached. Starting dose in children are based on Body Surface Area (BSA) category.

Monitor: Serum phosphate

Pharmacology/Pharmacokinetics: Sevelamer carbonate acts by bonding phosphate molecules in the gastrointestinal tract through ionic and hydrogen bonding. This bonding results in a decrease in phosphate absorption. Sevelamer carbonate is not absorbed. In addition to phosphate, sevelamer carbonate also binds bile acids.

Drug Interactions: May alter the absorption of some medications including ciprofloxacin and mycophenolate mofetil. It may be wise to separate other medications with narrow therapeutic margins from sevelamer carbonate.

Contraindications/Precautions: Use is contraindicated in patients with bowel obstruction. Use tablets with caution in patients with difficulty in swallowing as cases of dysphagia and esophageal tablet retention have been reported. Use may decrease the absorption of vitamins D, E, and K, and folic acid. Supplementation is recommended. Pregnancy Category A.

Adverse Effects: The most common adverse effects seen during use include vomiting (22%), nausea (20%), diarrhea (19%), dyspepsia (16%), abdominal pain (9%), flatulence (8%), and constipation (8%).

Patient Consultation:

Take with meals with a full glass of water.

Mix the contents of 800 mg powder packets with 30 mL of water and 1600 mg powder packets with 60 mL of water. Shake well and ingest within 30 minutes. Inform the patient the powder does not dissolve.

Contact a physician if the above adverse effects are severe or persistent.

[siglerprescriptiondrugcards]

Calcium Acetate

Brand Name: Phoslo

Generic Available

Common Dosage Forms:

Capsules: 667 mg

Tablets: 667 mg

FDA Indications/Dosages:

For the reduction of serum phosphorus in patients with end stage renal disease: Begin with 2 capsules/tablets given with each meal. Titrate dose 2-3 weeks until the desired serum phosphorus level is reached (serum phosphate <6 mg/dL). Usual adult dose is 3 to 4 capsules/tablets with each meal.

Monitor: Serum phosphorus, serum calcium.

Pharmacology/Pharmacokinetics: Patients with end-stage renal disease (ESRD) are susceptible to develop hyperphosphatemia. High serum phosphorus levels can precipitate calcium and cause painful ectopic calcification. High serum phosphorus levels in patients with ESRD may also contribute to the development of secondary hyperparathyroidism. Calcium acetate combines with dietary phosphate to form an insoluble calcium phosphate complex, decreasing serum phosphorus levels. The calcium phosphate complex is excreted in the feces.

Drug Interactions: May decrease the bioavailability of tetracyclines and fluoroquinolones. It is recommended to take calcium acetate capsules one hour before three hours following any medication in which bioavailability is in question. Secondary hypercalcemia may increase digitalis toxicity.

Contraindication/Precautions: Contraindicated in patients with hypercalcemia. Avoid the use of calcium supplements, including calcium-based antacids, with calcium acetate. Monitor serum calcium regularly, especially during initiation of treatment. The serum calcium times phosphate (CaxP) product should not exceed 66. Symptoms of mild hypercalcemia include nausea, vomiting, constipation, and anorexia. Severe hypercalcemia leads to stupor, delirium, confusion, and come. Pregnancy Category C.

Adverse Effects: The most common adverse effects are nausea, vomiting, and hypercalcemia.

Patient Consultation:

Take with food or meals.

If a dose is missed, skip it and return to normal dosing schedule.

Do not discontinue therapy without first consulting physician.

Contact a physician if the above side effects are severe or persistent.

Do not take additional calcium supplements.