Sevelamer (rINN) is a phosphate binding medication used to treat hyperphosphatemia in patients with chronic kidney disease.
Routes of administration By mouth
Bioavailability 0%
Excretion Feces 100%
When taken with meals, it binds to dietary phosphate and prevents its absorption.
Trade names Renagel, Renvela
Pregnancy category AU: B3
Sevelamer consists of polyallylamine that is crosslinked with epichlorohydrin.
The amine groups of sevelamer become partially protonated in the intestine and interact with phosphate ions through ionic and hydrogen bonding.
Sevelamer is used in the management of hyperphosphatemia in adult patients with stage 4 and 5 chronic kidney disease (CKD) on hemodialysis. Its efficacy at lowering phosphate levels is similar to that of calcium acetate, but without the accompanying risk of hypercalcemia and arterial calcification.
In patients with CKD, it has also been shown to reduce LDL and cholesterol.
Sevelamer therapy is contraindicated in hypophosphatemia or bowel obstruction.
In hypophosphatemia, sevelamer could exacerbate the condition by further lowering phosphate levels in the blood, which could be fatal.
Common adverse drug reactions (ADRs) associated with the use of sevelamer include: nausea and vomiting, constipation, diarrhea, stomach pain, heartburn, gas.
Sevelamer can significantly reduce serum uric acid.
Sevelamer is able to sequester advanced glycation end products (AGEs) in the gut, preventing their absorption into the blood.