Sevelamer Carbonate (sevelamer carbonate)

Sevelamer carbonate and sevelamer hydrochloride are phosphate binders used to reduce the intestinal absorption of phosphates.

Sevelamer carbonate and sevelamer hydrochloride, polymers of allylamine (cross-linked with epichlorohydrin), are phosphate binders used to reduce the absorption of dietary phosphates.

Patients with chronic kidney disease (CKD) retain phosphorus and may develop hyperphosphatemia. High serum phosphate concentrations can precipitate serum calcium resulting in ectopic calcification. To avoid ectopic calcification, the serum calcium (in mg/dL) times phosphorus (in mg/dL) product (Ca x P) should not be allowed to exceed 55.

In addition, hyperphosphatemia is associated with the development of secondary hyperparathyroidism, which is accompanied by increased parathyroid hormone (PTH) concentrations that can lead to osteitis fibrosa cystica, a bone disease. Although decreased serum phosphate concentrations may be associated with decreased PTH concentrations, administration of a vitamin D analog (e.g., calcitriol, doxercalciferol, paricalcitol) usually is necessary to reduce elevated PTH concentrations in patients with CKD undergoing hemodialysis. (See Uses: Renal Osteodystrophy or Hypocalcemia Secondary to Chronic Renal Disease, in Vitamin D Analogs General Statement 88:16.)

Following oral administration, sevelamer binds phosphate ions through ionic and hydrogen bonding and thus reduces intestinal absorption of phosphates. Reduced intestinal absorption of phosphates results in decreased serum and urinary phosphorus concentrations and increased fecal excretion of phosphorus.

Sevelamer binds bile acids in the intestine, forming a nonabsorbable complex. Sevelamer may interfere with normal fat absorption, possibly resulting in reduced absorption of fat-soluble vitamins (e.g., vitamin A, D, K).

Oral sevelamer hydrochloride has been shown to decrease serum total and LDL-cholesterol concentrations; however, the drug does not appear to alter serum high density lipoprotein (HDL)-cholesterol or triglyceride concentrations. In addition, the drug reportedly does not alter serum chloride, bicarbonate, or albumin concentrations. No substantial changes in serum calcium concentrations were reported during sevelamer hydrochloride therapy.

Unlike some other phosphate binders, sevelamer does not contain aluminum (or other metals) and does not cause aluminum toxicity.

In healthy individuals, orally administered sevelamer is not absorbed systemically; however, no absorption studies have been performed in patients with renal disease. Following oral administration, sevelamer binds bile acids in the intestine, forming a nonabsorbable complex that is excreted in feces.

USES: Sevelamer is used to lower high blood phosphorus (phosphate) levels in patients who are on dialysis due to severe kidney disease. Dialysis removes some phosphate from your blood, but it is difficult to remove enough to keep your phosphate levels balanced. Decreasing blood phosphate levels can help keep your bones strong, prevent unsafe buildup of minerals in your body, and possibly decrease the risk of heart disease and strokes that can result from high phosphate levels.

Sevelamer works by holding onto phosphate from the diet so that it can pass out of your body.

Generic name: sevelamer carbonate
Pronunciation: (seh-VELL-uh-mer)

The following indications are listed for Sevelamer Carbonate:

• Renal Osteodystrophy With Hyperphosphatemia

Also known as: Renal Osteodystrophy With Hyperphospheremia.

No ICD codes are available for this drug.