Phosphate Binders Rx Information PDF

PHOSPHATE BINDERS DRUG DOSE SAFETY/SIDE EFFECTS/MONITORING Aluminum-based: potent phosphate binders, but rarely used due to the risk of aluminum accumulation (which can cause nervous system and bone toxicity). Treatment duration is limited to 4 weeks. Aluminum hydroxide Suspension 300-600 mg PO...

PHOSPHATE BINDERS DRUG DOSE SAFETY/SIDE EFFECTS/MONITORING Aluminum-based: potent phosphate binders, but rarely used due to the risk of aluminum accumulation (which can cause nervous system and bone toxicity). Treatment duration is limited to 4 weeks. Aluminum hydroxide Suspension 300-600 mg PO TID with meals SIDE EFFECTS Aluminum Intoxication, “dialysis dementia," osteomalacia, constipation, nausea MONITORING Ca, PO4, PTH, s/sx of aluminum toxicity Calcium-based: first-line. Calcium acetate (Phoslyra. PhosLo', others) Formulation: Tablet, capsule, solution 1,334 mg PO TID with meals, titrate based on PO4 levels Calcium carbonate (Tums, others) Tablet, chewable tablet 500mg PO TID with meals (can vary with formulation used), titrate based on P04 levels Total daily dose of elemental calcium should be < 2,000 mg (from diet and supplements) SIDE EFFECTS Hypercalcemia, constipation, nausea MONITORING Ca, PO4, PTH NOTES Calcium acetate binds more dietary phosphorus on an elemental calcium basis compared to calcium carbonate Hypercalcemia Is especially problematic with concomitant use of vitamin P (due to Increased calcium absorption) Aluminum-free, calcium-free; no aluminum accumulation, less hypercalcemia, but more expensive. Sucroferric oxyhydroxide (Velphoro) Chewable tablet 500 mg PO TID with meals, titrate based on PO4 levels Ferric citrate (Auryxia) Tablet 2 tablets (420 mg) PO TIP with meals, titrate based on PO4 levels Lanthanum carbonate (Fosrenol) Chewable tablet, powder 500 mg PO TID with meals, titrate based on PO4 levels Must chew tablet thoroughly to reduce risk of severe Gl adverse effects Use powder if unable to chew tablets WARNINGS Iron absorption occurs with ferric citrate; dosage reduction of IV iron may be necessary; store out of reach of children to prevent accidental overdose SIDE EFFECTS Diarrhea, constipation, discolored (black) feces MONITORING Iron, ferritin, TSAT (only with ferric citrate), PO4, PTH NOTES Absorption is minimal with sucroferric oxyhydroxide CONTRAINDICATIONS Gl obstruction, fecal impaction, ileus WARNINGS Gl perforation SIDE EFFECTS Nausea/vomiting, diarrhea, constipation, abdominal pain MONITORING Ca, PO4, PTH Sevelamer: a non-calcium, non-aluminum based phosphate binder that is not systemically absorbed. Sevelamer carbonate (Renvela) Tablet, powder 800-1,600 mg PO TID with meals,titrate based on PO4 levels Sevelamer hydrochloride (Renagel) Tablet 800-1,600 mg PO TID with meals,titrate based on PO4 levels CONTRAINDICATIONS Bowel obstruction WARNINGS Can reduce dietary absorption of vitamins D, E, K and folic acid; consider vitamin supplementation Tablets can cause dysphagia and get stuck in the esophagus; consider using powder if swallowing difficulty is present SIDE EFFECTS Nausea/vomiting/diarrhea (all > 20%), dyspepsia, constipation, abdominal pain, flatulence MONITORING Ca, PO4, HCO3, Cl, PTH NOTES Can lower total cholesterol and LDL. Sevelamer carbonate can maintain bicarbonate concentrations by 15-30%. MONITORING Ca, PO4, PTH