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INTRODUCTION

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sevelamer (se-vel-a-mer)

Renagel, Renvela

Classification

Therapeutic: electrolyte modifiers

Pharmacologic: phosphate binders

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Indications
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Reduction of serum phosphate levels in patients with hyperphosphatemia associated with end-stage renal disease.

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Action
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A polymer that binds phosphate in the GI tract, preventing its absorption. Therapeutic Effects: Decreased serum phosphate levels and reduction in the consequences of hyperphosphatemia (ectopic calcification, secondary hyperparathyroidism with osteitis fibrosa).

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Adverse Reactions/Side Effects
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GI: diarrhea, dyspepsia, vomiting, constipation, flatulence, nausea.

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PHYSICAL THERAPY IMPLICATIONS

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Interventions
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  • Implement therapeutic exercises (resistive training, aerobic exercises, gait training) as tolerated to complement the effects of drug therapy and help maintain function in patients with end-stage renal disease.

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Patient/Client-Related Instruction
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  • Advise patient about the likelihood of GI reactions such as nausea, vomiting, diarrhea, constipation, indigestion, and flatulence. Instruct patient to report severe or prolonged GI problems.

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Pharmacokinetics
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Absorption: Not absorbed; action is local (in GI tract).

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Distribution: Unknown.

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Metabolism and Excretion: Eliminated in feces.

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Half-life: Unknown.

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TIME/ACTION PROFILE (decrease in serum phosphate levels)

ROUTE ONSET PEAK DURATION

PO

5 days

2 wk

unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Hypophosphatemia; Bowel obstruction.

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Use Cautiously in: Dysphagia, swallowing disorders, severe GI motility disorders, or major GI tract surgery; OB/Lactation/Pedi: Safety not established.

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Interactions
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Drug-Drug: Concurrent anticonvulsants or antiarrhythmics; sevelamer may affect absorption; administer 1 hr before or 3 hr after. May ↓ absorption of other drugs and ↓ effectiveness, especially drugs whose efficacy is dependent on tightly controlled blood levels.

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Route/Dosage
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PO (Adults): 800–1600 mg with each meal.

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Availability
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Tablets: 400 mg, 800 mg.

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