Sevelamer

INTRODUCTION

Indications

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

Action

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).

Adverse Reactions/Side Effects

GI: diarrhea, dyspepsia, vomiting, constipation, flatulence, nausea.

PHYSICAL THERAPY IMPLICATIONS

Interventions

• 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.

Patient/Client-Related Instruction

• 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.

Pharmacokinetics

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

Distribution: Unknown.

Metabolism and Excretion: Eliminated in feces.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Hypophosphatemia; Bowel obstruction.

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

Interactions

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.

Route/Dosage

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

Availability

Tablets: 400 mg, 800 mg.