This article's lead is ready for translation. Click for more information.

Sevelamer

From WikiProjectMed
Jump to navigationJump to search
Sevelamer
Names
Pronunciation(/sɛˈvɛləmər/ or/sɛˈvɛləmɪər/)
Trade namesRenagel, Renvela
  • poly(allylamine-
    co-N,N'-diallyl-1,3-diamino-2-hydroxypropane)
Clinical data
Main usesHyperphosphatemia inchronic kidney disease[1]
Side effectsAbdominal pain, diarrhea, nausea, constipation[1]
Pregnancy
category
Routes of
use		By mouth
Typical dose800 to 2,400 mg TID[1]
External links
AHFS/Drugs.comMonograph
MedlinePlusa601248
Legal
License data
Legal status
Pharmacokinetics
Bioavailability0%
ExcretionFeces 100%
Chemical and physical data
Formula[(C3H7N)a+b.(C9H17N2O)c]m
where a+b:c = 9:1
Molar massvariable

Sevelamer, sold under the brand nameRenagel among others, is a medication used to treathyperphosphatemia inchronic kidney disease.[1] In the United Kingdom it is a second line treatment.[2] It is taken by mouth with meals.[1]

Common side effects include abdominal pain, diarrhea, nausea, and constipation.[1] A skin rash may also occur.[2] It works bybinding phosphate in the intestines.[1]

Sevelamer was approved for medical use in the United States in 1998.[1] In the United States it costs about 48 USD for 270 tablets of 800 mg as of 2021.[3] This amount in the United Kingdom costs theNHS about £75.[2]

Contents

Medical uses

Sevelamer is used in the management ofhyperphosphatemia in adult patients with stage 4 and 5chronic kidney disease (CKD) on hemodialysis. Its efficacy at lowering phosphate levels is similar to that ofcalcium acetate, but without the accompanying risk ofhypercalcemia and arterial calcification.[4][5] In patients with CKD, it has also been shown to reducetriglycerides andLDL, and increaseHDL.[6]

Dosage

Sevelamer is used at a dose of 800 mg to 2,400 mg three times per day.[1]

Contraindications

Sevelamer therapy is contraindicated inhypophosphatemia or bowel obstruction. In hypophosphatemia, sevelamer could exacerbate the condition by further lowering phosphate levels in the blood, which could be fatal.[7]

Side effects

Perforation associated with sevelamer - Resected specimen revealed a 5 × 5 mm perforation in the sigmoid colon

Common side effects associated with the use of sevelamer include:hypotension,hypertension, nausea and vomiting,dyspepsia,diarrhea,flatulence, and/orconstipation.

Pharmacology

Sevelamer consists ofpolyallylamine that is crosslinked withepichlorohydrin.[8] The marketed form sevelamer hydrochloride is a partial hydrochloride salt being present as approximately 40%aminehydrochloride and 60% sevelamer base. The amine groups of sevelamer become partiallyprotonated in the intestine and interact with phosphate ions throughionic andhydrogen bonding.

History

It was invented and developed byGelTex Pharmaceuticals. Sevelamer is marketed bySanofi under the brand names Renagel (sevelamerhydrochloride) and Renvela (sevelamercarbonate).

Society and culture

Cost

This medication in the U.S. has a cost of $48 (USD) for 270 tablets (800 mg) as of 2021.[3]

  • Sevelamer costs (US)

    Sevelamer costs (US)

  • Sevelamer prescriptions (US)

    Sevelamer prescriptions (US)

Research

Sevelamer can significantly reduce serumuric acid.[9] This reduction has no known detrimental effect and several beneficial effects, including reducinghyperuricemia,uric acid nephrolithiasis, andgout.

Sevelamer is able to sequester advanced glycation end products (AGEs) in the gut, preventing their absorption into the blood. AGEs contribute tooxidative stress, which can damage cells (likebeta cells, which produceinsulin in thepancreas). As Vlassara and Uribarri explain in a 2014 review on AGEs, this may explain why sevelamer, but notcalcium carbonate (a phosphate binder thatdoes not sequester AGEs), has been shown to lower AGEs in the blood, as well as oxidative stress andinflammatory markers.[10]

References

  1. ↑1.01.11.21.31.41.51.61.71.8"Sevelamer Monograph for Professionals".Drugs.com.Archived from the original on 30 November 2020. Retrieved12 October 2021.
  2. ↑2.02.12.2BNF (80 ed.). BMJ Group and the Pharmaceutical Press. September 2020 – March 2021. p. 1116.ISBN 978-0-85711-369-6.{{cite book}}: CS1 maint: date format (link)
  3. ↑3.03.1"Sevelamer Prices, Coupons & Patient Assistance Programs".Drugs.com.Archived from the original on 19 January 2021. Retrieved7 April 2021.
  4. ↑Burke SK (September 2000). "Renagel: reducing serum phosphorus in haemodialysis patients". review.Hospital Medicine.61 (9): 622–7.doi:10.12968/hosp.2000.61.9.1419.PMID 11048603.
  5. ↑Habbous S, Przech S, Acedillo R, Sarma S, Garg AX, Martin J (January 2017)."The efficacy and safety of sevelamer and lanthanum versus calcium-containing and iron-based binders in treating hyperphosphatemia in patients with chronic kidney disease: a systematic review and meta-analysis". review.Nephrology, Dialysis, Transplantation.32 (1): 111–125.doi:10.1093/ndt/gfw312.PMID 27651467.
  6. ↑Patel L, Bernard LM, Elder GJ (February 2016)."Sevelamer Versus Calcium-Based Binders for Treatment of Hyperphosphatemia in CKD: A Meta-Analysis of Randomized Controlled Trials". review.Clinical Journal of the American Society of Nephrology.11 (2): 232–44.doi:10.2215/CJN.06800615.PMC 4741042.PMID 26668024.
  7. ↑Emmett M (September 2004). "A comparison of clinically useful phosphorus binders for patients with chronic kidney failure". review.Kidney International Supplements.66 (90): S25–32.doi:10.1111/j.1523-1755.2004.09005.x.PMID 15296504.
  8. ↑Ramsdell R (June 1999). "Renagel: a new and different phosphate binder". review.ANNA Journal.26 (3): 346–7.PMID 10633608.
  9. ↑Locatelli F, Del Vecchio L (May 2015). "Cardiovascular mortality in chronic kidney disease patients: potential mechanisms and possibilities of inhibition by resin-based phosphate binders". review.Expert Review of Cardiovascular Therapy.13 (5): 489–99.doi:10.1586/14779072.2015.1029456.PMID 25804298.S2CID 32586527.
  10. ↑Vlassara H, Uribarri J (January 2014)."Advanced glycation end products (AGE) and diabetes: cause, effect, or both?". review.Current Diabetes Reports.14 (1): 453.doi:10.1007/s11892-013-0453-1.PMC 3903318.PMID 24292971.

External links

Identifiers:
  • "Sevelamer".Drug Information Portal. U.S. National Library of Medicine.Archived from the original on 2020-11-20. Retrieved2020-12-16.
  • "Sevelamer hydrochloride".Drug Information Portal. U.S. National Library of Medicine.Archived from the original on 2021-08-29. Retrieved2020-12-16.
  • "Sevelamer carbonate".Drug Information Portal. U.S. National Library of Medicine.Archived from the original on 2020-10-22. Retrieved2020-12-16.
Drugs for treatment ofhyperkalemia andhyperphosphatemia (V03AE)
Potassium binders
Phosphate binders

Retrieved from "https://mdwiki.org/w/index.php?title=Sevelamer&oldid=1457217"
Categories: