Sevelamer
Phosphate binders
Phosphate binders
A calcium-free, non-absorbed polymer taken with meals that binds dietary phosphate in people with kidney disease on dialysis.
Also called: Sevelamer carbonate, Sevelamer hydrochloride
Quick facts
- Group
- Phosphate binders
- Target
- Dietary phosphate in the gut lumen (the drug is not absorbed and has no human receptor)
- Used for
- Control of serum phosphorus
- Key effects
- Nausea · Diarrhoea or constipation · Abdominal pain
- Monitor
- Serum phosphorus and calcium · PTH · Bowel habit
- ATC
- V03AE02
No doses: the clinician sets them by the current guideline.
Mechanism of action
Sevelamer is a large cross-linked polymer with many amine groups that become positively charged in the gut. They bind negatively charged phosphate from food, and the complex leaves in the stool. Less phosphate is absorbed, so serum phosphorus falls without adding calcium or a metal. It also binds bile acids, which lowers LDL cholesterol.
- Sevelamer is swallowed with a meal and stays in the gut
- Its charged amine groups trap dietary phosphate
- The phosphate-polymer complex leaves in the stool
- Less phosphate is absorbed and serum phosphorus falls
Indications
- Control of serum phosphorus in chronic kidney disease on dialysis Chronic kidney disease →
- Prevention of the mineral and bone disorder driven by high phosphate CKD-mineral and bone disorder (renal osteodystrophy) →
Adverse effects
Common
- Nausea, vomiting
- Diarrhoea or constipation
- Abdominal pain, bloating, flatulence
- Dyspepsia
Contraindications
- Bowel obstruction
- Hypersensitivity to sevelamer or its excipients
Key interactions
- Ciprofloxacin
- Much lower ciprofloxacin absorption; doses are separated
- Mycophenolate mofetil
- Lower mycophenolate levels; doses are separated
- Levothyroxine
- Raised TSH reported; doses are separated and TSH is watched
- Ciclosporin and tacrolimus
- Lower levels reported; drug levels are monitored
What is monitored
- Serum phosphorus and calcium
- PTH (as part of the mineral-bone panel)
- Bowel habit, abdominal pain or distension
- Vitamin D, folic acid and signs of vitamin K deficiency (bleeding)
- Drug levels of transplant immunosuppressants
Administration and safety
- Taken with meals; tablets are swallowed whole, not crushed or chewed
- The powder is mixed with water or food as the label says, not heated, and taken soon after mixing
- Other oral medicines with a narrow margin are spaced from it as ordered
- A missed dose is skipped, not doubled
Pregnancy and breastfeeding
It is not absorbed, so the fetus is not expected to be exposed; vitamin and folic acid supplements may be needed.
Nursing care
- Check that it is given with meals, not at fixed hours on an empty stomach
- Ask about trouble swallowing; consider the powder form
- Watch for constipation, abdominal pain or distension and report them
- Space other oral medicines (antibiotics, thyroid hormone, immunosuppressants) as ordered
- Reinforce the low-phosphate diet with the renal team
Pharmacokinetics
- Absorption
- Not absorbed into the body
- Elimination
- Leaves in the stool with the bound phosphate
Test yourself
Think of the answer, then tap the question to see it.
Why is sevelamer useful in a dialysis patient with vascular calcification?
It lowers phosphate without adding calcium, unlike calcium-based binders.
Which two drugs, for example, can sevelamer bind and absorb less?
Any two of: ciprofloxacin, mycophenolate mofetil, levothyroxine, ciclosporin, tacrolimus.
What extra effect does sevelamer have on lipids?
It binds bile acids in the gut and lowers total and LDL cholesterol.
Connections
← Back to the class: Phosphate binders
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: DailyMed - SEVELAMER CARBONATE powder, for suspension (DailyMed (U.S. National Library of Medicine), 2026); Sevelamer: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2024); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.