Generic Name

Sevelamer Carbonate

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Classification

FDA Approved Indications

• Control of serum phosphorus in patients with chronic kidney disease (CKD) on dialysis

Mechanism of Action

Sevelamer carbonate binds dietary phosphate in the gastrointestinal tract, reducing its absorption and thereby lowering serum phosphate levels.

Dosage and Administration

Adult: Initially 0.8 to 2.4 g taken with meals; titrate based on serum phosphate levels

Pediatric: Safety and effectiveness not established; use in children is not recommended without specialist consultation

Geriatric: No specific dose adjustment; monitor renal function and serum phosphate closely

Renal Impairment: Adjust dose based on serum phosphate levels; monitor closely

Hepatic Impairment: No specific adjustment needed

Pharmacokinetics

Absorption: Negligible oral absorption; acts locally in the gastrointestinal tract

Distribution: Not applicable, non-absorbed polymer

Metabolism: Not metabolized, remains unchanged in GI tract

Excretion: Excreted in feces

Half Life: Not applicable, as it acts locally and is not absorbed

Contraindications

• Bowel obstruction

Precautions

• Use with caution in patients with gastrointestinal motility disorders or bowel perforation; monitor serum electrolytes especially in diabetic or acidotic patients

Adverse Reactions - Common

• Nausea (Occasional)
• Vomiting (Less common)
• Diarrhea or constipation (Variable)

Adverse Reactions - Serious

• Esophageal or intestinal obstruction (Rare)
• Electrolyte disturbances, including hypokalemia, hypocalcemia, metabolic acidosis (Rare)

Drug-Drug Interactions

• Separate administration from drugs that bind minerals or have high affinity for phosphate, such as ferrous sulfate, delayed-release medications, separate by at least 1 hour before or 3 hours after

Drug-Food Interactions

• No significant interactions reported

Drug-Herb Interactions

• Limited data

Nursing Implications

Patient/Family Teaching

• Take with meals as directed
• Do not chew or crush the medication
• Report any gastrointestinal discomfort or signs of bowel obstruction
• Maintain dietary phosphate restrictions as advised by healthcare provider

Special Considerations

Black Box Warnings:

• None specifically labeled, but use cautiously in patients with bowel obstruction

Genetic Factors: None well established

Lab Test Interference: May interfere with assays measuring serum phosphorus levels; notify laboratory of medication use

Overdose Management

Signs/Symptoms: No specific overdose symptoms; may cause severe gastrointestinal obstruction or electrolyte disturbances

Treatment: Supportive care, gastrointestinal monitoring, and correction of electrolyte imbalances; no specific antidote

Storage and Handling

Storage: Store at room temperature away from moisture and heat

Stability: Stable under recommended storage conditions for the duration of the labeled expiration date