Renagel


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sevelamer

(se-vel-a-mer) ,

Renagel

(trade name),

Renvela

(trade name)

Classification

Therapeutic: electrolyte modifiers
Pharmacologic: phosphate binders
Pregnancy Category: C

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).

Pharmacokinetics

Absorption: Not absorbed; action is local (in GI tract).
Distribution: Unknown.
Metabolism and Excretion: Eliminated in feces.
Half-life: Unknown.

Time/action profile (↓ in serum phosphate levels)

ROUTEONSETPEAKDURATION
PO5 days2 wkunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Hypophosphatemia;Bowel obstruction.
Use Cautiously in: Dysphagia, swallowing disorders, severe GI motility disorders, or major GI tract surgery; Obstetric / Lactation / Pediatric: Safety not established.

Adverse Reactions/Side Effects

Gastrointestinal

  • bowel obstruction/perforation (life-threatening)
  • esophageal obstruction (tablet) (life-threatening)
  • diarrhea (most frequent)
  • dyspepsia (most frequent)
  • vomiting (most frequent)
  • choking (tablet)
  • constipation
  • dysphagia (tablet)
  • flatulence
  • nausea

Interactions

Drug-Drug interaction

May ↓ absorption of other drugs and ↓ effectiveness, especially drugs whose efficacy is dependent on tightly controlled blood levels.↓ absorption of ciprofloxacin.

Route/Dosage

Oral (Adults) 800–1600 mg with each meal; may titrate by 800 mg every 2 wk to achieve target serum phosphorus levels.

Availability

Tablets: 400 mg, 800 mg
Powder for oral suspension: 800 mg/packet, 2400 mg/packet

Nursing implications

Nursing assessment

  • Assess patient for GI side effects periodically during therapy.
  • Lab Test Considerations: Monitor serum phosphorous, calcium, bicarbonate, and chloride levels periodically during therapy.

Potential Nursing Diagnoses

Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Do not confuse Renagel with Renvela.
  • Doses of concurrent medications, especially antiarrhythmics, should be spaced at least 1 hr before or 3 hr after sevelamer.
  • Oral: Administer with meals. Do not break, chew, or crush tablets; contents expand in water.
    • Place contents of powder packet in a cup and mix thoroughly with at least 1 ounce of water for the 0.8-g dose or 2 ounces of water for the 2.4-g dose packet. Stir mixture vigorously (it does not dissolve) and drink entire preparation within 30 min or resuspend the preparation right before drinking.

Patient/Family Teaching

  • Instruct patient to take sevelamer with meals as directed and to adhere to prescribed diet.
  • Caution patient to space concurrent medications at least 1 hr before or 3 hr after sevelamer.
  • Advise patient to notify health care professional if GI effects are severe or prolonged.

Evaluation/Desired Outcomes

  • Decrease in serum phosphorous concentration to ≤6 mg/dL. Dose adjustment is based on serum phosphorous concentrations.

sevelamer

A phosphate chelator used to reduce phosphorus in patients with end-stage renal disease and in chronic renal failure patients not requiring dialysis. It also reduces uric acid levels, and may be of use in patients with hyperuricaemia, uric acid nephrolithiasis and gout.

Adverse effects
Blood pressure lability (hypo- or hypertension), nausea, vomiting, dyspepsia, diarrhoea, constipation.

Renagel®

Sevelamer, see there.
References in periodicals archive ?
Also Known Colesevelam Kayexalte Renagel, As (Welchol), Renvela colestipol (Colestid), and cholestyramine (LoCholest, Prevalite, and Questran) Target ion Bile acids Potassium Phosphate Clinical Diarrhea Chronic Chronic history renal renal failure failure Mucosal No Yes Possible injury Fish-scales None Yes Yes H&# Bright orange Purple 2-toned pink/yellow AFB Dull yellow Black Magenta
Enrollment is also complete in a study comparing a powder form of sevelamer carbonate dosed once a day to Renagel tablets dosed three times a day.
The total Medicare Parts A and B expenditures averaged $4,422 per member per month in the RenaGel group, compared with $5,866 per member per month in the controls, for an average annual difference of $17,328 per patient, he said.
Genzyme says Renvela is a next generation version of Renagel, a calcium-free, metal-free, non-absorbed phosphate binder, and has the added benefit of a carbonate buffer.
Renagel Capsules provide an elegant solution by using a phosphate-binding polymeric gel.
Renvela is a next-generation version of the company's Renagel, the most-prescribed phosphate binder in the US.
The program covers commonly prescribed bone disease medications, including Fosrenol, Hectorol, Phoslo, Renagel, Sensipar, and Semplar.
5 mg at HS, Labetolol 300 mg BID, Zestril 40 mg QD, Renagel 800 mg TID with meals, and Hectorol 5 mcg.
However, phosphate binders Renagel (sevelamer hydrochloride), Renvela (sevelamer carbonate), Fosrenol (lanthanum carbonate) and Phoslo Gelcaps (calcium acetate) all show low patient compliance due to low efficacy and safety profiles, common side effects such as gastrointestinal intolerance, a high pill burden, and a high expense of therapy.
The three- year trial involving more than 2,100 patients compared the difference in mortality and morbidity outcomes for patients receiving Renagel (sevelamer hydrochloride) with those using calcium-based phosphate binders.
Bone Care's Hectorol line of vitamin D2 prohormone product, is used to treat secondary hyperparathyroidism in patients on dialysis, where it can be taken in tandem with Genzyme's Renagel and other phosphate binders.
Genzyme's primary drug in the kidney transplant area is Renagel (sevelamer hydrochloride), a phosphate binder for patients with end stage renal disease undergoing hemodialysis.