sucroferric oxyhydroxide

sucroferric oxyhydroxide

(soo-kroe-fer-ik ox-ee-hye-drox-ide),

Velphoro

(trade name)

Classification

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

Indications

Control of elevated serum phosphorous levels in patients with chronic renal disease currently on dialysis.

Action

Binds dietary phosphorous in the GI tract via ligand exchange.

Therapeutic effects

Decreased serum phosphorous levels and sequelae of hyperphosphatemia.

Pharmacokinetics

Absorption: Phosphate binding is local with no systemic absorption. Minimal amounts of released iron may be absorbed.
Distribution: Unknown.
Metabolism and Excretion: Action is local, no metabolism. Bound phosphate is excreted in feces.
Half-life: Unknown.

Time/action profile (phosphorous lowering)

ROUTEONSETPEAKDURATION
POwithin 4 wk12–16 wklength of treatment

Contraindications/Precautions

Contraindicated in: None noted.
Use Cautiously in: Peritonitis (from peritoneal dialysis), significant hepatic/gastric disorders, following major GI surgery, history of hemochromatosis/diseases of iron accumulation; Obstetric: Use during pregnancy only if clearly needed; Pediatric: Safe and effective use in children has not been established.

Adverse Reactions/Side Effects

Gastrointestinal

  • discolored feces (most frequent)
  • diarrhea
  • nausea
  • unpleasant taste

Interactions

Drug-Drug interaction

Should not be used concurrently with oral levothyroxine or oral Vitamin D analogs due to interference with phosphorous homeostatis.May ↓ absorption and effectiveness of alendronate or doxycyline, administer 1 hr before sucroferric oxyhydroxide.

Route/Dosage

Oral (Adults) 500 mg three time daily (with meals) initially, may be titrated by 500 mg/day at weekly intervals depending on serum phosphorous, usual range is 1500–3000 mg/day in three divided doses.

Availability

Chewable tabletswildberry: 500 mg

Nursing implications

Nursing assessment

  • Monitor for abdominal pain or discomfort. Sucroferric oxyhydroxide causes discolored (black) stool and may mask GI bleeding. Medication does not effect guaiac based (Hemocult) or immunological based (iColoRectal and Hexagon Opti) fecal occult blood tests.
  • Lab Test Considerations: Monitor serum phosphorous levels and dose of sucroferric oxyhydroxide. Dose is titrated in increments of 500 mg (1 tablet) per day as needed until acceptable serum phosphorous level (≤5.5 mg/dL) is reached. Monitor periodically thereafter. May begin titration 1 wk after start of therapy and adjust at weekly intervals.
    • Monitor effect and iron homeostasis in patients with peritonitis during peritoneal dialysis, significant hepatic or gastric disorders, following major gastrointestinal surgery, or with a history of hemachromatosis or other diseases with iron accumulation.

Potential Nursing Diagnoses

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

Implementation

  • Oral: Administer 3 times daily with meals. Tablets must be chewed; do not swallow whole. Tablets may be crushed prior to swallowing. No additional fluid is required above usual amount taken.

Patient/Family Teaching

  • Instruct patient to take medication as directed. Do not attempt to replace missed doses; resume medication with next meal; do not double doses.
  • Advise patient to avoid taking levothyroxine and vitamin D analogs during therapy and to take alendronate and doxycycline at least 1 hr before sucroferric oxyhydroxide.
  • Advise female patient to notify health care professional if pregnancy is planned or suspected.

Evaluation/Desired Outcomes

  • Decreased serum phosphorous levels.
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References in periodicals archive ?
Several compounds, such as ferric citrate, iron-magnesium hydroxycarbonate, and sucroferric oxyhydroxide, have undergone clinical trials for evaluation of efficacy and safety (Negri & Torres, 2014).