Phosphorus binders for hyperphosphatemia treatment

Sucroferric oxyhydroxide was found to be noninferior to sevelamer carbonate in reducing serum phosphate in an open-label clinical trial of 1, patients. Phoslyra calcium acetate oral solution package insert. Hyperphosphatemia and phosphate binders. Patients should be monitored regularly for iron overload.

Phosphorus binders for hyperphosphatemia treatment

Caution should be used in patients who have peritonitis during peritoneal dialysis or hemochromatosis and immediately after GI surgery. Hence, these drugs are usually taken with meals to bind any phosphate that may be present in the ingested food. Selection of phosphate binders should be based on patient characteristics, including serum phosphate, serum calcium, and intact parathyroid hormone concentrations, and patient tolerability. Calcium acetate is effective over a wide pH range. Causes of hyperphosphatemia include impaired phosphorus excretion renal failure or hypoparathyroidism , redistribution of phosphorus to the extracellular fluid acid-base imbalance, rhabdomyolysis, muscle necrosis, or tumor lysis during chemotherapy , and increased phosphate intake. An advantage for calcium acetate is less systemic absorption compared to other calcium salts, but it still can cause hypercalcemia. The body's compensation mechanisms cause secondary hyperparathyroidism and renal osteodystrophy. Columbus, OH: Roxane Laboratories; The treatment of hyperphosphatemia in patients with chronic renal failure includes dialysis, dietary phosphorus restrictions, phosphate-binding medications, and vitamin D analogs. Package labeling indicates a starting dose of 2 tablets orally 3 times per day with meals, adjusting the dose by 1 to 2 tablets as needed to maintain serum phosphorus levels at target, with the maximum being 12 tablets daily. Recently, two iron-based phosphate binders have been approved. Velphoro sucroferric oxyhydroxide package insert. Common adverse effects include vomiting, nausea, diarrhea, and dyspepsia.

Sucroferric oxyhydroxide and ferric citrate are calcium-free and may offer benefits in those with a high pill burden and in patients with concurrent anemia, respectively. In addition, many patients with CKD are iron-deficient.

Magnesium hydroxide has similar phosphate-lowering capacity compared to calcium-based agents and is infrequently used as add-on therapy.

what are phosphate binders used for

Sevelamer revisited: pleiotropic effects on endothelial and cardiovascular risk factors in chronic kidney disease and end-stage renal disease. Recent advancements have been made in phosphate-binder treatment.

hyperphosphatemia treatment guidelines

TABLE 2 summarizes the place in therapy, dosing, adverse-effect profile, and patient considerations for these agents. Clinical Pharmacology [online database]. Iron in the ferric form binds phosphate in the GI tract and forms a precipitate of ferric phosphate, which is then excreted as fecal matter.

An advantage for calcium acetate is less systemic absorption compared to other calcium salts, but it still can cause hypercalcemia.

natural phosphorus binders for humans

This has not been reported in iron-based phosphate binders, but it remains a consideration. Ferric citrate has the potential to decrease the absorption of doxycycline.

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New Pharmacotherapy Options for Hyperphosphatemia