III. Technique

  1. Take Phosphate Binders with food
  2. Take other medications at least one hour before or 3 hours after Phosphate Binders

IV. Preparations: Calcium based

  1. Calcium Carbonate (e.g. Tums)
    1. Effective and inexpensive, but increases Serum Calcium
    2. Starting dose: 3 tabs daily (increase up to 17 tabs/day in some cases)
  2. Calcium Acetate (e.g. Phoslo, phoslyra)
    1. Effective and inexpensive, but increases Serum Calcium (less than Calcium Carbonate)
    2. Starting dose: 3 tabs daily

V. Preparations: Non-Calcium based agents

  1. Sevelamer HCl (RenaGel)
    1. Less effective than Calcium-based binders and expensive, but does not increase Serum Calcium
    2. Risk of Metabolic Acidosis
    3. Starting dose: 3-12 tabs daily (increase to 9 tabs/day or more in some cases)
  2. Sevelamer Carbonate (Renvela)
    1. Less effective than Calcium-based binders and expensive (but less expensive than RenaGel)
      1. However, does not increase Serum Calcium, unlike Calcium-based binders
      2. Does not cause Metabolic Acidosis unlike Sevelamer HCl (RenaGel)
    2. Starting dose: 3-6 tabs daily (increase to 9 tabs/day or more in some cases)
  3. Lanthanum Carbonate (Fosrenol)
    1. Effective and does not increase Serum Calcium, but expensive (more than Sevelamer)
    2. Starting dose: 3 tabs daily

VI. Preparations: Iron Containing Phosphate Binders

  1. Sucroferric oxyhydroxide (Velphoro)
    1. Effective and does not increase Serum Calcium, but expensive
    2. Increases iron levels minimally (less than ferric citrate)
    3. Starting dose: 3 tabs daily
  2. Ferric Citrate (Auryxia)
    1. Effective and does not increase Serum Calcium, but expensive
    2. Increases iron levels and reduces need for IV iron requirements and Erythropoietin (e.g. Epogen)
    3. Starting dose: 6 tabs daily (maximum 12 tabs/day)

VII. References

  1. (2019) Presc Lett 26(9):53
  2. (2015) Presc Lett 22(8)
  3. Hutchison (2009) Kidney Int 75:906-14 +PMID:19279554 [PubMed]

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Related Studies

Cost: Medications

sevelamer (on 9/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
SEVELAMER 0.8 GM POWDER PACKET Generic $3.10 each
SEVELAMER 2.4 GM POWDER PACKET Generic $3.55 each
SEVELAMER CARBONATE 800 MG TAB Generic $0.23 each
SEVELAMER HCL 800 MG TABLET Generic $3.36 each
lanthanum (on 10/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LANTHANUM CARB 1,000 MG TB CHW Generic $7.20 each
LANTHANUM CARB 500 MG TAB CHEW Generic $6.84 each
renvela (on 6/22/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
RENVELA 800 MG TABLET Generic $0.23 each
velphoro (on 9/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
VELPHORO 500 MG CHEWABLE TAB $16.23 each
auryxia (on 1/1/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
AURYXIA 210 MG TABLET $7.02 each