From the Guidelines
The starting dose of Renvela (sevelamer carbonate) is typically 800 mg to 1600 mg taken three times daily with meals. For patients who are not already taking phosphate binders, the recommended starting dose is 800 mg three times daily with meals, as suggested by the most recent guidelines 1. For patients switching from sevelamer hydrochloride (Renagel), the same dose should be used. Dosing should be individualized based on the patient's serum phosphorus level, with a target range of 3.5 to 5.5 mg/dL. Some key points to consider when prescribing Renvela include:
- Dose adjustments can be made by increasing or decreasing the dose by 800 mg per meal at two-week intervals as needed.
- Renvela works by binding phosphate in the gastrointestinal tract, preventing its absorption, which helps manage hyperphosphatemia in patients with chronic kidney disease on dialysis.
- It's essential to take Renvela with meals as it needs to be present when phosphate is consumed to effectively bind it.
- Patients should swallow the tablets whole and not crush, chew, or break them. The most recent study 1 supports the use of sevelamer carbonate as a first-line treatment for hyperphosphatemia in patients with chronic kidney disease, due to its ability to effectively lower phosphate levels without the potential harm associated with calcium-based phosphate binders.
From the FDA Drug Label
The recommended starting dose of sevelamer hydrochloride tablets is 800 to 1600 mg, which can be administered as one or two 800 mg sevelamer hydrochloride tablets or two to four 400 mg sevelamer hydrochloride tablets, with meals based on serum phosphorus level. Starting dose is one or two 800 mg or two to four 400 mg tablets three times per day with meals
The starting dose of Renvela (sevelamer) is 800 to 1600 mg per dose, administered three times a day with meals, based on serum phosphorus level 2 2.
- The dose can be given as:
- One or two 800 mg tablets
- Two to four 400 mg tablets The dose should be adjusted based on the serum phosphorus concentration with a goal of lowering serum phosphorus to 5.5 mg/dL or less.
From the Research
Starting Dose of Renvela
The starting dose of Renvela (sevelamer carbonate) is not explicitly stated in the provided studies. However, the following information can be gathered:
- Sevelamer carbonate is used to treat hyperphosphatemia in adults with chronic kidney disease (CKD) 3.
- The dose of sevelamer carbonate is typically titrated to achieve serum phosphorus levels within a target range 4.
- In a study comparing sevelamer hydrochloride and calcium acetate in patients on peritoneal dialysis, the dose of sevelamer hydrochloride was titrated to achieve serum phosphorus levels of 3.0-5.5 mg/dl 4.
- The efficacy and safety of sevelamer carbonate have been compared to other phosphate binders, including calcium-based binders and lanthanum carbonate, in several studies 3, 5, 6.
- Sevelamer carbonate has been shown to be effective in reducing serum phosphorus levels and has a favorable safety profile compared to other phosphate binders 3, 5, 6.
Key Points
- Sevelamer carbonate is used to treat hyperphosphatemia in adults with CKD.
- The dose of sevelamer carbonate is typically titrated to achieve serum phosphorus levels within a target range.
- Sevelamer carbonate has been shown to be effective in reducing serum phosphorus levels and has a favorable safety profile compared to other phosphate binders.
- The starting dose of Renvela is not explicitly stated in the provided studies, but it is typically titrated to achieve serum phosphorus levels within a target range.
Phosphate Binders
- Sevelamer carbonate is a non-absorbed phosphate-binding anion exchange resin 3.
- Calcium-based phosphate binders are effective, but may contribute to total body calcium overload and vascular calcification 5.
- Lanthanum carbonate is a potent and selective phosphate binder that retains high affinity for phosphate over a wide pH range 5.
- Sevelamer hydrochloride and sevelamer carbonate have similar efficacy and safety profiles 6.