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. Table 1 provides recommended starting doses of sevelamer hydrochloride tablets for patients not taking a phosphate binder Table 1: Starting Dose for Dialysis Patients Not Taking a Phosphate Binder Serum Phosphorus Sevelamer Hydrochloride Tablets 800 mg Sevelamer Hydrochloride Tablets 400 mg
5.5 and <7.5 mg/dL 1 tablet three times daily with meals 2 tablets three times daily with meals ≥7. 5 and <9 mg/dL 2 tablets three times daily with meals 3 tablets three times daily with meals ≥9 mg/dL 2 tablets three times daily with meals 4 tablets three times daily with meals Adjust dosage based on the serum phosphorus concentration with a goal of lowering serum phosphorus to 5. 5 mg/dL or less. Increase or decrease by one tablet per meal at two-week intervals as necessary.
The starting dose of Sevelamer is 800 to 1600 mg, administered as one or two 800 mg tablets or two to four 400 mg tablets, three times daily with meals, based on serum phosphorus level. The dose can be adjusted by one tablet per meal at two-week intervals to achieve a serum phosphorus target of 3.5 to 5.5 mg/dL 1.
From the Research
Sevelamer dosing should start at 800 mg three times daily with meals for adults with hyperphosphatemia due to chronic kidney disease, as evidenced by a study published in 2023 2. The dose should be adjusted based on serum phosphorus levels, with a target range of 3.5-5.5 mg/dL. Titration may occur every 2-4 weeks in increments of 800 mg per meal until phosphorus control is achieved, with maximum doses typically around 12-13 g daily. Sevelamer should always be taken with meals as it works by binding dietary phosphate in the gastrointestinal tract, preventing its absorption. The medication is available as sevelamer hydrochloride (Renagel) or sevelamer carbonate (Renvela), with the carbonate form generally preferred due to less risk of metabolic acidosis, as noted in a study from 2014 3. Patients should swallow tablets whole with water and not crush or chew them. Common side effects include gastrointestinal discomfort, constipation, and nausea. Sevelamer may interact with certain medications by binding to them, so other oral medications should be taken at least one hour before or three hours after sevelamer. Key considerations for sevelamer dosing include:
- Starting dose: 800 mg three times daily with meals
- Titration: every 2-4 weeks in increments of 800 mg per meal
- Maximum dose: typically around 12-13 g daily
- Target serum phosphorus range: 3.5-5.5 mg/dL
- Preferred formulation: sevelamer carbonate (Renvela) due to less risk of metabolic acidosis
- Administration: with meals, swallowing tablets whole with water, without crushing or chewing
- Potential interactions: with other oral medications, which should be taken at least one hour before or three hours after sevelamer. A study from 2022 4 also highlighted the importance of sevelamer carbonate in reducing serum phosphate levels and improving cardiovascular risk factors in patients with chronic kidney disease. Additionally, a meta-analysis from 2016 5 found that sevelamer was associated with lower all-cause mortality compared to calcium-based binders in patients with CKD stages 3-5D. However, the most recent and highest quality study 2 provides the most relevant guidance for sevelamer dosing.