From the Guidelines
Lanthanum carbonate (Fosrenol) is the most suitable alternative to Renvela (sevelamer) for administration via a Percutaneous Endoscopic Gastrostomy (PEG) tube, as it is available as a powder for oral suspension specifically designed for tube feeding. Several other phosphate binders can also be administered via PEG tubes, including calcium-based binders like calcium acetate (PhosLo) and calcium carbonate, which can be crushed and dissolved in water for PEG tube administration 1. Ferric citrate (Auryxia) tablets can be crushed and suspended in water, and aluminum hydroxide can be used short-term and comes in liquid formulations ideal for tube administration. Sucroferric oxyhydroxide (Velphoro) can be crushed and mixed with water.
When administering these alternatives through a PEG tube, it's essential to:
- Crush tablets completely
- Mix thoroughly with water
- Flush the tube before and after administration
- Temporarily stop tube feeding during administration to ensure proper binding of dietary phosphate These alternatives work by binding to phosphate in the gastrointestinal tract, preventing its absorption and helping manage hyperphosphatemia in patients with kidney disease who cannot take oral medications 1.
Key considerations for choosing a phosphate binder include patient preference, compliance, comorbid illnesses, side effects, cost, and the ability to control serum phosphorus levels while maintaining the desired calcium-phosphorus product and limiting total calcium intake 1. Additionally, non-calcium-based phosphate binders like sevelamer hydrochloride may be desirable in patients with severe vascular calcification, as they can help prevent the progression of calcification without increasing the risk of hypercalcemia 1.
From the Research
Alternative Phosphate Binders to Renvela
Alternative phosphate binders to Renvela (sevelamer) that can be administered via a Percutaneous Endoscopic Gastrostomy (PEG) tube include:
- Lanthanum carbonate: a non-calcium-based phosphate binder that has been shown to be effective in lowering serum phosphate levels in patients with chronic kidney disease (CKD) 2, 3
- Calcium acetate or carbonate: calcium-based phosphate binders that can be used as an alternative to sevelamer, but may have a higher risk of hypercalcemia 4, 5
- Magnesium carbonate: a phosphate binder that has been shown to have a high phosphate-binding capacity and may be a suitable alternative to sevelamer 4
Administration via PEG Tube
When administering phosphate binders via a PEG tube, it is essential to consider the formulation and dosage of the medication. Lanthanum carbonate, for example, is available in chewable tablets or powder form, which can be easily administered through a PEG tube 3. Calcium acetate or carbonate and magnesium carbonate may also be available in formulations suitable for administration via a PEG tube.
Efficacy and Safety
The efficacy and safety of alternative phosphate binders should be carefully evaluated, taking into account the individual patient's needs and medical history. Lanthanum carbonate, for example, has been shown to have a lower risk of hypercalcemia and may be a suitable alternative to sevelamer in patients at risk of metabolic acidosis 2, 3. However, the use of lanthanum carbonate may be associated with gastrointestinal side effects, such as nausea and alkaline gastric reflux 3.