What is the equivalent dose of Renvela (sevelamer carbonate) for a patient taking Phoslo (calcium acetate) 667mg, 2 capsules three times a day (tid)?

From the FDA Drug Label

Table 3: Starting Dose for Dialysis Patients Switching from Calcium Acetate to Sevelamer Carbonate for Oral Suspension Calcium Acetate 667 mg (Tablets per meal) Sevelamer Carbonate for Oral Suspension 1 tablet 0.8 g 2 tablets 1.6 g 3 tablets 2.4 g

The patient is taking Phoslo (calcium acetate) 667mg, 2 capsules three times a day. According to the table, the equivalent dose of Renvela (sevelamer carbonate) for 2 tablets of calcium acetate is 1.6 g. Since the patient is taking this dose three times a day, the total daily dose of Renvela would be 1.6 g x 3 = 4.8 g. Therefore, you should order 4.8 g of Renvela per day for this patient 1.

From the Research

The equivalent dose of Renvela (sevelamer carbonate) for a patient taking Phoslo (calcium acetate) 667mg, 2 capsules three times a day would be approximately 800mg, 3 tablets three times a day with meals. This conversion is based on the relative phosphate-binding capacity of these two medications, as discussed in various studies 2, 3, 4. Phoslo 667mg × 2 capsules equals 1334mg of calcium acetate per dose, taken three times daily, which provides significant phosphate binding. When switching to Renvela, the standard conversion suggests using 800mg tablets, with 3 tablets per dose to achieve similar phosphate control, as supported by the most recent study 5. It's essential to monitor serum phosphorus levels 2-4 weeks after making this medication change, as individual responses vary and dose adjustments may be necessary. Unlike Phoslo, Renvela is calcium-free, which may be beneficial for patients with hypercalcemia or concerns about calcium load, though it may be more expensive, as noted in 3. The medication should always be taken with meals to effectively bind dietary phosphate in the gastrointestinal tract. Key points to consider when making this conversion include:

• The patient's individual response to the medication change
• The need for ongoing monitoring of serum phosphorus levels
• The potential benefits of a calcium-free phosphate binder for patients with hypercalcemia or concerns about calcium load
• The importance of taking the medication with meals to maximize its effectiveness. Overall, the conversion from Phoslo to Renvela should be made with careful consideration of the patient's individual needs and ongoing monitoring to ensure optimal phosphate control.