Contraindications of Renvela (Sevelamer Carbonate)
Renvela is contraindicated in patients with bowel obstruction and in those with known hypersensitivity to sevelamer carbonate, sevelamer hydrochloride, or any of the excipients. 1
Absolute Contraindications
Bowel Obstruction
- Sevelamer carbonate is absolutely contraindicated in patients with bowel obstruction due to the risk of worsening obstruction. 1
- This is a critical safety concern given the medication's mechanism as a non-absorbable resin that remains in the gastrointestinal tract. 1
Hypersensitivity
- Known hypersensitivity to sevelamer carbonate, sevelamer hydrochloride, or any excipients is an absolute contraindication. 1
- This includes any previous allergic reactions to either formulation of sevelamer. 1
Clinical Situations Where Sevelamer Should Be Avoided
Active Gastrointestinal Pathology
- While not listed as a formal contraindication, caution is warranted in patients with gastrointestinal symptoms, as sevelamer crystal deposition can cause deep ulcers, mucosal edema, and lower gastrointestinal bleeding. 2
- Sevelamer should be discontinued immediately if gastrointestinal bleeding or severe abdominal pain develops, as symptoms and mucosal damage typically revert after cessation. 2
Relative Contraindications (Clinical Cautions)
Hypocalcemia: Sevelamer reduces serum calcium levels more than calcium-based binders and should be used cautiously in patients with existing hypocalcemia, particularly those on concurrent calcimimetics. 3, 4
Severe Dysphagia or Swallowing Disorders: Sevelamer tablets cannot be crushed and must be swallowed whole, making them inappropriate for patients requiring crushed medications. 3
Common Pitfalls to Avoid
- Do not confuse contraindications with preferred clinical scenarios—while sevelamer is preferred in hypercalcemia, vascular calcification, and low PTH states, these are indications for use, not contraindications. 3, 4
- The most common adverse events are gastrointestinal in nature, but these are not contraindications unless they progress to severe complications like obstruction or bleeding. 5