In order to reduce serum phosphate concentrations to recommended values, phosphate binders (P binders) are used to bind ingested phosphate in the digestive tract. Besides the traditional therapies with calcium and aluminium salts, sevelamer and lanthanum represent recent developments on the market.
Is lanthanum carbonate more potent than other dietary phosphate binders?
These studies indicate that lanthanum carbonate is the more potent of the currently available dietary phosphate binders. No adverse secondary pharmacological actions were observed in vivo in a systematic evaluation at high doses. Publication types Comparative Study Research Support, Non-U.S. Gov't
What is the effect of phosphate binders on calcium absorption?
Binding of phosphate in diet hampers the calcium absorption. It reduces absorption of calcium from the gut. But calcium based phosphate binders with or without administration of calcitriol may increase the risk of hypercalcemia.
What are the different types of phosphate binders?
On the basis of active ingredient of principle phosphate binding salt phosphate binders can be divided into following categories: Aluminium based phosphate binders also acts as an antacid as well. These are poorly absorbed from gut but have shown toxic side effects in long term.
What is chitosan based phosphate binders?
Chitosan based phosphate binders Chitosan is a natural polysaccharide derived from chitin (outer skeleton of shellfish, crab, lobster and shrimp etc.). It is a uremic toxin binder and also shown to reduce creatinine and urea levels. Usually comes in combination with other phosphate binders like calcium carbonate.
What are examples of phosphate binders?
Types of phosphate bindersExamples of calcium-based phosphate binders: PhosLyra, Calphron, PhosLo, Eliphos.Examples of aluminum-based binders: Alternagel, Amphojel (no longer available in the United States)Examples of calcium-free, aluminum-free binders: Renvela, Renagel, Fosrenol.More items...•
What is the drug of choice for hyperphosphatemia?
Aluminum Hydroxide: The antacid aluminum hydroxide (various formulations) is a phosphate binder used to treat hyperphosphatemia.
What medications are phosphorus binders?
List of Phosphate binders:Drug NameAvg. RatingReviewsRenvela (Pro) Generic name: sevelamer5.47 reviewsAuryxia (Pro) Generic name: ferric citrate5.16 reviewsFosrenol (Pro) Generic name: lanthanum carbonate7.25 reviewsPhosLo (Pro) Generic name: calcium acetate8.02 reviews7 more rows
What are natural phosphate binders?
Currently, the commonly used phosphate binders are calcium carbonate, calcium acetate, sevelamer hydrochloride, lanthanum carbonate, and magnesium hydroxide. These binders are reasonably safe and moderately bind dietary phosphates.
What is the best phosphorus binder?
Calcium carbonate is the most commonly used phosphate binder, but clinicians are increasingly prescribing the more expensive, non-calcium-based phosphate binders, particularly sevelamer.
What is treatment for elevated phosphorus in renal patients?
In daily clinical practice, the management of hyperphosphatemia is based on 4 main strategies: (i) restriction of dietary phosphate intake; (ii) reduction of its intestinal absorption; (iii) phosphate removal by dialysis; and (iv) treatment and prevention of renal osteodystrophy.
Is there an alternative to Renvela?
Sevelamer carbonate—the authorized generic identical to Renvela.
Do all dialysis patients need phosphate binders?
Dietary restriction of phosphate and current dialysis prescription practices are not enough to maintain serum phosphate levels within the recommended range so that the majority of dialysis patients require oral phosphate binders.
What OTC meds reduce hyperphosphatemia?
Drugs used to treat HyperphosphatemiaDrug nameRatingRx/OTCExpand current row for information about PhosLo PhosLo8.0Rx/OTCGeneric name: calcium acetate systemic Drug class: minerals and electrolytes, phosphate binders For consumers: dosage, interactions, side effects For professionals: Prescribing Information16 more rows
How can I lower my phosphorus naturally?
Lower-phosphorus alternatives to choose:Fresh fruits and vegetables.Rice milk, unenriched.Breads.Pasta.Rice.Fish.Corn and rice cereals.Soda without phosphate additives.More items...•
Is magnesium a phosphate binder?
Early studies comparing the use of aluminum hydroxide and magnesium hydroxide or magnesium carbonate showed that magnesium could be used as an effective phosphate binder, but it is widely acknowledged that magnesium hydroxide caused gastrointestinal side effects, whereas the carbonate salt is much better tolerated.
How do you lower phosphorus quickly?
Here are seven methods to help control high levels of phosphorus:Reduce the amount of phosphorus you eat. ... Take phosphorus binders. ... Take vitamin D. ... Take a calcimimetic medicine. ... Stay on dialysis the entire time. ... Start an exercise program approved by a doctor. ... Get an operation to remove some of the parathyroid glands.
What OTC meds reduce hyperphosphatemia?
Drugs used to treat HyperphosphatemiaDrug nameRatingRx/OTCExpand current row for information about PhosLo PhosLo8.0Rx/OTCGeneric name: calcium acetate systemic Drug class: minerals and electrolytes, phosphate binders For consumers: dosage, interactions, side effects For professionals: Prescribing Information16 more rows
Does calcium gluconate lower phosphorus?
We consider that i.v. drop of calcium gluconate can accelerate the elimination of phosphorus, and prevent phosphorus poisoning after phosphorus burns.
What is the brand name of sevelamer?
Renvela® (sevelamer carbonate) is used to control phosphorus levels in adults and children 6 years of age and older with chronic kidney disease (CKD) on dialysis.
How do you get your phosphorus level down?
Here are seven methods to help control high levels of phosphorus:Reduce the amount of phosphorus you eat. ... Take phosphorus binders. ... Take vitamin D. ... Take a calcimimetic medicine. ... Stay on dialysis the entire time. ... Start an exercise program approved by a doctor. ... Get an operation to remove some of the parathyroid glands.
What are phosphate binders used for?
Oral phosphate binders are widely used in clinical practice for patients with end-stage renal disease. It should be recognized that all phosphate binders have equal ability to maintain serum phosphorus in the targeted level provided the patient is compliant and tolerant of the treatment regimen. Calcium-based phosphate binders are often used for CKD stages 3 to 5; they are inexpensive, but have a potential to cause hypercalcemia. Recent advancements have been made in phosphate-binder treatment. Sevelamer and lanthanum can be used in the setting of hypercalcemia, and they offer a cardiovascular mortality benefit. The recently approved iron-based products may have a role in certain patients, but the long-term safety risk of these products has not been established. It is important for the pharmacist, as an essential member of the healthcare team, to be familiar with these new treatments in order to optimize therapy in the setting of hyperphosphatemia.
When was Sevelamer Hydrochloride and Carbonate approved?
Sevelamer Hydrochloride and Carbonate: Sevelamer hydrochloride (Renagel) was originally FDA-approved in 1998 for the treatment of hyperphosphatemia in hemodialysis patients and was approved in 2007 for patients on peritoneal dialysis. 9 Sevelamer carbonate (Renvela) received an indication for hemodialysis in 2007.
What is sucroferric oxyhydroxide?
15 This product is indicated for the treatment of hyperphosphatemia in patients with CKD on dialysis. Sucroferric oxyhydroxide is an iron (III) oxyhydroxide molecule bound to a carbohydrate molecule, with iron constituting approximately 20% of the molecular weight. Sucroferric oxyhydroxide uses a ligand exchange reaction with hydroxyl molecules to bind phosphorus in the GI tract. The active form of the drug is insoluble and cannot be metabolized or absorbed. Sucroferric oxyhydroxide was found to be noninferior to sevelamer carbonate in reducing serum phosphate in an open-label clinical trial of 1,059 patients. 14 The sugar portion is also absorbable, with one tablet producing 1.4 grams of carbohydrates, which may be of concern for the diabetic patient. 15 The initial dose is 500 mg three times daily with meals and can be titrated at weekly intervals by 500 mg/day until serum phosphorus levels are 5.5 mg/dL. The tablets should not be swallowed but can be chewed or crushed. 15
What is the stage of hyperphosphatemia in CKD?
Hyperphosphatemia in CKD stages 1 to 3 can typically be controlled with dietary changes. Calcium-based products are often started in stage 4 secondary to efficacy, safety, and cost. In CKD stage 5, hypercalcemia can increase the risk of cardiovascular disease.
What binders are used for CKD?
4 These guidelines recommend that for high phosphorus uncontrolled by dietary measures, calcium-based phosphate binders are a reasonable choice for CKD stages 3 and 4. Stage 5 patients may use either calcium or non-calcium-based binders, and if a dialysis patient remains hyperphosphatemic (>5.5 mg/dL) it is reasonable to use a combination of both. 4
What is hyperphosphatemia in kidneys?
ABSTRACT: Hyperphosphatemia is an abnormally high level of serum phosphate that contributes to chronic kidney disease (CKD). The management of hyperphosphatemia has included dietary phosphate restriction and use of phosphate binders. The first phosphate binders were aluminum- and magnesium-based antacids.
What is calcium carbonate?
Calcium Carbonate: Calcium carbonate (Os-Cal, Tums, various other brands), commonly used as a calcium supplement or as an antacid, has phosphate-binding properties . It has been used for decades in patients with high serum phosphate who are undergoing dialysis and is one of the most commonly used phosphate binders in practice. 2 The usefulness of calcium carbonate as a phosphate binder is limited by its insolubility at high gastric pH, which is common in those with renal disease. 7 The greatest safety concern is hypercalcemia, which has the potential to cause arterial calcification and has been associated with cardiac death. Overall cost of this medication is low, so it is an attractive first-line agent if hypercalcemia is not a concern. 8
What are phosphate binders?
Phosphate-binding agents are indicated to the vast majority of adult and pediatric patients undergoing current standard dialysis regimens.1 Reducing the daily dietary load of phosphorus by restricting the intake of foods with high phosphorus content cannot be undertaken without severely compromising protein intake. Furthermore, long-term compliance with a restricted diet is generally poor. In addition, current dialysis prescription is unable to maintain normal phosphorus balance if an adequate protein intake is given.1,2 Prolonged nocturnal dialysis has been shown to achieve better control of phosphorus compared to short daily dialysis and the use of phosphate binders may not be required. In some instances, phosphate should be added to the dialysate solution.3,4 However, such dialytic modality is not yet widely accepted. Therefore, because of these limitations, the majority of patients with advanced chronic kidney disease (CKD) require treatment with phosphate binders to limit the absorption of dietary phosphorus and to maintain serum phosphorus levels within the normal physiological range.
What binders are used for CKD?
Therefore, phosphate binders that limit the absorption of dietary phosphorus are commonly prescribed for this patient group. The first phosphate binders were introduced more than 30 years ago and included aluminum salts; however, although effective binders, the use of these agents was subsequently restricted because of concerns over aluminum accumulation in the central nervous system, bone, and hematopoietic cells. In subsequent years, calcium salts, namely calcium carbonate and calcium acetate, became the most widely used phosphate binders; however, increasing evidence now suggests that prolonged use of these agents increases the total body calcium load, induces adynamic bone, and potentially increases the risk of cardiovascular and soft tissue calcification. Sevelamer is the first phosphate- binding agent that is non-absorbed, calcium-free, and metal-free. To date, this agent has been shown to effectively control serum phosphorus levels in patients with CKD. It may also attenuate coronary and aortic calcification and has a number of other beneficial effects on lipid metabolism and inflammation among others. Lanthanum carbonate is another new agent that is reported to provide similar phosphate control to calcium-based phosphate binders but concerns that the long-term administration of such compound may lead to tissue accumulation may limit its use.
Is aluminum a phosphate binder?
Until the mid-1980s, the aluminum-containing phosphate binder, aluminum hydroxide, and to a lesser extent aluminum carbonate, constituted the mainstay of treatment for hyperphosphatemia in patients with CKD.2,5 However, although aluminum salts are highly effective as phosphate binders, it is now recognized that chronic administration of these compounds leads to significant accumulation of aluminum in the central nervous system, bone and hematopoietic cells, and the development of severe toxic effects including encephalopathy, osteomalacia, myopathy, and microcytic anemia.5,6 Patients with CKD treated with aluminum salts are particularly susceptible to the effects of cumulative ingestion of aluminum because plasma protein binding prevents the removal of high concentrations of aluminum by dialysis.7 Furthermore, when recommended ‘safe’ doses of aluminum hydroxide were prospectively compared to calcium-based binders, Salusky et al.8 demonstrated that, aluminum hydroxide was less effective than calcium carbonate as a phosphate binder, and plasma aluminum levels increased over time and were associated with an increased aluminum body burden. One patient actually developed aluminum bone disease in this study. Thus, if prescribed, aluminum should be used only for 4–8 weeks.9 Moreover, care should be taken to avoid concomitant use of sodium citrate or calcium citrate, which markedly enhance gastrointestinal absorption of aluminum.10,11
Is lanthanum carbonate a phosphate binder?
Lanthanum carbonate is a non-calcium, metal-based phosphate binder that has only recently become available for the management of hyperphosphatemia in patients on dialysis (US Food and Drug Administration approval in 2004). Lanthanum carbonate is reported to provide similar phosphate control to calcium-based phosphate binders in patients on dialysis but with a lower incidence of hypercalcemia.44,45 In a large 6-month, multicenter, randomized study ( n =800), phosphate control was similar with lanthanum carbonate (elemental lanthanum≤3.0 g/day) and calcium carbonate (elemental calcium of 1.5-9.0 g/day, median dose 3.0 g/day), with approximately 65% of patients in both groups achieving control of serum phosphate (≤5.58 mg/dl); however, the incidence of hypercalcemia was markedly higher in the calcium carbonate group (20.2 vs 0.4% of patients). 45 Similarly, in a 12-month randomized study in patients on dialysis, a comparable level of phosphate control with lanthanum (at doses≤3.75 g/day) and calcium carbonate (≤9.0 g/day) was contrasted by a higher incidence of hypercalcemia in the calcium carbonate group (49 vs 6% of patients). 44 In a bone histology study, lanthanum carbonate was not associated with the development of adynamic bone when compared with calcium-based treated patients.