A non-calcium phosphate binder for kidney disease
Sevelamer
A phosphate binder taken with food to lower high phosphate levels in people with chronic kidney disease.
What is Sevelamer?
Sevelamer is a phosphate binder, a medicine that lowers high phosphate levels in the blood in people with chronic kidney disease, particularly those on dialysis. When the kidneys cannot remove phosphate properly it builds up and, over time, can harm the bones, heart and blood vessels. Sevelamer works inside the gut by grabbing hold of phosphate from food so it passes out in the stool instead of being absorbed; this is why it must be taken with meals. It does not contain calcium, which can be an advantage for some people. It can cause stomach upset and should be kept apart from some other medicines.
Education and reference only. This is a plain-language guide to Sevelamer — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Sevelamer is a phosphate binder used in people with chronic kidney disease, mostly those on dialysis, who have too much phosphate in their blood. Unlike some other binders, it does not contain calcium, so it can be useful for people who need to avoid taking in extra calcium. It works only inside the gut and is not absorbed into the body. It comes as tablets or as a powder mixed with water, and it must be taken with food so that it can do its job of trapping phosphate from the meal. It is a long-term treatment used as part of kidney care.
How it works
Phosphate from food is normally absorbed through the gut into the blood, and healthy kidneys keep the level under control. In chronic kidney disease this control is lost and phosphate builds up, which over the years can weaken the bones and harden the blood vessels and heart. Sevelamer works in the gut by binding to phosphate from the food you eat, forming a substance that cannot be absorbed and is passed out in the stool. Because it acts on the phosphate in each meal, it has to be taken with food to work, and it is taken regularly to keep levels controlled.
Company & origin
Originated / developed by: Specialist manufacturers.
A medicine used in the UK to lower high phosphate levels in people with chronic kidney disease, especially those on dialysis.
What it treats
Conditions Sevelamer is used for
Practical use
How to take Sevelamer
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it with meals, as it works by binding the phosphate in the food you eat.
- Match it to your meals as your team advises, taking more with larger meals if directed.
- Swallow the tablets whole with water, or mix the powder as instructed; do not take it on an empty stomach.
- Keep it apart in time from some other medicines, as it can stop them being absorbed properly.
- Follow the low-phosphate diet you are given, with help from a dietitian.
Weighing it up
Advantages & disadvantages of Sevelamer
Advantages
- Effectively lowers high phosphate levels in people with chronic kidney disease.
- Does not contain calcium, which suits people who need to limit their calcium intake.
- Works only in the gut and is not absorbed into the body.
Disadvantages
- Must be taken with every meal, which means several doses a day.
- Can cause stomach upset such as nausea, wind, constipation or diarrhoea.
- Can reduce how well some other medicines are absorbed if taken at the same time.
Practical use
Good to know
The single most important thing about sevelamer is that it must be taken with food, because it works by binding the phosphate in your meals; taking it on an empty stomach does very little. It is taken regularly with meals throughout the day, and matching it to the size of your meals, as your team advises, helps it work well. Because it does not contain calcium, it can be a good choice for people who need to limit calcium. A practical point is that it can reduce how well some other medicines are absorbed, so certain tablets are taken at a different time, separated from sevelamer. The most common side effects are tummy related, such as nausea, wind, constipation or diarrhoea. A low-phosphate diet, with advice from a dietitian, works hand in hand with the medicine.
Who should not take it / use with caution
- People with a blocked bowel should not take it.
- People who have had a serious allergic reaction to sevelamer should not take it.
- It is used with care in people with certain bowel or swallowing problems, under specialist guidance.
Monitoring
- Regular blood tests to check phosphate and related mineral levels.
- Reviewing how well levels are controlled and adjusting the dose with meals.
- Watching for bowel side effects and overall tolerance.
Side effects
- Nausea, wind, tummy pain, constipation or diarrhoea.
- Indigestion or a feeling of fullness.
- Rarely, more serious bowel problems, which should be reported promptly.
Key interactions
- It can reduce the absorption of some other medicines, so certain tablets are taken at a separate time.
- Tell your team about all your medicines so timing can be arranged to avoid clashes.
- It is used alongside dietary phosphate restriction rather than instead of it.
Available as: Tablets and a powder to mix with water, taken with meals.
Answers
Sevelamer: frequently asked questions
What is sevelamer used for?
It is a phosphate binder used to lower high phosphate levels in people with chronic kidney disease, especially those on dialysis.
Why must I take it with food?
It works by binding the phosphate in your meals so it passes out in the stool; taken on an empty stomach it has little phosphate to bind.
How is it different from calcium-based binders?
Sevelamer does not contain calcium, so it can be a better choice for people who need to limit how much calcium they take in.
Can I take my other tablets at the same time?
Not always; sevelamer can stop some medicines being absorbed, so certain tablets are taken at a separate time, as your team advises.
What are the most common side effects?
They are usually tummy related, such as nausea, wind, constipation or diarrhoea.
The wider class
About Phosphate binder (non-calcium)
Sevelamer belongs to the phosphate binder (non-calcium) class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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