Sevelamer

Sevelamer (rINN) is a phosphate binding medication used to treat hyperphosphatemia in patients with chronic kidney disease. When taken with meals, it binds to dietary phosphate and prevents its absorption. Sevelamer was invented and developed by GelTex Pharmaceuticals. Sevelamer is marketed by Sanofi under the brand names Renagel (sevelamer hydrochloride) and Renvela (sevelamer carbonate).

Sevelamer
Clinical data
Pronunciation(/sɛˈvɛləmər/ or /sɛˈvɛləmɪər/)
Trade namesRenagel, Renvela
AHFS/Drugs.comMonograph
MedlinePlusa601248
License data
Pregnancy
category
  • AU: B3
Routes of
administration		By mouth
ATC code
Legal status
Legal status
  • AU: S4 (Prescription only)
  • US: ℞-only
  • EU: Rx only
Pharmacokinetic data
Bioavailability0%
ExcretionFeces 100%
Identifiers
IUPAC name
  • poly(allylamine-
    co-N,N'-diallyl-1,3-diamino-2-hydroxypropane)
CAS Number
PubChem CID
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
CompTox Dashboard (EPA)
Chemical and physical data
Formula[(C3H7N)a+b.(C9H17N2O)c]m
where a+b:c = 9:1
Molar massvariable
 NY (what is this?)  (verify)

Chemistry and pharmacology

Sevelamer consists of polyallylamine that is crosslinked with epichlorohydrin.[1] The marketed form sevelamer hydrochloride is a partial hydrochloride salt being present as approximately 40% amine hydrochloride and 60% sevelamer base. The amine groups of sevelamer become partially protonated in the intestine and interact with phosphate ions through ionic and hydrogen bonding.

Medical uses

Sevelamer is used in the management of hyperphosphatemia in adult patients with stage 4 and 5 chronic kidney disease (CKD) on hemodialysis. Its efficacy at lowering phosphate levels is similar to that of calcium acetate, but without the accompanying risk of hypercalcemia and arterial calcification.[2][3] In patients with CKD, it has also been shown to reduce LDL and cholesterol.[4]

Contraindications

Sevelamer therapy is contraindicated in hypophosphatemia or bowel obstruction.[5] In hypophosphatemia, sevelamer could exacerbate the condition by further lowering phosphate levels in the blood, which could be fatal.[6]

Adverse effects

Common adverse drug reactions (ADRs) associated with the use of sevelamer include: nausea and vomiting, constipation, diarrhea, stomach pain, heartburn, gas.[7]

Other effects

Sevelamer can significantly reduce serum uric acid.[8] This reduction has no known detrimental effect and may be helpful in patients with gout.

Sevelamer is able to sequester advanced glycation end products (AGEs) in the gut, preventing their absorption into the blood. AGEs contribute to oxidative stress, which can damage cells (like beta cells, which produce insulin in the pancreas). As Vlassara and Uribarri explain in a 2014 review on AGEs, this may explain why sevelamer, but not calcium carbonate (a phosphate binder that does not sequester AGEs), has been shown to lower AGEs in the blood, as well as oxidative stress and inflammatory markers.[9]

References
  1. Ramsdell R (June 1999). "Renagel: a new and different phosphate binder". review. ANNA Journal. 26 (3): 346–7. PMID 10633608.
  2. Burke SK (September 2000). "Renagel: reducing serum phosphorus in haemodialysis patients". review. Hospital Medicine. 61 (9): 622–7. doi:10.12968/hosp.2000.61.9.1419. PMID 11048603.
  3. Habbous S, Przech S, Acedillo R, Sarma S, Garg AX, Martin J (January 2017). "The efficacy and safety of sevelamer and lanthanum versus calcium-containing and iron-based binders in treating hyperphosphatemia in patients with chronic kidney disease: a systematic review and meta-analysis". review. Nephrology, Dialysis, Transplantation. 32 (1): 111–125. doi:10.1093/ndt/gfw312. PMID 27651467.
  4. Patel L, Bernard LM, Elder GJ (February 2016). "Sevelamer Versus Calcium-Based Binders for Treatment of Hyperphosphatemia in CKD: A Meta-Analysis of Randomized Controlled Trials". review. Clinical Journal of the American Society of Nephrology. 11 (2): 232–44. doi:10.2215/CJN.06800615. PMC 4741042. PMID 26668024.
  5. Yuste, Claudia (2017). "Gastrointestinal complications induced by sevelamer crystals". Clinical Kidney Journal. 10 (4): 539–544. doi:10.1093/ckj/sfx013. PMC 5570024. PMID 28852493.
  6. Emmett M (September 2004). "A comparison of clinically useful phosphorus binders for patients with chronic kidney failure". review. Kidney International Supplements. 66 (90): S25–32. doi:10.1111/j.1523-1755.2004.09005.x. PMID 15296504.
  7. "Sevelamer". MedlinePlus.{{cite web}}: CS1 maint: url-status (link)
  8. Locatelli F, Del Vecchio L (May 2015). "Cardiovascular mortality in chronic kidney disease patients: potential mechanisms and possibilities of inhibition by resin-based phosphate binders". review. Expert Review of Cardiovascular Therapy. 13 (5): 489–99. doi:10.1586/14779072.2015.1029456. PMID 25804298. S2CID 32586527.
  9. Vlassara H, Uribarri J (January 2014). "Advanced glycation end products (AGE) and diabetes: cause, effect, or both?". review. Current Diabetes Reports. 14 (1): 453. doi:10.1007/s11892-013-0453-1. PMC 3903318. PMID 24292971.
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