Erdafitinib
Severe
Database
Drug interaction classified as: others
Source: DDInter
Drug reference
Sevelamer
Non-absorbed phosphate-binding polymer · Renal Support
Also known as Sevelamer Hydrochloride, Sevelamer Carbonate
START
Check baseline serum phosphate, calcium, PTH. Ensure patient is on dialysis. Counsel on taking WITH meals (ineffective without food).
TYPICAL MAX
14g/day. Monitor for GI obstruction, especially in patients with history of bowel surgery or motility disorders.
STOP IF
Bowel obstruction symptoms, severe constipation, hypophosphatemia (<2.5 mg/dL), fecal impaction.
WATCH
Serum phosphate, calcium, PTH every 2-4 weeks during titration. Separate from other oral medications by 1-2 hours (binding interaction). Monitor fat-soluble vitamin levels (A, D, E, K) and folic acid—supplement if needed.
CDSCO approvedSchedule H (Prescription drug in India). Requires a prescription from a registered medical practitioner to dispense due to its indication and potential side effects requiring medical monitoring and titration. Sevelamer is not OTC, H1, or X. It falls under Schedule H which refers to a drug that can be dispensed only on prescription. Therefore, it is a Schedule H drug in India. It is generally prescribed for chronic conditions and requires medical supervision. It is not available over the counter, nor does it fall into the stricter categories of H1 (requiring separate record-keeping) or X (narcotics/psychotropics with very strict dispensing rules). Therefore, Schedule H is the most appropriate classification. Final check: yes, it's a typical prescription-only medicine. So, Schedule H is correct. I will use 'Schedule H' as the final answer. It means 'prescription-only drug'. This is accurate for the Indian context. I will output 'Schedule H'. This is an important detail for Indian doctors. So the answer should be Schedule H. This is a general prescription drug in India, not OTC, H1 or X. So Schedule H is correct. It requires a prescription. Thus, 'Schedule H' is correct. The question specifically asks forATC V03AE02
KDIGO 2024 + manufacturer label
- ONSET
- 1h · Onset ~1 hour
- PEAK
- 2h · Max binding during meal absorption
- t½
- 0s · Not absorbed (N/A)
- DURATION
- 8h · Per meal dose
EXCRETION
Fecal as complex (100%)
route + CYP
INTERACTIONS
1 major
SEVERE in our sources
PREGNANCY
Not systemically absorbed—no fetal exposure expected. Consider folic acid and fat-soluble vitamin supplementation (may reduce absorption).
FDA category + note
Top interactionssee all 6 →
- ErdafitinibSevereDatabaseDDInter
Available in India
133 branded formulations. Look up specific brands in the Drugs workspace.
Mechanism
Polyallylamine hydrochloride polymer binds dietary phosphate in the GI tract through ionic exchange, forming an insoluble complex that is excreted in feces, reducing serum phosphorus levels
Indications
Hyperphosphatemia in chronic kidney disease (CKD) patients on dialysis
Dosing
- Adult
- Phosphate binder-naive: start 800mg TID with meals; titrate by 400-800mg per meal at 2-week intervals to target serum phosphate 3.5-5.5 mg/dL. Average daily dose ~7.2g. Max studied: 14g/day.
- Pediatric
- ≥6 years: start 800mg TID with meals; titrate based on serum phosphate.
- Renal adjustment
- No adjustment needed (not systemically absorbed).
- Hepatic adjustment
- No adjustment needed.
- Geriatric
- No specific adjustment; monitor for GI adverse effects and constipation.
- Max dose
- 14g/day (studied max)
Pharmacokinetics
Onset
Phosphate reduction within days to weeks of starting
Peak effect
Steady-state phosphate control within 2-4 weeks of dose titration
Duration
Dose-dependent; requires administration with each meal
Half-life
Not applicable (not systemically absorbed)
Bioavailability
0% (not absorbed)
Protein binding
Not applicable
Metabolism
Not metabolized (remains in GI lumen)
Excretion
Fecal (100%, as polymer-phosphate complex and unchanged polymer)
Contraindications
- Bowel obstruction
- Hypersensitivity to sevelamer
- Hypophosphatemia
Side effects
Common
ConstipationNauseaVomitingDiarrheaDyspepsiaAbdominal painFlatulence
Serious
- Intestinal obstruction / ileus
- Intestinal perforation (rare)
- Fecal impaction
- Bowel necrosis / ischemic colitis (rare)
- Hypophosphatemia (over-treatment)
Pregnancy & lactation
Pregnancy
Not systemically absorbed—no fetal exposure expected. Consider folic acid and fat-soluble vitamin supplementation (may reduce absorption).
Lactation
Not systemically absorbed; no excretion in breast milk. Compatible with breastfeeding.
Drug interactions
Ciprofloxacin
Moderate
Database
Sevelamer binds fluoroquinolones in GI tract, reducing absorption by ~50%.
Administer fluoroquinolone ≥2 hours before or 6 hours after sevelamer.
Source: Kimi deep-research + Cla
Cyclosporine
Moderate
Database
Reduced absorption of immunosuppressants; risk of transplant rejection.
Separate by 2-3 hours; monitor drug levels closely.
Source: Kimi deep-research + Cla
Levofloxacin
Moderate
Database
Decreased levofloxacin bioavailability and efficacy.
Administer levofloxacin at least 2 hours before or 2 hours after sevelamer.
Source: DDInter
Levothyroxine
Moderate
Database
Binding in GI tract reduces levothyroxine absorption by 30-50%.
Separate administration by at least 4 hours; monitor TSH.
Source: Kimi deep-research + Cla
Antiepileptics
Moderate
Database
Reduced absorption of antiepileptics if co-administered.
Separate administration by ≥2 hours; monitor seizure control and drug levels.
Source: Kimi deep-research + Cla
6 additional unreviewed or low-confidence interactions hidden because their provenance or source detail is insufficient.
Related guidelines
Chronic kidney disease — assessment and management
KDIGO · Nephrology · 2024
Acute kidney injury
KDIGO · Nephrology · 2012
Chronic kidney disease — assessment and management
NICE · Nephrology · 2021
Chronic kidney disease — mineral and bone disorder
KDIGO · Nephrology · 2017
Dialysis — initiation and maintenance
ISN_INDIA · Nephrology · 2023
Ask House about Sevelamer
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Textbook-sourced·Sources: Katzung, BNF·Updated: 2026-05-19·Cockpit curated: 2026-05-19