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

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

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

2 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 7 →

ErdafitinibSevereDatabaseDDInter
Mycophenolate SodiumSevereDatabase

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

Erdafitinib

Severe

Database

Drug interaction classified as: others

Source: DDInter

Mycophenolate Sodium

Severe

Database

Significantly reduced MPA exposure (AUC), leading to decreased immunosuppressive efficacy and increased risk of rejection.

Avoid concomitant use if possible. If co-administration is necessary, separate administration by several hours (e.g., mycophenolate 2 hours before or 4-6 hours after sevelamer) and closely monitor mycophenolate levels and clinical response. Significant dose increase of mycophenolate may be necessary.

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