Bisphosphonates
Moderate
Database
Reduced absorption
Separate widely
Source: Kimi deep-research + Cla
Drug reference
sucroferric oxyhydroxide
Iron-based phosphate binder (non-calcium) · Phosphate-binding agent
START
500 mg iron PO three times daily with meals
TYPICAL MAX
3 g of iron/day (6 tablets)
STOP IF
Severe diarrhoea, suspected obstruction, or hypersensitivity
WATCH
Serum phosphate q2–4w; ferritin/iron status (rarely changes)
CDSCO approvedATC V03AE05
KDIGO 2024 + manufacturer label
- ONSET
- 1d · phosphate fall
- PEAK
- 1w · 1-wk benefit
- t½
- 36s · not absorbed
- DURATION
- 8h · TID
EXCRETION
Faecal — bound iron-phosphate complex
route + CYP
INTERACTIONS
—
none in our sources
PREGNANCY
Limited data; phosphate control may be needed.
FDA category + note
Mechanism
Polynuclear iron(III) oxyhydroxide stabilised on sucrose/starch — binds dietary phosphate in the gut by ligand exchange forming insoluble iron-phosphate; lowers serum phosphate in dialysis-dependent CKD with negligible iron absorption.
Indications
Hyperphosphataemia in adult dialysis-dependent chronic kidney disease
Dosing
- Adult
- 500 mg of iron (1 tablet) PO three times daily with meals; titrate by 500 mg/day every 2–4 weeks based on phosphate; usual 1.5–3 g iron/day in divided doses.
- Pediatric
- Not established.
- Renal adjustment
- Indicated population is dialysis-dependent CKD.
- Hepatic adjustment
- No adjustment.
- Geriatric
- Standard dose; monitor for GI symptoms.
- Max dose
- 3 g of iron/day (6 tablets)
Pharmacokinetics
Onset
Phosphate lowering within weeks
Peak effect
Local gut effect (sustained)
Duration
Meal-related (TID dosing)
Half-life
Not applicable (negligible absorption)
Bioavailability
Negligible iron absorption (<0.04%)
Protein binding
Not applicable
Metabolism
Not metabolised (acts in gut lumen)
Excretion
Faecal — bound iron-phosphate
Contraindications
- Hypersensitivity
- Iron overload syndromes (haemochromatosis, multiple transfusions) — caution
- Caution: peritonitis on PD
Side effects
Common
DiarrhoeaDiscoloured (black) stoolsNauseaHyperphosphaturia (laboratory)
Serious
- Iron overload (rare, theoretical)
- Severe hypersensitivity
- Bowel obstruction (rare)
Pregnancy & lactation
Pregnancy
Limited data; phosphate control may be needed.
Lactation
Minimal absorption — likely compatible.
Drug interactions
Doxycycline
Moderate
Database
Iron-tetracycline chelation
Separate dosing
Source: Kimi deep-research + Cla
Fluoroquinolones
Moderate
Database
Iron-quinolone chelation
Separate by ≥2 h
Source: Kimi deep-research + Cla
Levothyroxine
Moderate
Database
Reduced thyroxine absorption
Separate by ≥4 h; monitor TSH
Source: Kimi deep-research + Cla
Other Phosphate Binders
Mild
Database
Combined phosphate binding (sometimes intended)
Adjust per phosphate response
Source: Kimi deep-research + Cla
Related guidelines
Chronic kidney disease — assessment and management
KDIGO · Nephrology · 2024
Acute kidney injury
KDIGO · Nephrology · 2012
Chronic kidney disease — mineral and bone disorder
KDIGO · Nephrology · 2017
Chronic kidney disease — assessment and management
NICE · Nephrology · 2021
Dialysis — initiation and maintenance
ISN_INDIA · Nephrology · 2023
Ask House about sucroferric oxyhydroxide
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: Goodman & Gilman 14e·Verified: 2026-05-20 · House clinical team·Cockpit curated: 2026-05-20