Sevelamer Carbonate Tablets

SEVERCAN​‍​‌‍​‍‌​‍​‌‍​‍‌ 400 is a prescription medication made up of sevelamer carbonate that is used to treat hyperphosphatemia in adult patients with chronic kidney disease (CKD), mainly those on dialysis. It is a non-absorbable, polymeric phosphate binder that complexes dietary phosphate in the gastrointestinal tract and thus, lowers serum phosphate without the involvement of calcium or aluminum, which makes it a perfect ion if calcium load is to be kept at a minimum.

Key features and clinical use

• Active ingredient: Sevelamer carbonate 400 mg per tablet (non-absorbable polymeric amine).

• Indications: It is used to control elevated phosphate levels in the blood of adult CKD patients who are on hemodialysis or peritoneal dialysis. The drug is used as one of the several measures in the phosphorus management program (dietary phosphate restriction + dialysis + phosphate binders) in these patients.

Dosing and administration 

SEVERCAN must be accompanied by a meal if it is to efficiently trap dietary phosphate. Normally, after food, tablets are given thrice daily. The doctor deciding on initial as well as maintenance doses does so based on serum phosphorus levels in the blood. In general, the usual titration steps are 400–800 mg per meal every 2 weeks until the target phosphate is reached; typical adult daily dosage in real-life patient situations is about 7.2 g (e.g., 2.4 g with each meal), and the maximum daily dosage that was tested went up to 14 g. However, you should always follow the clinician's instructions.

Safety, monitoring, and adverse effects

Among the adverse effects, those affecting the gastrointestinal tract are the most frequently encountered (nausea, vomiting, diarrhea, dyspepsia, abdominal pain, flatulence, and constipation). Cases of serious GI complications (for example, fecal impaction, intestinal obstruction, or very infrequent instances of mucosal injury) have been reported; evaluation as well as management of constipation, should be done before and during treatment. Apart from serum phosphorus (target usually ≤5.5 mg/dL or according to the local guidelines), calcium, and parathyroid hormone should be monitored when clinically indicated.

Drug interactions and clinical pearls for HCPs

Sevelamer may form complexes with and thus lower the absorption of some orally administered drugs (e.g., ciprofloxacin, levothyroxine, mycophenolate/mycophenolic acid, and some immunosuppressants). In addition, dosing time for drugs causing this interaction should not coincide with that of the susceptible drug administration (or drug levels/clinical effect should be monitored) as indicated by product labeling. Despite the fact that SEVERCAN does not systemically absorb, kindly take note of the interactions that will require slight adjustments in the timing of your dose.

Packaging, storage, and ordering

SEVERCAN 400 comes in the form of tablets for oral administration; sellers and hospitals should follow the instructions on the label to store them in a cool, dry place and should only dispense them upon a prescription. To place a wholesale, distribution, or technical product literature order, get in touch with the manufacturer/distributor (when ordering, include regulatory/labeling and batch ​‍​‌‍​‍‌​‍​‌‍​‍‌documentation).