Sevelamer

What is sevelamer?

Sevelamer is a drug used to control high blood levels of phosphorus (hyperphosphatemia) in dogs and cats with chronic kidney disease. It acts as a phosphate binder in the intestines (it attaches to phosphates in ingested food, preventing them from entering the blood).

There are no licensed veterinary versions of sevelamer available. Human formations (Renagel®, Renvela®) may be prescribed for off-label use.

Many drugs are commonly prescribed for off-label use in veterinary medicine. “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How do I give my pet sevelamer?

• Sevelamer is given orally (by mouth) and comes in the form of tablets and powder for liquid suspension. It may also be compounded into other forms.
• Give this medication with meals.
• Do not crush tablets or allow the dog to chew tablets.
• Follow your veterinarian’s directions and measure liquid compounded forms of this medication carefully.
• Ideally, give this medication at the same time daily.
• Give sevelamer at least 1 hour apart from other medications and/or supplements.
• This drug is usually given along with a low-phosphorus diet. Consult your veterinarian before making any changes to the diet.

This medication should take effect within 1 to 2 hours; however, effects may not be noted outwardly, so laboratory tests may be needed to evaluate this medication’s effectiveness.

What if I miss giving my pet the medication?

If you miss a dose, give it as soon as you remember, and then continue with the regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not give the pet two doses at once.

Are there any potential side effects from sevelamer?

Sevelamer may cause the following side effects:

• Reduced appetite
• Vomiting
• Nausea
• Diarrhea
• Constipation
• Flatulence

Serious adverse reactions associated with this drug may occur without warning and could, in rare cases, lead to death. If any of the following signs develop, stop giving sevelamer and contact your veterinarian immediately:

• Bleeding

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of the treatment and notify your veterinarian if you have any concerns.

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. Sevelamer has the possibility to bind vitamins at higher doses, so vitamin supplementation has been recommended. This short-acting medication should stop working within 24 hours, although effects can be longer in animals with liver or kidney disease.

Are there any risk factors for this medication?

DO NOT USE sevelamer in:

• Pets that are allergic to it
• Pets with low blood phosphorus levels (hypophosphatemia)
• Pets with an intestinal blockage

USE WITH CAUTION in:

• Pets that are pregnant or nursing

Are there any drug interactions I should be aware of?

The following drugs should be used WITH CAUTION when given with sevelamer:

• Fluroquinolone antibiotics (e.g., ciprofloxacin)
• Furosemide
• Mycophenolate
• Tacrolimus
• Thyroid hormones (e.g., levothyroxine)
• Warfarin

It is recommended to separate all oral drugs and vitamins from sevelamer dosing by at least 1 hour. Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.

Is any monitoring needed with this medication?

• Blood tests to assess levels of phosphorus and other electrolytes (e.g., calcium, bicarbonate, chloride) should be done at the start of treatment, and periodically throughout treatment.
• Blood tests to assess clotting ability should be done before using sevelamer, and then after starting use, since absorption of vitamin K may be impacted by the binding effects of sevelamer.
• At home, monitor for any side effects such as those noted above. If any occur, stop using the medication and contact your veterinarian.

How do I store sevelamer?

• Ensure sevelamer is tightly stored in its original container in a cool, dry place, and protected from light.
• Store this medication at room temperature between 68°F and 77°F (20°C and 25°C).
• Keep the container out of reach of children and pets.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet’s weight and symptoms.