Fosfamer Drug Interactions

Drug/Drug: Interaction studies have not been conducted in patients on dialysis. In interaction studies in healthy volunteers, Sevelamer Carbonate had no effect on the bioavailability of a single-dose of digoxin, warfarin, enalapril, metoprolol or iron. However, the bioavailability of ciprofloxacin was decreased by approximately 50% when co-administered with Sevelamer Carbonate in a single dose study. Consequently, Sevelamer Carbonate should not be taken simultaneously with ciprofloxacin.
During postmarketing experience, reduced concentrations of cyclosporin, mycophenolate mofetil and tacrolimus have been reported in transplant patients when co-administered with Sevelamer hydrochloride without any clinical consequences (for example, graft rejection). The possibility of an interaction cannot be excluded and close monitoring of blood concentrations of cyclosporin, mycophenolate mofetil and tacrolimus should be considered during the use of any of these agents in combination with Sevelamer and after its withdrawal.
During post-marketing experience, very rare cases of increased TSH levels have been reported in patients co-administered Sevelamer Carbonate and levothyroxine. Closer monitoring of TSH levels is therefore recommended in patients receiving both medications. During postmarketing experience, very rare cases of increased phosphate levels have been reported in patients taking proton pump inhibitors co-administered with Sevelamer hydrochloride.
Food: In all clinical studies patients were instructed to take Sevelamer with meals.