Control of serum P in patients w/ CKD on dialysis. Control of hyperphosphatemia in adults receiving hemodialysis. Adult CKD patients not on dialysis w/ serum P >1.78 mmol/L (5.5 mg/dL).
Patient not taking a phosphate binder Initially 0.8-1.6 g based on serum P level. Serum P level >5.5 & <7.5 mg/dL 1 tab tid; ≥7.5 mg/dL 2 tab tid. Titrate dose by 0.8 g tid at 2-wk intervals as necessary. Switching from sevelamer HCl tab to sevelamer carbonate tab/powd Use same dose in g. Max: 14 g in CKD patients on dialysis. Switching between sevelamer carbonate tab & powd, & from Ca Acetate Use same dose in g.
Monitor bicarbonate & Cl levels; monitor for reduced Vit D, E, K (clotting factors) & folic acid levels. Consider monitoring clinical responses &/ blood levels of concomitant drugs that have a narrow therapeutic range. Patients w/ history of swallowing disorders. Pregnancy & lactation. Childn <6 yr. Elderly >65 yr.
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