Renvela (Sevelamer Carbonate / Sevelamer Hydrochloride)
Also sold as: Renvela, Renagel, Svaphos, Sevelamer (Sun Pharma), PhosLo (calcium acetate — different)
Pregnancy
Cat C
Lactation
Unknown
Schedule
H
Forms
Tablet 400mg, 800mg (sevelamer carbonate) +1
Indications
- Hyperphosphataemia in chronic kidney disease (CKD stages 4–5 / dialysis patients)
- Preferred over calcium-based binders in patients with hypercalcaemia, vascular calcification, or calciphylaxis
Adult Dosing
Hyperphosphataemia (dialysis / CKD stage 4–5)
Start 800 mg PO TDS with meals (if serum phosphate 1.78–2.42 mmol/L)
Titrate by 800 mg per meal every 2 weeks to achieve phosphate target 1.1–1.8 mmol/L (3.5–5.5 mg/dL). Typical maintenance: 1600–3200 mg per meal (TDS). Take WITH or immediately after meals. Must be chewed or crushed for powder forms.
Pediatric Dosing
Use powder sachets for children who cannot swallow large tablets
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| CKD stage 4–5 / ESRD | This is the primary indication — no dose reduction needed for renal impairment itself (not systemically absorbed) |
Hepatic Adjustment
Not systemically absorbed — no hepatic adjustment required
Pregnancy & Lactation
Pregnancy: Category C
Limited data in pregnancy — not absorbed systemically. However, may reduce absorption of vitamins and minerals (fat-soluble vitamins, folate). Supplement appropriately. Use only if clearly needed.
Lactation: Unknown
Not systemically absorbed — likely safe. Theoretical concern about fat-soluble vitamin depletion with prolonged use.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Ciprofloxacin | Sevelamer significantly reduces ciprofloxacin absorption — separate by ≥2 hours | Major |
| Levothyroxine | Sevelamer reduces thyroid hormone absorption — separate by 4 hours | Major |
| Mycophenolate mofetil | Reduced MMF absorption — separate by 2 hours | Moderate |
| Fat-soluble vitamins (A, D, E, K) | Sevelamer may bind fat-soluble vitamins — supplement separately | Moderate |
| Tacrolimus, ciclosporin | Possible reduced absorption of immunosuppressants — take 2 hours apart; monitor drug levels | Moderate |
DoctorScribe — AI Medical Scribe
Stop looking up Renvela — just speak the prescription
"Renvela as per dose, BD for 5 days." DoctorScribe writes the full prescription with brand, strength, frequency, and route — auto-applies pediatric weight-based dosing and renal adjustments. Try the live demo.
Side Effects
Common
- Nausea and vomiting
- Diarrhoea or constipation
- Dyspepsia
- Abdominal pain
- Flatulence
Serious / Discontinue If
- GI obstruction (with large tablet doses — especially in gastroparesis or dysmotility; bowel obstruction, faecaloma)
- Metabolic acidosis (sevelamer hydrochloride form — carbonate form is preferred to avoid this)
- Hypophosphataemia (over-treatment)
- Fat-soluble vitamin deficiency (long-term)
Contraindications
- Bowel obstruction
- Dysphagia (large tablets — use powder form)
- Hypophosphataemia
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Renvela 800mg | Genzyme/Sanofi India | 30 tab ₹2,250 |
| Svaphos 800mg | Sun Pharma | 30 tab ₹1,850 |
| Sevelamer 800mg (generic) | Cipla | 30 tab ₹1,650 |
Monitoring Required
- Serum phosphate (monthly — target 1.1–1.8 mmol/L; KDIGO: < 1.78 mmol/L dialysis)
- Serum calcium (with sevelamer, calcium rises less than calcium-based binders)
- PTH levels (CKD-MBD management)
- Bicarbonate (HCO₃⁻) — metabolic acidosis risk (less with carbonate vs HCl form)
- Fat-soluble vitamin levels (annually)
- GI symptoms (bowel obstruction)
- Drug levels of immunosuppressants if on them
Patient Counseling Points
- Take WITH or immediately after meals — must be taken with food to bind dietary phosphate
- Swallow tablets whole with plenty of water (do not crush or chew standard tablets — powder sachets are pre-dissolved in water)
- Low-phosphate diet is essential alongside tablets — sevelamer alone is not enough. Avoid processed foods, dairy, nuts, cola drinks
- Report any difficulty swallowing, severe constipation, or abdominal pain — serious GI side effect
- Keep ALL other medications 2 hours before or after sevelamer — especially thyroid tablet, antibiotics, and transplant medicines
- Annual blood tests to check vitamin levels — long-term use can deplete vitamins
Stop Googling drug references mid-consultation
EasyClinic auto-flags Renvela interactions, renal cutoffs, and pregnancy warnings the moment you write the prescription. Built-in safety net for every Indian doctor.
Clinically reviewed by: Dr. Anand Prabhakar, DM (Nephrology), Consultant Nephrologist
Last reviewed: 2026-04-01
References
- KDIGO CKD-MBD Guidelines 2017 (updated 2020)
- BNF — Sevelamer
- NICE CKD Mineral Bone Disorders
- Indian Society of Nephrology — Dialysis Guidelines
- ERA-EDTA CKD-MBD Guidelines