Phosphate binder

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Phosphate binders are a group of medications used to reduce the absorption of phosphate and taken with meals and snacks. They are typically used in patients with chronic renal failure (CRF) as they cannot get rid of the phosphates that get into their blood (i.e., the serum phosphate in chronic renal failure is typically elevated).

Clinical use[edit]

For patients with chronic renal failure, controlling serum phosphate is important because it is associated with bone pathology and regulated together with serum calcium by the parathyroid hormone (PTH).[1]

Mechanism of action[edit]

These agents work by binding to phosphate in the GI tract, thereby making it unavailable to the body for absorption. Hence, these drugs are usually taken with meals to bind any phosphate that may be present in the ingested food. Phosphate binders may be simple molecular entities (such as magnesium, aluminium, calcium, or lanthanum salts) that react with phosphate and form an insoluble compound. Phosphate binders such as sevelamer may also be polymeric structures which bind to phosphate and are then excreted.

Adverse effects[edit]

With regard to phosphate binders, aluminium-containing compounds (such as aluminium hydroxide) are the least preferred because prolonged aluminium intake can cause encephalopathy and osteomalacia. If calcium is already being used as a supplement, additional calcium used as a phosphate binder may cause hypercalcemia and tissue-damaging calcinosis. One may avoid these adverse effects by using phosphate binders that do not contain calcium or aluminium as active ingredients, such as lanthanum carbonate or sevelamer.

Common phosphate binders[edit]

Summary of Common Oral Phosphate Binders[1]
Phosphate Binder Brands Advantages Disadvantages
Aluminum salts Alucaps Calcium free Risk of aluminum toxicity
Basaljel High binder efficiency regardless of pH Requires frequent monitoring-extra cost
Cheap
Moderate tablet burden
Calcium carbonate Calcichew Aluminum free Calcium containing-potential risk of hypercalcemia and ectopic calcification
Titralac Moderate binding efficacy Parathyroid hormone oversuppression
Relatively low cost Gastrointestinal side effects
Moderate tablet burden Efficacy pH dependent
Chewable
Calcium acetate Lenal Ace Aluminum free Calcium containing-potential risk of hypercalcemia and ectopic calcification
PhosLo Higher efficacy than calcichew/sevelamer Parathyroid hormone oversuppression
Moderately cheap Gastrointestinal side effects
Lower calcium load than calcium carbonate Large tablets, nonchewable formulation
Sevelamer hydrochloride Renagel Aluminium and calcium free Relatively costly
Renvela No gastrointestinal absorption High pill burden
Moderate efficacy Large tablets, nonchewable formulation
Reduces total and low-density lipoprotein cholesterol Gastrointestinal side effects
Binds fat-soluble vitamins
Lanthanum carbonate Fosrenol Aluminum and calcium free Relatively costly
Minimal gastrointestinal absorption Gastrointestinal side effects
High efficacy across full pH range
Chewable formulation
Palatable
Low tablet burden

References[edit]

  1. ^ Burtis, C.A.; Ashwood, E.R. and Bruns, D.E. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 5th Edition. Elsevier. pp1552
  1. ^ Lederer E, Ouseph R, Erbeck K. Hyperphosphatemia, eMedicine.com, URL: http://www.emedicine.com/med/topic1097.htm, Accessed on July 14, 2005.
  2. ^ Spiegel DM, Farmer B, Smits G, Chonchol M.,Magnesium carbonate is an effective phosphate binder for chronic hemodialysis patients: a pilot study, pubmed.com. URL: http://www.ncbi.nlm.nih.gov/pubmed/17971314

External links[edit]

Common Phosphate Binders[edit]