Sevelamer
Sevelamer hydrochloride
Also known as: Renagel · Renvela · GT16-026A · Sevelamer carbonate
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hyperphosphatemia | 400 mg PO with meals | PO | with meals | — | 🌎 NA |
| Chronic kidney disease (hyperphosphataemia) | 30-40 mg/kg | PO | q8h | Titrated to the desired serum phosphate concentration | 🌍 EU |
- Hyperphosphatemia: For medium to large sized dog
- Chronic kidney disease (hyperphosphataemia): Should be given with meals and at least 1 hour before or 3 hours after other medications.
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hyperphosphatemia | 200 mg 2-3 times daily | PO | q8-12h | — | 🌎 NA |
| Chronic kidney disease (hyperphosphataemia) | 30-40 mg/kg | PO | q8h | Titrated to the desired serum phosphate concentration | 🌍 EU |
- Hyperphosphatemia: Anecdotally appears to be safe and effective.
- Chronic kidney disease (hyperphosphataemia): Should be given with meals and at least 1 hour before or 3 hours after other medications.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Sevelamer is a non-calcium, non-aluminum phosphorus binding agent used primarily in the management of hyperphosphatemia associated with chronic kidney disease (CKD).
- Clinical Advantage: Unlike traditional phosphate binders (such as aluminum hydroxide or calcium carbonate), sevelamer does not carry the risk of aluminum toxicity or iatrogenic hypercalcemia.
- It is particularly useful in late-stage CKD patients who cannot tolerate aluminum salts or when calcium-based binders might exacerbate metastatic tissue calcification.
- Note: It is generally more expensive than traditional aluminum or calcium-based products.
Mechanism of action
Sevelamer is a cross-linked polymeric amine that acts locally in the gastrointestinal tract.
- Mechanism: The polymer contains multiple amine groups that become partially protonated in the acidic environment of the stomach and intestine. These protonated amines interact with dietary phosphate ions via ionic and hydrogen bonding → preventing phosphate absorption across the gut wall → increasing fecal excretion of phosphate → ultimately lowering serum phosphorus levels.
- Secondary Effects: It also binds bile acids in the gut, which can lead to a reduction in serum low-density lipoproteins (LDL) and total cholesterol.
Safety & warnings
Contraindications
- Hypophosphatemia
- Bowel obstruction
- Known hypersensitivity to sevelamer
- Gastrointestinal obstruction
Adverse effects
- Gastrointestinal upset (nausea, vomiting, diarrhea, or constipation)
- Decreased absorption of fat-soluble vitamins (A, D, E, K) and folic acid
- Pills are hygroscopic and will expand (potential risk of esophageal obstruction if not swallowed quickly)
Precautions
Pregnancy & Nursing: Safety during pregnancy is not established (FDA Category C). Because of the potential for binding vitamins, additional vitamins (both fat and water-soluble) may be necessary for pregnant or nursing animals.
- Vitamin K Deficiency: Because sevelamer can bind fat-soluble vitamins, it may impact Vitamin K absorption, potentially affecting coagulation.
- Administration Timing: Must be given with meals to be effective at binding dietary phosphorus.
Drug interactions
Sevelamer may reduce oral absorption; give at least 1 hour before or 3 hours after sevelamer.
Sevelamer may reduce oral absorption; give at least 1 hour before or 3 hours after sevelamer.
Concurrent administration may decrease absorption by 50%; administer at least 1 hour before or 3 hours after sevelamer.
May reduce absorption; consider dosing other oral drugs separately.
Sevelamer may reduce vitamin absorption from food; consider administering vitamin supplements separately.
May bind to and decrease the absorption of concurrently administered oral drugs. Should be given at least 1 hour before or 3 hours after other medications.
May inhibit vitamin absorption; consider monitoring prothrombin time.
Monitoring
- Serum phosphorus
- Serum calcium
- Serum bicarbonate
- Serum chloride
- Baseline coagulation screening test (before and after therapy implementation, due to potential Vitamin K malabsorption)
- Serum phosphate levels (at 4-6 week intervals to adjust dosage)
- Prothrombin time (due to potential vitamin K malabsorption)
- Bowel movements (monitor for constipation)
Pharmacokinetics
Half-life
Absorption
Administered orally, but is not absorbed systemically.
Distribution
Remains entirely within the gastrointestinal tract.
Metabolism
Not metabolized systemically.
Elimination
Excreted unchanged in the feces.
Overdose
Because sevelamer is not absorbed systemically, the potential for acute toxicity from an overdose appears to be negligible. Overdose would likely result in gastrointestinal distress (constipation or diarrhea) and potential hypophosphatemia.
Available products
Formulations
- Oral tablets
- Powder for oral suspension
- Oral: 800 mg tablets
Human-labeled
- sevelamer HCl Oral Tablets: 400 mg & 800 mg (Renagel, Renvela)
- sevelamer Powder for Oral Suspension: 0.8 grams/packet & 2.4 grams/packet (Renvela)
- Renagel 800 mg tablets
Regulatory status
Human authorized product used off-label in veterinary medicine under the cascade.
POM (Prescription Only Medicine). Human authorized product used off-label.
No regulatory data for: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Sevelamer capsules/tablets should be stored at room temperature and protected from moisture.
Client information
Crucial Timing: This medication must be given with meals to work properly. It acts like a sponge to soak up the phosphorus in your pet's food before it can enter their body.
- Separate from other medications: Sevelamer can prevent other drugs from being absorbed. Give other medications at least 1 hour before or 3 hours after giving sevelamer.
- Vitamins: Your veterinarian may recommend a vitamin supplement, as this drug can reduce the absorption of vitamins from food.
- Side Effects: Watch for signs of stomach upset, such as vomiting, diarrhea, or constipation. Contact your veterinarian if these occur.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.