セベラマー
セベラマー（Sevelamer）は、カルシウムやアルミニウムを含まない**リン吸着剤**であり、主に**慢性腎臓病（CKD）**に伴う高リン血症の管理に使用されます。 * **臨床的利点**：従来のリン吸着剤（水酸化アルミニウムや炭酸カルシウムなど）とは異なり、アルミニウム中毒や医原性高カルシウム血症のリスクがありません。 * アルミニウム塩に耐えられない場合や、カルシウムベースの吸着剤が転移性組織石灰化を悪化させる可能性のある進行したCKD患者に特に有用です。 * **注意**：従来のアルミニウムやカルシウムベースの製品と比較して、一般的に高価です。
作用機序: 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.
動物種別の用量
- Hyperphosphatemia · 200 mg 2-3 times daily · PO · q8-12h · Anecdotally appears to be safe and effective.
- Chronic kidney disease (hyperphosphataemia) · 30-40 mg/kg · PO · q8h · Titrated to the desired serum phosphate concentration · Should be given with meals and at least 1 hour before or 3 hours after other medications.
- Hyperphosphatemia · 400 mg PO with meals · PO · with meals · For medium to large sized dog
- Chronic kidney disease (hyperphosphataemia) · 30-40 mg/kg · PO · q8h · Titrated to the desired serum phosphate concentration · Should be given with meals and at least 1 hour before or 3 hours after other medications.
用量は獣医療従事者向けの臨床リファレンスです。必ず最新の添付文書と個々の患者で確認してください。
投与経路
禁忌
- Hypophosphatemia
- Bowel obstruction
- Known hypersensitivity to sevelamer
- Gastrointestinal obstruction
有害事象
- Gastrointestinal upset (nausea, vomiting, diarrhea, or constipation)
- Decreased absorption of fat-soluble vitamins (A, D, E, K) and folic acid
- Constipation
- Pills are hygroscopic and will expand (potential risk of esophageal obstruction if not swallowed quickly)
薬物相互作用
- Anticonvulsants (oral) · Sevelamer may reduce oral absorption; give at least 1 hour before or 3 hours after sevelamer.
- Antiarrhythmics (oral) · Sevelamer may reduce oral absorption; give at least 1 hour before or 3 hours after sevelamer.
- Ciprofloxacin (and other oral fluoroquinolones) · Concurrent administration may decrease absorption by 50%; administer at least 1 hour before or 3 hours after sevelamer.
- Oral Medications (Narrow Therapeutic Index) · May reduce absorption; consider dosing other oral drugs separately.
- Vitamins · Sevelamer may reduce vitamin absorption from food; consider administering vitamin supplements separately.
- Other oral medications · 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. · moderate
- Fat-soluble vitamins (e.g., Vitamin K) · May inhibit vitamin absorption; consider monitoring prothrombin time. · moderate
モニタリング
- 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)
過量投与
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.
VetSheet の薬剤リファレンスは、獣医療従事者向けの臨床意思決定支援を目的としており、専門的判断やメーカーの最新添付文書に代わるものではありません。