세벨라머

인 결합제

세벨라머(Sevelamer)는 칼슘과 알루미늄이 없는 **인 결합제**로, 주로 **만성 신장 질환(CKD)**과 관련된 고인산혈증 관리에 사용됩니다. * **임상적 장점**: 기존의 인 결합제(수산화알루미늄 또는 탄산칼슘 등)와 달리 알루미늄 독성이나 의인성 고칼슘혈증의 위험이 없습니다. * 알루미늄 염에 내성이 없거나 칼슘 기반 결합제가 전이성 조직 석회화를 악화시킬 수 있는 말기 CKD 환자에게 특히 유용합니다. * **참고**: 기존의 알루미늄이나 칼슘 기반 제품에 비해 일반적으로 가격이 비쌉니다.

작용 기전: 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.

동물 종별 용량

Cats

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.

Dogs

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.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

Hypophosphatemia
Bowel obstruction
Known hypersensitivity to sevelamer
Gastrointestinal obstruction

이상반응

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)

약물 상호작용

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

모니터링

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)

과용량

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 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.