There are no empirical data on avoiding drug interactions between sevelamer and most concomitant oral drugs. For oral medication where a reduction in the bioavailability of that medication would have a clinically significant effect on its safety or efficacy (e.g., cyclosporine, tacrolimus, levothyroxine), consider separation of the timing of the administration of the two drugs. The duration of separation depends upon the absorption characteristics of the medication concomitantly administered, such as the time to reach peak systemic levels and whether the drug is an immediate release or an extended release product. Where possible consider monitoring clinical responses and/or blood levels of concomitant drugs that have a narrow therapeutic range.
Sevelamer carbonate did not alter the pharmacokinetics when administered concomitantly in the following drugs digoxin, enalapril, iron, metoprolol and warfarin.
The anti-arrhythmic and anti-seizure medical product should be taken at least one hour before or three hours after sevelamer, and blood monitoring can be considered.
Very rare cases of increased phosphate levels have been reported in patients taking proton pump inhibitors co-administered with sevelamer carbonate. Caution should be exercised when prescribing PPI (omeprazole, pantoprazole, or lansoprazole) to patients concomitantly treated with sevelamer. The phosphate serum level should be monitored and the sevelamer carbonate dosage adjusted consequently.
Oral drugs that have demonstrated interaction with sevelamer and are to be dosed separately from sevelamer: Ciprofloxacin: Dosing Recommendations - Take at least 2 hours before or 6 hours after sevelamer.
Mycophenolate mofetil: Dosing Recommendations - Take at least 2 hours before sevelamer.