Sevelamer is currently not recommended for use in adult patients with chronic kidney disease not on dialysis with serum phosphorus < 1.78 mmol/l.
Caution should be exercised when Sevelamer is used in patients with the following disorders: Dysphagia; swallowing disorders; Severe gastrointestinal motility disorders including untreated or severe constipation or major gastrointestinal tract surgery. Use with caution in patients with these gastrointestinal disorders.
Monitor serum chemistries: Bicarbonate and chloride levels should be monitored.
Reductions in Vitamins A, D, E, K (clotting factors) and Folic Acid Levels: Patients with CKD may develop low levels of fat-soluble vitamins A, D, E and K, depending on dietary intake and the severity of their disease. It cannot be excluded that Sevelamer can bind fat-soluble vitamins contained in ingested food. In patients not taking supplemental vitamins but on sevelamer, serum vitamin A, D, E and K status should be assessed regularly. It is recommended that vitamin supplements be given if necessary. It is recommended that CKD patients not on dialysis are given vitamin D supplements (approximately 400 IU of native vitamin D daily) which can be part of a multivitamin preparation to be taken apart from their dose of Sevelamer. In patients undergoing peritoneal dialysis additional monitoring of fat-soluble vitamins and folic acid is recommended.
Effects on Ability to Drive and Use Machines: Sevelamer has no or negligible influence on the ability to drive and use machines.