Sucroferric oxyhydroxide, known by the brand name Velphoro, is a prescription medication used to manage high levels of phosphorus in the blood. This condition is called hyperphosphatemia.
Medical Use and Function
Hyperphosphatemia commonly affects individuals with chronic kidney disease (CKD), especially those undergoing dialysis. When kidneys do not function properly, they struggle to filter excess phosphorus, leading to its accumulation and potential health issues.
Sucroferric oxyhydroxide acts as a phosphate binder in the gastrointestinal tract. This mixture, containing polynuclear iron (III)-oxyhydroxide, sucrose, and starches, binds to dietary phosphate as food travels through the digestive system. This prevents phosphate absorption into the bloodstream, allowing elimination through stool. The process helps lower and maintain serum phosphorus levels.
Administration and Dosage
Sucroferric oxyhydroxide is provided as a chewable tablet, and it is important to chew or crush the tablet completely before swallowing. It should not be swallowed whole. Taking this medication with meals is necessary because its function relies on binding to the phosphate in the food being consumed.
The initial dosage typically begins with 500 milligrams, taken three times per day with meals. A healthcare provider will then adjust the dosage based on individual blood phosphorus levels. Adjustments are usually made in increments or decrements of 500 milligrams daily, at intervals of at least one week, until desired phosphorus levels are achieved.
The usual maintenance dose often ranges from 1500 to 2000 milligrams daily, divided into multiple doses. The maximum daily dose should not exceed 3000 milligrams. Regular monitoring of serum phosphorus levels by a doctor helps ensure the medication is effective and the dosage is appropriate for the patient’s ongoing needs.
Potential Side Effects
Individuals taking sucroferric oxyhydroxide may experience certain reactions. Common side effects include discolored stools, which often appear black. This discoloration is an expected and harmless effect of the iron content in the medication and does not typically indicate a serious problem.
Other frequently reported reactions include diarrhea and nausea. Some patients might also experience constipation, dyspepsia, or flatulence. These gastrointestinal symptoms are generally mild and can often be managed.
Less common but more severe reactions that require medical attention include severe constipation or significant stomach pain. Any persistent or worsening abdominal discomfort should be reported to a healthcare provider. Discomfort such as dysphagia, gastritis, or abdominal pain can also occur.
Important Safety Considerations
Sucroferric oxyhydroxide can interact with other oral medications, potentially reducing their absorption. For instance, certain antibiotics like doxycycline or cefalexin, as well as levothyroxine used for thyroid conditions, may have their effectiveness diminished if taken too close to sucroferric oxyhydroxide. It is generally recommended to take such interacting medications at least one hour before sucroferric oxyhydroxide, with levothyroxine requiring a four-hour separation.
Patients should inform their doctor about all medications they are currently taking, including over-the-counter drugs and supplements, to avoid potential interactions. Specific patient populations, such as those with a history of major gastrointestinal surgery, significant gastrointestinal disorders, hemochromatosis, or peritonitis, need to use this medication with caution. These conditions may affect how the drug is tolerated or absorbed.
For individuals who are pregnant or breastfeeding, discussing the use of sucroferric oxyhydroxide with a doctor is important. While studies suggest minimal risk during breastfeeding, a healthcare provider can assess the benefits and potential risks for both the mother and child. Liver impairment also warrants careful consideration before starting treatment.