Drug Topics - November 19, 2007 - (Page H10)

10 HSE DRUG TOPICS NOVEMBER 19, 2007 www.drugtopics.com Clinical Practice proach, following the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommending sevelamer HCl as a first-line option for hyperphosphatemia. But as with any other drug, sevelamer HCl does have its shortcomings, and, thus, the newly approved and improved version, Renvela (sevelamer carbonate, Genzyme), may come in handy. Similar to sevelamer HCl, sevelamer carbonate is indicated for control of serum phosphorus in CKD patients on dialysis, but the new agent is claimed to have a lower incidence of gastrointestinal (GI) adverse effects and a carbonate buffer. According to Mathis, the carbonate product’s ability to maintain bicarbonate levels within the recommended KDOQI ranges is a significant advantage, since sevelamer HCl was shown in a recent study, published in the October issue of Artificial Organs, to cause small but persistent acid-base disturbances in hemodialysis patients. “Patients with CKD already have metabolic acidosis as a result of their disease,” but sevelamer HCl was found to worsen the complication by reducing serum bicarbonate levels via HCl release in the gut, explained José Menoyo, M.D., senior medical director at Genzyme. “Because the carbonate product doesn’t contribute to the chloride exchange, it has not been shown to worsen metabolic acidosis; in fact, it may actually improve it,” he noted. Since the carbonate and HCl products have the same active moiety, they share similar pharmacology, lowering serum phosphate concentrations by binding phosphate in the dietary tract and decreasing its absorption. “As a result of their action in the gut, both products have to be given with meals, three times daily” and adjusted at two-week intervals to obtain serum phosphorus targets, noted Mathis. What to watch for Despite its favorable GI tolerability claim, sevelamer is still contraindicated in patients with bowel obstruction and should be used with caution in those with dysphagia, swallowing disorders, severe GI motility disorders, or a history of major GI tract surgery. Overall, treatment of hyperphosphatemia should focus on achieving and maintaining a serum phosphate concentration of less than 5.5 mg/dl through dietary restrictions, adequate or intensified dialysis, rational use of phosphate binders, and conservative use of oral or intravenous vitamin D or its analogs. THE AUTHOR is a writer and hospital pharmacist based in New Jersey. www.drugtopics.com

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Drug Topics - November 19, 2007 Contents Latebreakers Letters Leukemia Patients Now Have More Options First-in-Class HIV Drug Boon to Patients at End of Tether 150 Years of American Pharmacy Pharmacy Schools Confront New Pressures From Pariah to Patient ACCP Releases Position Paper on Ethical Interactions New Injectable Antibiotic Welcomed with Open Arms NCCN Updates Head and Neck Cancer Guide Improved Phosphate Binder Approved for Dialysis Patients Considering Combination Concern Ensuring Seamless Care Bill Would Create Center for Comparative Effectiveness Hospital Improves Patient Safety with Automatic Drug Distribution System Infection Rates, Patient Stays Drop with New Drug Device How R.Ph.s Helped Three Hospitals Win Quality and Safety Awards A Pharmacist and Dog in Tow are Alzheimer’s Patients’ Best Friends More PBMs Agreeing to Pricing Transparency New Insulins in the Management of Diabetes New Products Advertisers Index Classified VIEWPOINT: Reflections on Pharmacy School After 30 Years

Drug Topics - November 19, 2007

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