Drug Topics - November 19, 2007 - (Page H9)

DRUG TOPICS HSE 9 Clinical Practice Improved phosphate binder approved for dialysis patients Elena Beyzarov, Pharm.D. Icomes to the treatment of hyperphosphatemia in dialysis pa- t seems that there’s always room for improvement when it tients. First came aluminum-containing phosphorus binders, which were found to be very effective in lowering phosphorous levels but caused multisystem toxicity and were, therefore, largely abandoned. Calcium-containing binders came next and were considered somewhat safer initially. “But these products were later found to accumulate and cause calcifications in multiple tissues, leading to increased mortality, particularly in the more advanced stage chronic kidney disease [CKD] patients on dialysis,” noted A. Scott Mathis, Pharm.D., assistant director for clinical services and residency program director in the department of pharmacy at Saint Barnabas Medical Center in Livingston, N.J. The introduction of non-calcium-, non-aluminum-containing phosphorus binders (e.g., Renagel/sevelamer HCl, Genzyme) was considered a significant improvement. The new binders were not systemically absorbed and provided phosphorus control without concerns of calcium or metal accumulation. The class made an even bigger stir in nephrology when a study published in Kidney International demonstrated that patients using sevelamer experienced a significantly lower rate of death (associated with control of coronary artery calcifications) compared with those treated with calcium-based phosphate binders. Better safe than sorry A more recent study, published in Nephrology Dialysis Transplant, did not substantiate sevelamer’s mortality benefits; however, nephrologists have maintained a “better safe than sorry” ap- TIPS TO REMEMBER Renvela The starting dose of Renvela is one to two 800mg tablets three times per day with meals. The dosage should be adjusted by one tablet per meal in two-week intervals as needed to obtain serum phosphorus target (3.5 to 5.5 mg/dl). When administering an oral medication for which a reduction in bioavailability would have a clinically significant effect on its safety or efficacy, the drug should be administered at least one hour before or three hours after Renvela. Most frequently occurring adverse reactions for Renvela in a short-term study included nausea and vomiting. Cases of fecal impaction and, less commonly, ileus, bowel obstruction, and bowel perforation have been reported.

Table of Contents Feed for the Digital Edition of Drug Topics - November 19, 2007

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

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.