Renagel Dosage

Generic name: sevelamer hydrochloride
Dosage form: tablet

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Patients Not Taking a Phosphate Binder. The recommended starting dose of Renagel is 800 to 1600 mg, which can be administered as one or two 800 mg Renagel® Tablets or two to four 400 mg Renagel® Tablets, with meals based on serum phosphorus level. Table 1 provides recommended starting doses of Renagel for patients not taking a phosphate binder.

Table 1. Starting Dose for Dialysis Patients Not Taking a Phosphate Binder
Serum Phosphorus Renagel® 800 mg Renagel® 400 mg

> 5.5 and < 7.5 mg/dL

1 tablet three times daily with meals

2 tablets three times daily with meals

≥ 7.5 and < 9.0 mg/dL

2 tablets three times daily with meals

3 tablets three times daily with meals

≥ 9.0 mg/dL

2 tablets three times daily with meals

4 tablets three times daily with meals

Patients Switching From Calcium Acetate. In a study in 84 CKD patients on hemodialysis, a similar reduction in serum phosphorus was seen with equivalent doses (approximately mg for mg) of Renagel and calcium acetate. Table 2 gives recommended starting doses of Renagel based on a patient's current calcium acetate dose.

Table 2. Starting Dose for Dialysis Patients Switching From Calcium Acetate to Renagel
Calcium Acetate 667 mg
(Tablets per meal)
Renagel® 800 mg
(Tablets per meal)
Renagel® 400 mg
(Tablets per meal)

1 tablet

1 tablet

2 tablets

2 tablets

2 tablets

3 tablets

3 tablets

3 tablets

5 tablets

Dose Titration for All Patients Taking Renagel. Dosage should be adjusted based on the serum phosphorus concentration with a goal of lowering serum phosphorus to 5.5 mg/dL or less. The dose may be increased or decreased by one tablet per meal at two week intervals as necessary. Table 3 gives a dose titration guideline. The average dose in a Phase 3 trial designed to lower serum phosphorus to 5.0 mg/dL or less was approximately three Renagel 800 mg tablets per meal. The maximum average daily Renagel dose studied was 13 grams.

Table 3. Dose Titration Guideline
Serum Phosphorus
Renagel® Dose

>5.5 mg/dL

Increase 1 tablet per meal at 2 week intervals

3.5 - 5.5 mg/dL

Maintain current dose

<3.5 mg/dL

Decrease 1 tablet per meal

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