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Renagel Dosage

Generic name: SEVELAMER HYDROCHLORIDE 400mg
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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