sucroferric oxyhydroxide

General

Pronunciation:
soo-kroe-fer-ik ox-ee-hye-drox-ide

Trade Name(s)

• Velphoro

Ther. Class.
electrolyte modifiers

Pharm. Class.
phosphate binders

Indications

Control of elevated serum phosphorous levels in patients with chronic renal disease currently on dialysis.

Action

Binds dietary phosphorous in the GI tract via ligand exchange.

Therapeutic Effect(s):

Decreased serum phosphorous levels and sequelae of hyperphosphatemia.

Pharmacokinetics

Absorption: Phosphate binding is local with no systemic absorption. Minimal amounts of released iron may be absorbed.

Distribution: Unknown.

Metabolism and Excretion: Action is local, no metabolism. Bound phosphate is excreted in feces.

Half-life: Unknown.

TIME/ACTION PROFILE (phosphorous lowering)

Contraindication/Precautions

Contraindicated in:

• None noted.

Use Cautiously in:

• Peritonitis (from peritoneal dialysis), significant hepatic/gastric disorders, following major GI surgery, history of hemochromatosis/diseases of iron accumulation;
• OB: Use during pregnancy only if clearly needed;
• Pedi: Safety and effectiveness not established.

Adverse Reactions/Side Effects

GI: discolored feces, diarrhea, nausea, unpleasant taste

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• Should not be used concurrently with oral levothyroxine due to interference with phosphorous homeostasis.
• May ↓ absorption and effectiveness of doxycycline; administer 1 hr before sucroferric oxyhydroxide.

Route/Dosage

PO (Adults) 500 mg 3 times daily (with meals) initially, may be titrated by 500 mg/day at weekly intervals depending on serum phosphorous; usual range is 1500–3000 mg/day in 3 divided doses.

Availability

Chewable tablets (wild berry-flavored): 500 mg

Assessment

• Monitor for abdominal pain or discomfort. Sucroferric oxyhydroxide causes discolored (black) stool and may mask GI bleeding. Medication does not effect guaiac based (Hemocult) or immunological based (iColoRectal and Hexagon Opti) fecal occult blood tests.

Lab Test Considerations: Monitor serum phosphorous levels and dose of sucroferric oxyhydroxide. Dose is titrated in increments of 500 mg (1 tablet) per day as needed until acceptable serum phosphorous level (≤5.5 mg/dL) is reached. Monitor periodically thereafter. May begin titration 1 wk after start of therapy and adjust at weekly intervals.

• Monitor effect and iron homeostasis in patients with peritonitis during peritoneal dialysis, significant hepatic or gastric disorders, following major gastrointestinal surgery, or with a history of hemachromatosis or other diseases with iron accumulation.

Potential Diagnoses

• Deficient knowledge, related to medication regimen (Patient/Family/Teaching)

Implementation

• PO Administer 3 times daily with meals. Tablets must be chewed; do not swallow whole. Tablets may be crushed prior to swallowing. No additional fluid is required above usual amount taken.

Patient/Family Teaching

• Instruct patient to take medication as directed. Do not attempt to replace missed doses; resume medication with next meal; do not double doses.
• Advise patient to avoid taking levothyroxine and vitamin D analogs during therapy and to take alendronate and doxycycline at least 1 hr before sucroferric oxyhydroxide.
• Advise female patient to notify health care professional if pregnancy is planned or suspected.

Evaluation/Desired Outcomes

Decreased serum phosphorous levels.