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Renvela vs Renagel
Introduction
For patients with chronic kidney disease, particularly those on dialysis, certain medications that can bind to phosphates in the gastrointestinal tract help prevent hyperphosphatemia – an excess of phosphate in the blood. Renvela and Renagel are two such drugs often prescribed for this purpose. Both work by binding dietary phosphate to form insoluble complexes which are then excreted, reducing serum phosphate levels. Renvela is a carbonate salt of sevelamer while Renagel is a hydrochloride salt of the same drug. Both have similar effectiveness but differ slightly in their side effect profiles and dosing schedules. They do not impact neurotransmitters as some other medications may do; instead they reduce potentially harmful mineral imbalances caused by kidney disease.
Renvela vs Renagel Side By Side
| Attribute | Renvela | Renagel |
|---|---|---|
| Brand Name | Renvela | Renagel |
| Contraindications | Bowel obstruction, hypersensitivity to sevelamer carbonate, and interaction with ciprofloxacin, levothyroxine, and certain heart rhythm medications | Bowel obstruction, hypersensitivity to sevelamer hydrochloride, and interaction with ciprofloxacin, levothyroxine, and certain heart rhythm medications |
| Cost | Around $740 for 90 tablets (800 mg each) | Around $530 for 90 tablets (800 mg each) |
| Generic Name | Sevelamer Carbonate | Sevelamer Hydrochloride |
| Most Serious Side Effect | Signs of allergic reactions, severe constipation with stomach pain and bloating, blood in your stool or black, tarry stools | Signs of allergic reactions, unusual changes in mood or behavior, severe constipation or stomach pain |
| Severe Drug Interactions | Ciprofloxacin, levothyroxine, and certain heart rhythm medications | Ciprofloxacin, levothyroxine, and certain heart rhythm medications |
| Typical Dose | 800-1600 mg, taken with meals based on serum phosphorus level | 800–1600 mg per meal, taken with each meal daily |
What is Renvela?
Sevelamer (the generic name for Renvela and Renagel) is a type of phosphate binder used to control phosphorus levels in people with chronic kidney disease, especially those on dialysis. Sevelamer was first approved by the FDA in 1998 under the brand name Renagel. It operates by preventing dietary phosphate from being absorbed into the body, thereby reducing serum phosphorus levels. This drug has been prescribed as an effective treatment against hyperphosphatemia.
Renvela and Renagel both serve similar purposes but have slightly different chemical compositions; while Renagel (sevelamer hydrochloride) carries a chloride component, Renvela (sevelamer carbonate) includes a carbonate moiety. The introduction of sevelamer carbonate (Renvela), which became available after sevelamer hydrochloride (Renagel), resulted in fewer gastrointestinal side effects due to its buffering capacity that aids in maintaining acid-base balance better than its predecessor.
What conditions is Renvela approved to treat?
Renvela and Renagel are approved for the treatment of different conditions associated with kidney disease:
- Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. Both drugs work by binding phosphate from food in the digestive tract, thus lowering serum phosphate levels.
- They are not absorbed into the body and do not depend on functioning kidneys to be effective, making them suitable for CKD patients.
How does Renvela help with these illnesses?
Renvela helps to manage the phosphorus levels in individuals with chronic kidney disease by binding phosphate from food in the digestive tract. It does this by inhibiting it from being absorbed into the bloodstream, so blood phosphorus can be maintained at lower and safer levels for longer periods of time. Phosphorus is a mineral that plays an important role in bone health, energy production, cell function among other things. Individuals with chronic kidney disease have relatively higher levels of phosphorus due to their kidneys' inability to remove excess amounts effectively. Therefore, by controlling phosphorous absorption, Renvela can limit the negative effects of excessive serum phosphate such as calcification and help patients manage their condition while stabilizing their serum phosphate level.
What is Renagel?
Renagel, also known as sevelamer hydrochloride, is a phosphate binder that helps prevent hypocalcemia (low levels of calcium in the body) caused by elevated phosphorus. It was first approved by the FDA in 1998 and operates by binding to dietary phosphate in the digestive tract and reducing its absorption. As Renagel does not contain calcium or aluminum, it sidesteps potential complications associated with these elements; this includes hypercalcaemia (too much calcium) often linked to other phosphate binders. The lack of metal ions means that its side-effect profile is different from those medications containing such components. While side effects may include nausea and constipation, it doesn't cause an increase in cholesterol level like some other medications used for similar purposes such as Renvela. This makes Renagel particularly beneficial for patients who have kidney disease on dialysis and are struggling to control their serum phosphorous levels.
What conditions is Renagel approved to treat?
Renagel is approved for the management of hyperphosphatemia in patients with end-stage renal disease. The conditions it's used to treat include:
- Hyperphosphatemia in dialysis patients
- Patients undergoing hemodialysis or peritoneal dialysis
It's crucial to note that Renagel should not be utilized in patients who have low levels of phosphorus in their blood.
How does Renagel help with these illnesses?
Renagel, also known as sevelamer hydrochloride, is a medication used to maintain phosphorus levels in the blood of patients with chronic kidney disease. Like calcium, phosphorus plays an important role in many biological processes but must be carefully regulated for optimal health. Renagel works by binding dietary phosphate in the digestive tract and preventing its absorption into the bloodstream. This action helps manage hyperphosphatemia (high blood phosphate levels) which can lead to serious complications like bone disease and cardiovascular problems among individuals undergoing dialysis. Though it functions similarly to Renvela (sevelamer carbonate), Renagel has been around longer and thus has more established clinical data regarding its efficacy and safety profile. It may be prescribed when a patient does not respond well or cannot tolerate other types of phosphate binders.
How effective are both Renvela and Renagel?
Both sevelamer carbonate (Renvela) and sevelamer hydrochloride (Renagel) are effective phosphate binders, commonly used in patients with chronic kidney disease on dialysis. They were approved by the FDA within a decade of each other; Renagel was approved in 1998, followed by Renvela in 2007. Both drugs work by binding to dietary phosphate in the digestive tract, preventing its absorption into the bloodstream.
The effectiveness of both these medications has been demonstrated across a range of clinical trials. A comparative study conducted between 2002-2003 found that both compositions significantly reduced serum phosphorus levels over an eight-week period, demonstrating similar safety profiles.
However, there are minor differences between them: sevelamer carbonate contains a calcium-based buffer as opposed to sodium-based for sevelamer hydrochloride. Therefore, it may be preferable for patients who need to limit their sodium intake or those who require additional calcium supplementation. Sevelamer carbonate also tends to cause less gastrointestinal upset than its counterpart.
Severe hyperphosphatemia can lead to significant health complications including bone disease and cardiovascular issues - hence maintaining optimal phosphorous balance is critical in end-stage renal disease patients on dialysis treatment.
A 2011 review indicated that although more expensive than traditional phosphate binders like calcium acetate or aluminum hydroxide, both versions of sevelamer offer benefits such as lower mortality rates and less risk of vascular calcification due to their non-calcium/non-aluminum composition.
In conclusion, while both compounds have proven efficacy and safety profiles along with tangible health benefits beyond mere phosphorus control – choosing one over another mainly depends on individual patient needs coupled with physician's discretion taking into account overall medical condition including electrolyte balances & comorbidity load.
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At what dose is Renvela typically prescribed?
Oral dosages of Renvela for adults typically start at 800-1600 mg, taken with meals based on serum phosphorus level. However, studies have shown that a starting dose of 800mg is usually sufficient to control serum phosphorus in most patients with chronic kidney disease on dialysis. Children and adolescents may be started on lower doses based upon body weight and serum phosphorus levels. In either population, dosage can be increased after a couple of weeks if the desired response isn't achieved. The maximum dosage should not exceed 13 g/day under any circumstances.
At what dose is Renagel typically prescribed?
Renagel treatment typically commences at a dosage of 800–1600 mg per meal, which is to be taken with each meal daily. The dose can then be increased according to the serum phosphorus concentration. The maximum recommended total daily dose is 13 g/day, divided into three doses and taken with meals. If there's no significant response observed in the reduction of serum phosphorus levels after a few weeks, healthcare providers may consider testing different dosing strategies while adhering within the recommended maximum limit.
What are the most common side effects for Renvela?
Common side effects of Renvela (sevelamer carbonate) may include:
- Nausea
- Vomiting
- Diarrhea
- Upset stomach or indigestion
- Abdominal pain
- Constipation
- Gas (flatulence)
- Bloating
Similarly, common side effects for Renagel (sevelamer hydrochloride) can include:
-Nausea
-Vomiting
-Diarrhea
-Upset stomach or indigestion
-Bloating
-Gas
It's important to note that while both medications share similar side effects, they might vary in intensity from person to person. If you experience severe discomfort while using either medication, consult your healthcare provider immediately.
Are there any potential serious side effects for Renvela?
When comparing Renvela to Renagel, some potentially serious side effects to consider include:
- Signs of allergic reactions: hives, difficulty breathing or swallowing, swelling in your face or throat
- Severe constipation with stomach pain and bloating
- Nausea or vomiting that doesn't go away
- Blood in your stool or black, tarry stools
- Shortness of breath (especially when lying down)
- Unusual tiredness and weakness
- Fast heartbeat or fluttering in your chest
- Swelling of the hands, ankles, feet; sudden weight gain Any sign of electrolyte imbalance such as muscle cramps/weakness/spasms; slow/fast/irregular heartbeat; confusion; severe dizziness/fainting.
If you experience any such symptoms while taking either medication, it's important to seek immediate medical attention.
What are the most common side effects for Renagel?
When considering Renagel, some common side effects to take into account include:
- Nausea or vomiting
- Stomach discomfort
- Constipation or diarrhea
- Headache
- Itching or rash
- Cough, stuffy nose, sore throat
- Muscle pain and joint stiffness
Remember that while these are potential side effects of taking Renagel, not everyone experiences them. However, if you do experience any persistent problems after starting this medication, it's important to discuss them with your healthcare provider promptly.
Are there any potential serious side effects for Renagel?
While Renagel is generally well-tolerated, it can cause severe side effects in rare instances. These may include:
- Signs of allergic reactions: hives, difficulty breathing, swelling of your face or throat
- Unusual changes in mood or behavior
- Severe constipation or stomach pain
- Trouble swallowing the tablet whole
- Nausea and vomiting that doesn't go away
- Low blood pressure (feeling faint, dizzy)
If you experience any of these symptoms while taking Renagel, contact your healthcare provider immediately for further advice.
Contraindications for Renvela and Renagel?
Renvela and Renagel, like all phosphate binders, may cause adverse gastrointestinal effects in some people. If you notice symptoms such as nausea, vomiting or constipation worsening after starting these medications, please seek immediate medical attention.
Neither Renvela nor Renagel should be taken if you are taking other drugs that can interact with them like ciprofloxacin, levothyroxine and certain heart rhythm medications without informing your doctor. Always remember to tell your healthcare provider about any other medications or supplements you are taking; there might need to be a gap of 2 hours before or after the dose of these medications to prevent unwanted interactions with Renvela and Renagel.
Moreover, these drugs are contraindicated for those who have bowel obstruction issues. It's also important that patients on dialysis keep their physician informed about their use of either medication – adjustments in dosages or scheduling may be necessary depending upon individual patient factors including blood phosphorus levels.
How much do Renvela and Renagel cost?
For the brand name versions of these drugs:
- The price of a package containing 90 tablets (800 mg each) of Renvela averages around $740, which works out to approximately $24–48/day, depending on your dose.
- The price for a similar quantity of Renagel (800 mg), is about $530, working out to roughly $17-$34/day.
Thus, if you are in the higher dosage range for Renvela (i.e., 2400 mg/day or higher), then brand-name Renagel can be less expensive on a per-day treatment basis. It's important to remember that cost should not be the primary factor when deciding which drug is best suited for you.
As it stands today, there are no generic versions available for either drug. However, both medicines have been effective at reducing phosphate levels in people with chronic kidney disease who are on dialysis. So while costs may vary greatly based upon dosages and local pricing variations across different pharmacies and regions – both medications offer viable solutions depending upon specific patient needs and responses.
Popularity of Renvela and Renagel
Sevelamer, in generic form and under brand names such as Renagel or Renvela, is a common medication prescribed to patients with chronic kidney disease (CKD) on dialysis. This drug helps control hyperphosphatemia by reducing the absorption of phosphate from food intake.
In 2020, it was estimated that Sevelamer hydrochloride (Renagel) was prescribed to about 1.2 million people in the US. It accounted for nearly 8% of prescriptions for CKD-related conditions in the country during this time period.
On the other hand, sevelamer carbonate (Renvela), which offers similar efficacy but has a better gastric tolerability profile compared to its predecessor Renagel, had slightly higher prescription rates. In 2020 alone, approximately 1.5 million people in the USA were prescribed with this version of sevelamer. Thus accounting for around 10% of all medications related to managing CKD symptoms during that same year.
It's important to note that both versions have remained fairly steady in their prevalence over recent years due largely to their effectiveness at controlling phosphorous levels without causing significant side effects often associated with other phosphate binders like calcium accumulation.
Conclusion
Both Renvela (sevelamer carbonate) and Renagel (sevelamer hydrochloride) have been widely used in patients with chronic kidney disease to control high blood phosphorus levels, which can lead to serious health problems. They work by binding phosphate from food within the digestive tract, thereby preventing its absorption into the bloodstream.
Renagel was introduced first but has since been largely replaced by Renvela due to its improved gastrointestinal tolerability. The key difference between them is that while both are non-calcium, metal-free phosphate binders, Renagel is a hydrochloride salt whereas Renvela is a carbonate salt. This allows for better pH balance in your body's acid-base level with less potential for metabolic acidosis compared to using calcium or aluminum-based binders.
Both drugs are available in generic forms and represent significant cost savings especially for patients who must pay out of pocket. Like other medications, both may require an adjustment period during which physicians carefully monitor blood chemistry values.
The side effect profile is similar between these two drugs — common effects include nausea, vomiting and constipation — although some people find they tolerate one form better than the other. Patients should inform their healthcare provider if they experience severe stomach/abdominal pain or unusually slow heartbeat.
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Refrences
- Frazão, J. M., & Adragão, T. (2008, December). Treatment of hyperphosphatemia with sevelamer hydrochloride in dialysis patients: effects on vascular calcification, bone and a close look into the survival data. Kidney International. Elsevier BV.http://doi.org/10.1038/ki.2008.544
- Fischer, D., Cline, K., Plone, M. A., Dillon, M., Burke, S. K., & Blair, A. T. (2006, September). Results of a Randomized Crossover Study Comparing Once-Daily and Thrice-Daily Sevelamer Dosing. American Journal of Kidney Diseases. Elsevier BV.http://doi.org/10.1053/j.ajkd.2006.05.026
- Perry, C. M., & Plosker, G. L. (2014, May). Sevelamer Carbonate: A Review in Hyperphosphataemia in Adults with Chronic Kidney Disease. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-014-0215-7
- Huybrechts, K. F., Caro, J. J., & O'Brien, J. A. (2009, January). Prevention and Management of Hyperphosphatemia with Sevelamer in Canada: Health and Economic Consequences. Value in Health. Elsevier BV.http://doi.org/10.1111/j.1524-4733.2008.00408.x
- Burke, S. K., Amin, N. S., Incerti, C., Plone, M. A., & Lee, J. W. (2001, February). Sevelamer Hydrochloride (Renagel®), a Phosphate‐Binding Polymer, Does Not Alter the Pharmacokinetics of Two Commonly Used Antihypertensives in Healthy Volunteers. The Journal of Clinical Pharmacology. Wiley.http://doi.org/10.1177/00912700122009881
- Wrong, O., & Harland, C. (2007, August 3). Sevelamer and Other Anion-Exchange Resins in the Prevention and Treatment of Hyperphosphataemia in Chronic Renal Failure. Nephron Physiology. S. Karger AG.http://doi.org/10.1159/000106568