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Velphoro vs Renvela
Introduction
For patients with chronic kidney disease who are on dialysis, certain medications can help control high levels of phosphorus in the blood, a condition common in these individuals. Velphoro and Renvela are two such drugs that bind to dietary phosphate and prevent its absorption into the bloodstream. Both have beneficial effects in managing hyperphosphatemia in patients undergoing dialysis. Velphoro is an iron-based phosphate binder, which may also help manage any underlying iron deficiency without increasing the risk of iron overload. On the other hand, Renvela is a calcium-free metal cation-free phosphate binder made from polymers and works by binding to dietary phosphates before they can be absorbed into your body.
Velphoro vs Renvela Side By Side
| Attribute | Velphoro | Renvela |
|---|---|---|
| Brand Name | Velphoro | Renvela |
| Contraindications | Should not be used with certain medications like levothyroxine or ciprofloxacin due to the risk of reduced absorption. Not recommended for people with bowel obstruction issues or those with swallowing difficulties. | Should not be used with certain medications without careful timing to avoid unfavorable interactions. Not recommended for people with bowel obstruction issues. |
| Cost | Around $890 for a 1-month supply of 90 tablets (500mg) | Around $990 for a 1-month supply of 90 packets (800 mg/packet) |
| Generic Name | sucroferric oxyhydroxide | sevelamer carbonate |
| Most Serious Side Effect | Signs of allergic reactions, unusual changes in mood or behavior, dark colored stools, shortness of breath | Severe constipation and stomach pain, nausea or vomiting that doesn't go away, unusual tiredness or weakness, blood in stool or change in bowel habits, rapid weight gain due to fluid retention, shortness of breath especially when lying down |
| Severe Drug Interactions | Reduced absorption of levothyroxine or ciprofloxacin | May require specific timing for taking other medications to avoid reduced absorption or effectiveness |
| Typical Dose | Started at 1,500 mg/day (taken as one chewable tablet three times per day with meals), not to exceed a total daily dose of 3,000 mg | Initiated at 800–1600 mg with each meal for adults, adjusted every 2-3 weeks until an acceptable serum phosphorus level is reached. For children aged six years and older, the starting dose should not exceed 1800 mg per day. |
What is Velphoro?
Velphoro (generic name sucroferric oxyhydroxide) and Renvela (generic name sevelamer carbonate) are both phosphate binders, a class of drugs that help manage high blood phosphate levels in people with chronic kidney disease. Velphoro was approved by the FDA in 2013. It works by binding dietary phosphates within the gastrointestinal tract to prevent its absorption into the bloodstream effectively "trapping" it for elimination via digestion. This medication is commonly prescribed for patients undergoing dialysis due to end-stage renal disease.
On the other hand, Velphoro has a selective influence on phosphate absorption with minimal systemic effects or interactions with other medications as compared to Renvela. By having fewer side effects than Renvela, which can cause gastrointestinal issues like nausea and constipation more frequently, Velphoro is considered a safer option for long-term use by some healthcare professionals.
What conditions is Velphoro approved to treat?
Velphoro is approved for the treatment of certain conditions, such as:
- Hyperphosphatemia in patients with chronic kidney disease on dialysis
- Controlling serum phosphorous levels in adult patients undergoing hemodialysis or peritoneal dialysis
On the other hand, Renvela is also used for similar purposes which include:
- Lowering serum phosphorus in patients with chronic kidney disease who are on dialysis
- It can be used by adults and children who are at least 6 years old
How does Velphoro help with these illnesses?
Velphoro is designed to manage high phosphate levels in patients with chronic kidney disease who are on dialysis. It does this by binding dietary phosphate in the digestive tract, preventing its absorption into the body, so that it can be excreted instead. Phosphate is a mineral which plays an important role in many biological processes such as cell function and bone health; however, excessive amounts due to impaired kidney function can lead to various complications including heart disease and bone disorders. It's believed that individuals with advanced renal diseases have higher levels of serum phosphates. Therefore, by reducing the amount of phosphate absorbed from food, Velphoro helps limit these negative effects associated with elevated blood phosphate levels and helps patients manage their condition more effectively.
What is Renvela?
Renvela is the brand name for sevelamer, a phosphate binder that helps prevent hypocalcemia (low levels of calcium in the body) caused by elevated phosphorus. It works by binding to dietary phosphate in the digestive tract and reducing its absorption into the body. Sevelamer was first approved by the FDA in 2007. As it does not contain calcium or metal cations, it avoids complications associated with excessive intake of these substances which are common with other binders such as Velphoro. Its lack of metallic ions means that it does not result in iron overload, a significant concern particularly with chronic kidney disease patients on dialysis who receive intravenous iron supplementation regularly. Renvela's side-effect profile is also different from that of other binders; specifically, it may lower LDL cholesterol levels, an effect which can be beneficial for cardiovascular health especially important for patients undergoing hemodialysis. The impact on lipid profile distinguishes Renvela from many "typical" phosphate-binding drugs like Velphoro.
What conditions is Renvela approved to treat?
Renvela, also known as sevelamer carbonate, is an effective medication used in the treatment of:
- Hyperphosphatemia (high blood phosphate levels) commonly found in patients with kidney disease who are on dialysis
- It's a phosphate binder which helps to prevent hypocalcemia, or low calcium levels caused by elevated phosphorus.
How does Renvela help with these illnesses?
Renvela, a phosphate binder medication, plays a role in many processes within the body. It is primarily used to control phosphorus levels in adults with chronic kidney disease who are on dialysis. High levels of phosphorous can lead to serious health issues such as bone disorders and calcification of tissues. Renvela works by binding with phosphate from the diet and reducing its absorption into the bloodstream, thereby decreasing overall phosphate levels within the body.
Like Velphoro, it does not contain calcium or aluminum which significantly reduces risks associated with these elements seen in other binders - such as hypercalcemia (high calcium level) or toxicity respectively. However, where Renvela stands out is that it has been shown to have fewer instances of drug interactions compared to some other binders like Velphoro while also having a more manageable dosing schedule for patients.
How effective are both Velphoro and Renvela?
Both Velphoro (sucroferric oxyhydroxide) and Renvela (sevelamer carbonate) are highly effective at controlling serum phosphate levels in patients with chronic kidney disease on dialysis, and were approved by the FDA only a few years apart. As they bind to dietary phosphate in different ways, they may be prescribed under different circumstances. The effectiveness of Velphoro and Renvela was directly compared in a 24-week randomized control trial published in 2013; both medications demonstrated similar efficacy in managing hyperphosphatemia as well as comparable safety profiles.
A systematic review from 2016 showed that Velphoro is generally well-tolerated with common side effects including discolored feces due to its iron content and mild gastrointestinal discomfort. It also indicated that the medication starts reducing serum phosphate levels within one week of treatment initiation. Furthermore, since it has a lower pill burden than most other phosphate binders, compliance might be better for some patients.
On the other hand, Renvela has become one of the most widely used non-calcium-based phosphate binders worldwide because it does not contribute to vascular calcification or parathyroid hormone increases seen with calcium-based binders. While there is significant research supporting sevelamer's efficacy as a stand-alone treatment for hyperphosphatemia management due to its unique mechanism of action, evidence supporting sucroferric oxyhydroxide's superiority over sevelamer is still generally lacking.
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At what dose is Velphoro typically prescribed?
Oral dosages of Velphoro are typically started at 1,500 mg/day (taken as one chewable tablet three times per day with meals) for patients with chronic kidney disease on dialysis. Studies have indicated that this starting dose is effective in reducing serum phosphorus levels. If necessary, the dosage can be adjusted every 2-4 weeks, but should not exceed a total daily dose of 3,000 mg. In comparison, Renvela is usually started at 800 to 1600 mg with each meal for these same patients and may also be adjusted accordingly based on serum phosphorus levels; however the upper limit differs and must be set by your healthcare provider.
At what dose is Renvela typically prescribed?
Renvela therapy is typically initiated at a dosage of 800–1600 mg with each meal for adults, depending on the serum phosphorus level. The dose can then be adjusted every 2-3 weeks until an acceptable serum phosphorus level is reached. For children aged six years and older, the starting dose should not exceed 1800 mg per day and it can be increased gradually based on response to treatment and tolerability. Each Renvela tablet or sachet should be taken with meals and adherence to this regimen is critical for achieving optimal therapeutic outcomes.
What are the most common side effects for Velphoro?
The side effects of Velphoro and Renvela are somewhat different due to their composition, but some common ones include:
- Nausea
- Vomiting
- Diarrhea or constipation
- Stomach pain
- Hypercalcemia (excessive calcium in the blood)
- Muscle spasms or stiffness
For Velphoro specifically, other potential adverse reactions may include tooth discoloration and rash. For Renvela, more severe side effects can occur such as chest pain, coughing up blood, or feeling short of breath. As always, consult a healthcare professional if you experience any adverse effects after starting these medications.
Are there any potential serious side effects for Velphoro?
While both Velphoro and Renvela are used to control phosphorus levels in people with chronic kidney disease, they can have different side effects. For Velphoro, watch out for:
- Signs of allergic reactions: hives; difficulty breathing; swelling of your face, lips, tongue, or throat
- Unusual changes in mood or behavior
- Dark colored stools (due to the iron content)
- Shortness of breath
On the other hand, Renvela may cause:
- Nausea and vomiting
- Constipation
- Upset stomach
- Bloating
More serious side effects could include:
- Severe constipation
- Bowel obstruction symptoms like abdominal pain or swelling, severe constipation or vomiting.
In any case where you experience these severe adverse reactions after taking either medication - immediate medical attention is required.
What are the most common side effects for Renvela?
Renvela can have numerous side effects, some of which are similar to Velphoro but others differ. The most commonly experienced ones include:
-
Nausea or vomiting
-
Stomach pain
-
Constipation
-
Diarrhea
-
Gas or bloating
-
Headaches or dizziness Some patients may also experience more severe symptoms such as:
-
Severe stomach/abdominal pain,
-
Unusual bleeding/bruising, These adverse reactions should be promptly communicated with your healthcare provider for appropriate action and management.
Are there any potential serious side effects for Renvela?
Renvela, like any medication, is not without its potential side effects. The more serious ones are rare but require immediate medical attention if they occur:
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue or throat
- Severe constipation and stomach pain
- Nausea or vomiting that doesn't go away
- Unusual tiredness or weakness
- Blood in stool or change in bowel habits
- Rapid weight gain due to fluid retention
- Shortness of breath especially when lying down
These symptoms could indicate a severe reaction to the drug. If you experience any of these after taking Renvela, it's important that you seek immediate medical attention.
Contraindications for Velphoro and Renvela?
Both Velphoro and Renvela, like many other phosphate binders, may have side effects. It's crucial to monitor your health while taking these medications. If you notice severe constipation, diarrhea or experience unexplained weight loss or gain, contact your healthcare provider immediately.
Neither Velphoro nor Renvela should be used if you are taking certain other medicines such as levothyroxine or ciprofloxacin due to the risk of reduced absorption of these drugs. Always inform your doctor about any medications you're currently using; some medicines may require a specific time gap before or after taking Velphoro or Renvela in order to avoid unfavorable interactions.
Moreover, if you suffer from bowel obstruction issues it might not be safe for you to take either drug without medical supervision. People with swallowing difficulties should also inform their doctors since both these tablets can pose a choking hazard.
How much do Velphoro and Renvela cost?
Comparing the prices of Velphoro and Renvela:
For the brand name versions of these drugs:
- The price for 90 tablets (1-month supply) of Velphoro (500mg) averages around $890, which works out to approximately $30/day.
- The cost for 90 packets (1-month supply) of Renvela powder (800 mg/packet) is about $990, equating to roughly $33/day.
Thus, if you're on a standard dose regimen for either medication, brand-name Velphoro tends to be less expensive on a per-day treatment basis. However, it's important to remember that cost should not be your primary consideration when deciding between these two medications.
As far as generic versions are concerned:
- There is currently no generic version available for Velphoro.
- Sevelamer carbonate, the active ingredient in Renvela does have a generic form which significantly reduces its daily cost. Prices can vary considerably depending upon insurance coverage and location but expect costs well under those associated with brand names.
It’s always prudent to discuss options with your healthcare provider who can factor in both clinical efficacy and financial considerations into their recommendations.
Popularity of Velphoro and Renvela
Velphoro (generic form: sucroferric oxyhydroxide) and Renvela (generic form: sevelamer carbonate) are both prescribed to patients with chronic kidney disease on dialysis, helping them control the levels of phosphorus in their blood.
In 2020, Velphoro was estimated to have been prescribed to about 100,000 people in the US. It accounted for just over 10% of phosphate binder prescriptions in the country. Despite being a relatively newer medication compared to other phosphate binders, its use has increased notably since it became available in late 2013 due to its lower pill burden and better tolerance among patients.
Renvela on the other hand, was prescribed to approximately 200,000 people in the US during that same period. This accounted for around 20% of all phosphate binder prescriptions across America. The prevalence of Renvela has remained steady over recent years as it continues to be a preferred choice due its efficacy and safety profile despite having higher pill burden than Velphoro.
Conclusion
Both Velphoro (sucroferric oxyhydroxide) and Renvela (sevelamer) have been shown to be effective in patients with chronic kidney disease for the control of serum phosphorus levels. They work by binding phosphate from food in the digestive tract, preventing its absorption into the blood. Both are usually taken with meals and can be used together if required, although this would need careful consideration by a healthcare provider as they also interact with other medications.
While both drugs share a similar purpose, their mechanisms of action differ slightly: Velphoro uses an iron-based compound to bind phosphates, while Renvela is based on polymer technology.
Both drugs come in generic form which significantly reduces costs especially for patients who must pay out-of-pocket; however, it's important to note that only sevelamer hydrochloride is currently available as a generic drug - not sevelamer carbonate which is found specifically in Renvela.
The side effects between these two medicines vary too; common adverse events reported include gastrointestinal disturbances such as nausea or diarrhea. For both drugs, patients should report any unusual symptoms to their healthcare provider immediately. It may take some time before you notice significant changes in your phosphorus levels after starting treatment with either medication.
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Refrences
- Sakurada, T., Oishi, D., Shibagaki, Y., Yasuda, T., & Kimura, K. (2013, October). Efficacy of oral powder compared with chewable tablets for lanthanum carbonate administration in hemodialysis patients. Hemodialysis International. Wiley.http://doi.org/10.1111/hdi.12081
- Ogata, H., Takeshima, A., & Ito, H. (2022, February 21). An update on phosphate binders for the treatment of hyperphosphatemia in chronic kidney disease patients on dialysis: a review of safety profiles. Expert Opinion on Drug Safety. Informa UK Limited.http://doi.org/10.1080/14740338.2022.2044472
- Ikee, R., Tsunoda, M., Sasaki, N., Sato, N., & Hashimoto, N. (2013). Emerging Effects of Sevelamer in Chronic Kidney Disease. Kidney and Blood Pressure Research. S. Karger AG.http://doi.org/10.1159/000343397