Gastric pH, sevelamer hydrochloride and omeprazole

Capitanini, Alessandro; Lupi, Andrea; Osteri, F.; Petrone, Isabella; Corso, Cristiane del; M, Straniti; Gallieni, Maurizio; Rossi, Angelo

doi:10.5414/cnp64320

Cited by 9 publications

(8 citation statements)

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“…The authors suggested the excessive increase in gastric pH measured was probably responsible for the decreased phosphate binding capacity of sevelamer. A rapid reduction of phosphate was also noted after omeprazole was reduced to 20 mg/day 11 . Our results also differed from the in vitro findings of Ross et al ., which showed transient acid exposure elevated sevelamer phosphate binding because of increased protonated sites.…”

Section: Discussioncontrasting

confidence: 99%

“…Also the dose–response relationship of pantoprazole was not investigated in our study; it is possible that the phosphate binding capacity of sevelamer is influenced by higher doses of pantoprazole. High‐dose omeprazole has been noted to profoundly increase gastric pH and significantly elevate serum phosphate concentration; normalization of hyperphosphatemia was observed with the subsequent reduction of omeprazole dose 11 . Clinically, however, we tested a commonly prescribed clinical dose that a majority of patients would be prescribed.…”

Section: Discussionmentioning

confidence: 99%

“…In an in vitro study by Ross et al ., transient acid exposure was found to increase sevelamer HCL phosphate binding, partly because of increased protonated sites 9 . In vivo , the potential influence of gastric pH on sevelamer phosphate binding capacity in humans was recently documented by a case report, which suggested that high‐dose omeprazole decreased the phosphate binding efficacy of sevelamer HCL 11 …”

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confidence: 99%

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Effect of gastric acid suppression with pantoprazole on the efficacy of sevelamer hydrochloride as a phosphate binder in haemodialysis patients: A pilot study

Lai

Cervelli

2012

Nephrology

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Sevelamer hydrochloride (HCL) is thought to require an appropriately acidic environment in order to bind gastrointestinal phosphate. Changes in gastric acidity with acid suppressants may therefore alter the efficacy of sevelamer HCL. Given the widespread use of acid suppression therapy in chronic kidney disease patients, there is potential for a common significant drug interaction to occur. This pilot study evaluated the in vivo effect of gastric acid suppression with pantoprazole on the efficacy of sevelamer HCL as a phosphate binder in maintenance haemodialysis patients. The study protocol was a cross-over, double-blinded, randomized, placebo-controlled trial in 10 haemodialysis patients randomly assigned to pantoprazole 40 mg daily or placebo for two consecutive 6-week periods. Serum phosphate was not significantly altered during pantoprazole compared with placebo treatment (1.61 ± 0.45 mmol/L vs 1.76 ± 0.42 mmol/L, P = 0.204). There were no differences in serum calcium, parathyroid hormone and bicarbonate. This pilot study demonstrates preliminary in vivo evidence for no effect of gastric acid suppression on the effectiveness of sevelamer HCL. Our results are limited by small sample size and therefore, larger experimental studies should be conducted. Although our study did not find a significant drug interaction, given the high prevalence of acid suppressant use in dialysis patients, physicians should be aware of the potential influence of acid suppression on the efficacy of phosphate binders and regularly assess the clinical need for acid suppression therapy.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Effect of gastric acid suppression with pantoprazole on the efficacy of sevelamer hydrochloride as a phosphate binder in haemodialysis patients: A pilot study

Lai

Cervelli

2012

Nephrology

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“…Sevelamer has some limitations: big tablet size, higher cost of treatment than other phosphate binders and interference in action by agents like proton pump inhibitors [15]. Being a retrospective study, and without a control group it is difficult to comment on the role of sevelamer in decreasing phosphatemia beyond the contribution of other measures like hyper-hydration.…”

Section: Discussionmentioning

confidence: 99%

Sevelamer is an Effective Drug in Treating Hyperphosphatemia Due to Tumor Lysis Syndrome in Children: A Developing World Experience

Kahlon

Dinand

Yadav³

et al. 2014

Indian J Hematol Blood Transfus

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We report here a study on efficacy of sevelamer hydrochloride in treating hyperphosphatemia due to tumor lysis syndrome (TLS) in a developing world setting. Twenty one children with hyperphosphatemia due to TLS were included. All received hyper-hydration, allopurinol and sevelamer. Efficacy was assessed by decrease in serum phosphate level, calcium-phosphate product and TLS score as per Cairo Bishop definition. Four children who underwent dialysis were excluded from analysis. Among the remaining 17 patients with hyperphosphatemia, laboratory TLS was recorded in 15 patients and clinical TLS in five. Sevelamer was given according to weight, most often 400 mg twice to thrice daily. Mean phosphatemia decreased from 8.3 ± 3.0 to 6.7 ± 2.1 mg/dl within 24 h of starting sevelamer (p = 0.02), 6.0 ± 2.1 mg/dl at 48 h, 4.9 ± 1.5 mg/dl at 72 h and 4.39 ± 1.7 mg/dl at 96 h. TLS was corrected in 72 h in 14 patients, 96 h in 1 and 120 h in another patient. Mean calcium-phosphate product decreased from 63.0 ± 14.0 to 49.2 ± 9.7 mg/dl (p = 0.002) at 24 h, 46.1 ± 17.0 mg/dl at 48 h and 39.7 ± 13.5 mg/dl at 72 h. There was no mortality due to hyperphosphatemia. Sevelamer is efficacious in children with malignancy-associated hyperphosphatemia in the developing world.

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“…Sevelamer works by binding phosphorus contained in food within the patient's gut. The maximal phosphate binding capacity occurs at a gastric pH of 7, and so its efficacy may be limited by concomitant use of proton pump inhibitors, which are frequently used in cancer patients undergoing chemotherapy [101]. There is only a single retrospective study on the use of sevelamer in pediatric cancer patients.…”

Section: Hyperphosphatemia Case #6mentioning

confidence: 99%

Electrolyte Disorders in Cancer Patients

Latcha

2015

Onconephrology

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Gastric pH, sevelamer hydrochloride and omeprazole

Cited by 9 publications

References 0 publications

Effect of gastric acid suppression with pantoprazole on the efficacy of sevelamer hydrochloride as a phosphate binder in haemodialysis patients: A pilot study

Effect of gastric acid suppression with pantoprazole on the efficacy of sevelamer hydrochloride as a phosphate binder in haemodialysis patients: A pilot study

Sevelamer is an Effective Drug in Treating Hyperphosphatemia Due to Tumor Lysis Syndrome in Children: A Developing World Experience

Electrolyte Disorders in Cancer Patients

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