Fosbind Dosage/Direction for Use

Because of the rapid disintegration of the carbonate salt tablet and its rapid reaction with the hydrochloric acid in the stomach, the dosing of Sevelamer Carbonate is anticipated to be similar to that of the hydrochloride salt.
Patients Not Taking a Phosphate Binder. The recommended starting dose of Sevelamer Carbonate is 800 to 1600 mg, which can be administered as one or two Sevelamer Carbonate 800 mg Tablets, with meals based on serum phosphorus level. Table 3 provides recommended starting doses of Sevelamer Carbonate for patients not taking a phosphate binder. (See Table 3.)

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Patients Switching From Sevelamer Hydrochloride. For patients switching from sevelamer hydrochloride, sevelamer carbonate should be prescribed on a gram per gram basis.
Further titration to the desired phosphate levels may be necessary. The highest daily dose of sevelamer carbonate studied was 14 grams in CKD patients on dialysis.
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 sevelamer hydrochloride and calcium acetate. Table 4 gives recommended starting doses of Sevelamer Carbonate based on a patient's current calcium acetate dose. (See Table 4.)

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Dose Titration for All Patients Taking Sevelamer Carbonate. The dose should be increased or decreased by one tablet per meal at two week intervals, as necessary, with the goal of controlling serum phosphorus within the target range of 3.5 mg/dL to 5.5 mg/dL.