User:PharmD2026/Phosphate binder
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Mechanism of action
[edit]These agents work by binding to phosphate in the GI tract, thereby making it unavailable to the body for absorption. Hence, these drugs are usually taken with meals to bind any phosphate that may be present in the ingested food. Phosphate binders may be simple molecular entities (such as magnesium, aluminium, calcium, or lanthanum salts) that react with phosphate and form an insoluble compound. Phosphate binders such as sevelamer may also be polymeric structures which bind to phosphate and are then excreted.[citation needed]
*Want to re-write MOA b/c it's very unorganized and difficult to understand. Also, none of it is supported by any references.
Calcium carbonate
Calcium-based phosphate binders, such as calcium carbonate, directly decrease phosphate levels by creating insoluble calcium-phosphate complexes which gets eliminated in the feces.[1]
Lanthanum carbonate
Non-calcium-based phosphate binders, including lanthanum carbonate, form insoluble complexes with phosphates in your food; thereby reducing phosphate levels in the body.[1]
Sevelamer carbonate
Sevelamer is an insoluble polymeric amine, which is protonated once in the intestines & this allows it to bind dietary phosphate. Phosphates are eliminated along with sevelamer, leading to a decrease in the body's phosphate levels.[1]
Medical use
[edit]For people with chronic kidney failure, controlling serum phosphate is important because it is associated with bone pathology and regulated together with serum calcium by the parathyroid hormone (PTH).[1]
*Want to find a citation to support the last sentence about hypoparathroidism.
- Hypoparathyroidism is when PTH conc is very low & leads to hypocalcemia. The goal of clinical management of hypoparathyroidism is to correct acute & chronic hypocalcemia. The tx cornerstones of chronic hypoparathyroidism are oral supplementation of calcium and/or vit D, that can be associated w/ dietary restriction of sodium & phosphates, thiazide diuretics, & phosphate binders[2]
- Relationship b/w PTH & Ca2+ is inversely proportional - low Ca2+ levels stimulate PTH secretion[2]
- There's NO data available on the use of phosphate binders in hypoparathyroidism; therefore, phosphate binders should be used cautiously, & only if severe hyperphosphatemia is present[2]
- A low-phosphate diet is recommended, & phosphate binders are rarely needed[3]
- Phosphate binders are generally not used unless severe hyperphosphatemia[4]
Adverse effects
[edit]With regard to phosphate binders, aluminium-containing compounds (such as aluminium hydroxide) are the least preferred because prolonged aluminium intake can cause encephalopathy and osteomalacia. If calcium is already being used as a supplement, additional calcium used as a phosphate binder may cause hypercalcemia and tissue-damaging calcinosis. One may avoid these adverse effects by using phosphate binders that do not contain calcium or aluminium as active ingredients, such as lanthanum carbonate or sevelamer.
*Want to re-write also b/c unorganized and not supported by any references.
Calcium carbonate
- GI effects (nausea, vomiting, constipation)[1]
- Risk of cardiovascular calcification[5]
- Risk of hypercalcemia[5]
Lanthanum carbonate
- GI obstruction[1]
- Bile duct obstruction[1]
- Hepatic impairment[1]
- No hypercalcemia risk[5]
Sevelamer carbonate
- GI effects (nausea, vomiting, constipation, flatulence)[1]
- No hypercalcemia risk[5]
References
[edit]- ^ a b c d e f g h Daoud, Kirollos; Anwar, Nihad; Nguyen, Timothy (2023). "The Role of Iron-Based Phosphate Binder in the Treatment of Hyperphosphatemia". Nephrology Nursing Journal. 50 (2): 140. doi:10.37526/1526-744x.2023.50.2.140. ISSN 1526-744X.
- ^ a b c Tecilazich, Francesco; Formenti, Anna Maria; Frara, Stefano; Giubbini, Raffaele; Giustina, Andrea (December 2018). "Treatment of hypoparathyroidism". Best Practice & Research Clinical Endocrinology & Metabolism. 32 (6): 955–964. doi:10.1016/j.beem.2018.12.002 – via National Library of Medicine.
- ^ Sakane, Eliane Naomi; Vieira, Maria Carolina Camargo; Vieira, Gabriela Mazzarolo Marcondes; Maeda, Sergio Setsuo (2022-11-16). "Treatment options in hypoparathyroidism". Archives of Endocrinology and Metabolism. 66 (5): 651–657. doi:10.20945/2359-3997000000554. ISSN 2359-3997. PMC 10118816. PMID 36382754.
{{cite journal}}: CS1 maint: PMC format (link) - ^ Bilezikian, John P.; Brandi, Maria Luisa; Cusano, Natalie E.; Mannstadt, Michael; Rejnmark, Lars; Rizzoli, René; Rubin, Mishaela R.; Winer, Karen K.; Liberman, Uri A.; Potts, John T. (2016-06-01). "Management of Hypoparathyroidism: Present and Future". The Journal of Clinical Endocrinology & Metabolism. 101 (6): 2313–2324. doi:10.1210/jc.2015-3910. ISSN 0021-972X. PMC 5393596. PMID 26938200.
{{cite journal}}: CS1 maint: PMC format (link) - ^ a b c d Jadav, Paresh R.; Husain, S. Ali; Mohan, Sumit; Crew, Russell (May 2022). "Non calcium phosphate binders - Is there any evidence of benefit". Current Opinion in Nephrology & Hypertension. 31 (3): 288–296. doi:10.1097/MNH.0000000000000796. ISSN 1062-4821 – via Ovid.