INTRODUCTION

Renasel 800mg Tablet FC is used to treat increased phosphate level in the blood. It is used in patients who are on dialysis due to severe kidney disease. It inhibits the absorption of phosphate from the intestine and lower the phosphate levels in the blood.

Renasel 800mg Tablet FC should be taken with food. Take it in the dose and duration as advised by your doctor. Take it regularly and at a fixed time each day to get maximum benefit of the medicine.

Using of Renasel 800mg Tablet FC may cause side effects such as nausea, vomiting, abdominal pain, constipation and diarrhea. You may also develop low levels of calcium, folic acid and vitamins A, D, E and K in your blood. Take necessary supplements as advised by your doctor.

USES OF RENASEL TABLET FC

• High phosphate levels in blood

SIDE EFFECTS OF RENASEL TABLET FC

Common

• Nausea
• Vomiting
• Abdominal pain upper
• Flatulence
• Constipation
• Diarrhea
• Dyspepsia

HOW TO USE RENASEL TABLET FC

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Renasel 800mg Tablet FC is to be taken with food.

HOW RENASEL TABLET FC WORKS

Renasel 800mg Tablet FC inhibits the absorption of phosphate from the intestine and lower the phosphate levels in the blood.

SAFETY ADVICE

Alcohol

CONSULT YOUR DOCTOR

It is not known whether it is safe to consume alcohol with Renasel 800mg Tablet FC. Please consult your doctor.

Pregnancy

CONSULT YOUR DOCTOR

Renasel 800mg Tablet FC may be unsafe to use during pregnancy. Although there are limited studies in humans, animal studies have shown harmful effects on the developing baby. Your doctor will weigh the benefits and any potential risks before prescribing it to you. Please consult your doctor.

Breastfeeding

SAFE IF PRESCRIBED

Renasel 800mg Tablet FC is probably safe to use during breastfeeding. Limited human data suggests that the drug does not represent any significant risk to the baby.

Driving

CONSULT YOUR DOCTOR

It is not known whether Renasel 800mg Tablet FC alters the ability to drive. Do not drive if you experience any symptoms that affect your ability to concentrate and react.

Kidney

SAFE IF PRESCRIBED

Renasel 800mg Tablet FC is safe to use in patients with kidney disease. No dose adjustment of Renasel 800mg Tablet FC is recommended.
However, regular monitoring of calcium levels is advisable in these patients.

Liver

SAFE IF PRESCRIBED

Renasel 800mg Tablet FC is probably safe to use in patients with liver disease. Limited data available suggests that dose adjustment of Renasel 800mg Tablet FC may not be needed in these patients. Please consult your doctor.

WHAT IF YOU FORGET TO TAKE RENASEL TABLET FC?

If you miss a dose of Renasel 800mg Tablet FC, skip it and continue with your normal schedule. Do not double the dose.

Sevelamer Carbonate Tablets 800mg (Renasel) Taj Pharma

1.Name of the medicinal product

a) Sevelamer carbonate 400mg (Renasel)
b) Sevelamer carbonate 800mg (Renasel)

2.  Qualitative and quantitative composition

a) Each Tablet Contains:
Sevelamer Carbonate     400mg
Excipients                             q.s.

b) Each Tablet Contains:
Sevelamer Carbonate      800mg
Excipients                              q.s.

For the full list of excipients, see section 6.1.

3. Pharmaceutical form

Film-coated tablet.

Oval, white to off-white film-coated tablets (20 mm x 7 mm) without scoring line.

4. Clinical particulars

4.1 Therapeutic indications

Sevelamer is indicated for the control of hyperphosphataemia in adult patients receiving haemodialysis or peritoneal dialysis.

Sevelamer is also indicated for the control of hyperphosphataemia in adult patients with chronic kidney disease not on dialysis with serum phosphorus ≥ 1.78 mmol/l.

Sevelamer should be used within the context of a multiple therapeutic approach, which could include calcium supplement, 1,25-dihydroxy Vitamin D₃ or one of its analogues to control the development of renal bone disease.

4.2 Posology and method of administration

Posology

Starting dose

The recommended starting dose of sevelamer carbonate is 2.4 g or 4.8 g per day based on clinical needs and serum phosphorus level. Sevelamer must be taken three times per day with meals.

*Plus subsequent titrating as per instructions

For patients previously on phosphate binders (sevelamer hydrochloride or calcium based), Sevelamer should be given on a gram for gram basis with monitoring of serum phosphorus levels to ensure optimal daily doses.

Titration and Maintenance

Serum phosphorus levels must be monitored and the dose of sevelamer carbonate titrated by 0.8 g three times per day (2.4 g/day) increment every 2-4 weeks until an acceptable serum phosphorus level is reached, with regular monitoring thereafter.

Patients taking Sevelamer should adhere to their prescribed diets.

In clinical practice, treatment will be continuous based on the need to control serum phosphorus levels and the daily dose is expected to be an average of approximately 6 g per day.

Paediatric population

The safety and efficacy of Sevelamer has not been established in children below the age of 18 years.

Sevelamer is not recommended in children below the age of 18 years.

Method of administration

For oral use.

Tablets should be swallowed intact and should not be crushed, chewed, or broken into pieces prior to administration.

4.3 Contraindications

• Hypersensitivity to the active substance or to any of the excipients listed in section 6.1.
• Hypophosphataemia
• Bowel obstruction.

4.4 Special warnings and precautions for use

The safety and efficacy of Sevelamer have not been established in adult patients with chronic kidney disease not on dialysis with serum phosphorus < 1.78 mmol/l. Therefore Sevelamer is currently not recommended for use in these patients.

The safety and efficacy of Sevelamer have not been established in patients with the following disorders:

• dysphagia
• swallowing disorders
• severe gastrointestinal motility disorders including untreated or severe gastroparesis, retention of gastric contents and abnormal or irregular bowel motion
• active inflammatory bowel disease
• major gastrointestinal tract surgery

Therefore caution should be exercised when Sevelamer is used in these patients.

Intestinal obstruction and ileus/subileus

In very rare cases, intestinal obstruction and ileus/subileus have been observed in patients during treatment with sevelamer hydrochloride (capsule/tablets), which contains the same active moiety as sevelamer carbonate. Constipation may be a preceding symptom. Patients who are constipated should be monitored carefully while being treated with Sevelamer. Sevelamer treatment should be re-evaluated in patients who develop severe constipation or other severe gastrointestinal symptoms.

Fat-soluble vitamins

Patients with CKD may develop low levels of fat-soluble vitamins A, D, E and K, depending on dietary intake and the severity of their disease. It cannot be excluded that Sevelamer can bind fat-soluble vitamins contained in ingested food. In patients not taking supplemental vitamins but on sevelamer, serum vitamin A, D, E and K status should be assessed regularly. It is recommended that vitamin supplements be given if necessary. It is recommended that CKD patients not on dialysis are given vitamin D supplements (approximately 400 IU of native vitamin D daily) which can be part of a multivitamin preparation to be taken apart from their dose of Sevelamer. In patients undergoing peritoneal dialysis additional monitoring of fat soluble vitamins and folic acid is recommended, since vitamin A, D, E and K levels were not measured in a clinical study in these patients.

Folate deficiency

There is at present insufficient data to exclude the possibility of folate deficiency during long term Sevelamer treatment.

Hypocalcaemia/hypercalcaemia

Patients with CKD may develop hypocalcaemia or hypercalcaemia. Sevelamer does not contain any calcium. Serum calcium levels should therefore be monitored at regular intervals and elemental calcium should be given as a supplement if required.

Metabolic acidosis

Patients with chronic kidney disease are predisposed to developing metabolic acidosis. As part of good clinical practice, monitoring of serum bicarbonate levels is therefore recommended.

Peritonitis

Patients receiving dialysis are subject to certain risks for infection specific to dialysis modality. Peritonitis is a known complication in patients receiving peritoneal dialysis and in a clinical study with sevelamer hydrochloride, a greater number of peritonitis cases were reported in the sevelamer group than in the control group. Patients on peritoneal dialysis should be closely monitored to ensure the correct use of appropriate aseptic technique with the prompt recognition and management of any signs and symptoms associated with peritonitis.

Swallowing and choking difficulties

Uncommon reports of difficulty swallowing the Sevelamer tablet have been reported. Many of these cases involved patients with co-morbid conditions including swallowing disorders or oesophageal abnormalities. Caution should be exercised when Sevelamer is used in patients with difficulty swallowing. For patients with swallowing difficulties, sevelamer carbonate is also available as a powder for oral suspension.

Hypothyroidism

Closer monitoring of patients with hypothyroidism co-administered with sevelamer carbonate and levothyroxine is recommended (see section 4.5).

Long-term chronic treatment

In a clinical trial of one year, no evidence of accumulation of sevelamer was seen. However the potential absorption and accumulation of sevelamer during long-term chronic treatment (> one year) cannot be totally excluded (see section 5.2).

Hyperparathyroidism

Sevelamer is not indicated for the control of hyperparathyroidism. In patients with secondary hyperparathyroidism Sevelamer should be used within the context of a multiple therapeutic approach, which could include calcium as supplements, 1,25 – dihydroxy Vitamin D3 or one of its analogues to lower the intact parathyroid hormone (iPTH) levels.

Inflammatory Gastrointestinal Disorders

Cases of serious inflammatory disorders of different parts of the gastrointestinal tract (including serious complications such as bleeding, perforation, ulceration, necrosis, colitis, …) associated with the presence of sevelamer crystals have been reported in literature. However, the causality of the sevelamer crystals in initiating such disorders has not been demonstrated. Sevelamer carbonate treatment should be re-evaluated in patients who develop severe gastrointestinal symptoms.

Lactose intolerance

Sevelamer tablets contain lactose. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

4.5 Interaction with other medicinal products and other forms of interaction

Dialysis

Interaction studies have not been conducted in patients on dialysis.

Ciprofloxacin

In interaction studies in healthy volunteers, sevelamer hydrochloride, which contains the same active moiety as in Sevelamer, decreased the bioavailability of ciprofloxacin by approximately 50% when co-administered with sevelamer hydrochloride in a single dose study. Consequently, Sevelamer should not be taken simultaneously with ciprofloxacin.

Ciclosporin, mycophenolate mofetil and tacrolimus in transplant patients

Reduced levels of ciclosporin, mycophenolate mofetil and tacrolimus have been reported in transplant patients when co-administered with sevelamer hydrochloride without any clinical consequences (i.e graft rejection). The possibility of an interaction cannot be excluded and a close monitoring of blood concentrations of ciclosporin, mycophenolate mofetil and tacrolimus should be considered during the use of combination and after its withdrawal.

Levothyroxine

Very rare cases of hypothyroidism have been reported in patients co-administered sevelamer hydrochloride, which contains the same active moiety as sevelamer carbonate, and levothyroxine. Closer monitoring of thyroid stimulating hormone (TSH) levels is therefore recommended in patients receiving sevelamer carbonate and levothyroxine.

Anti-arrhythmics and anti-seizure medicinal products

Patients taking anti-arrhythmic medicinal products for the control of arrhythmias and anti-seizure medicinal products for the control of seizure disorders were excluded from clinical trials. Caution should be exercised when prescribing Sevelamer to patients also taking these medicinal products

Digoxin, warfarin, enalapril or metoprolol

In interaction studies in healthy volunteers, sevelamer hydrochloride, which contains the same active moiety as Sevelamer, had no effect on the bioavailability of digoxin, warfarin, enalapril or metoprolol.

Proton pump inhibitors

During post-marketing experience, very rare cases of increased phosphate levels have been reported in patients taking proton pump inhibitors co-administered with sevelamer carbonate.

Bioavailability

Sevelamer is not absorbed and may affect the bioavailability of other medicinal products. When administering any medicinal product where a reduction in the bioavailability could have a clinically significant effect on safety or efficacy, the medicinal product should be administered at least one hour before or three hours after Sevelamer, or the physician should consider monitoring blood levels.

4.6 Fertility, pregnancy and lactation

Pregnancy

There are no or limited amount of data from the use of sevelamer in pregnant women. Animal studies have shown some reproductive toxicity when sevelamer was administered to rats at high doses (see section 5.3). Sevelamer has also been shown to reduce the absorption of several vitamins including folic acid (see sections 4.4 and 5.3). The potential risk to humans is unknown. Sevelamer should only be given to pregnant women if clearly needed and after a careful risk/benefit analysis has been conducted for both the mother and the foetus.

Breast-feeding

It is unknown whether sevelamer/metabolites are excreted in human milk. The non-absorbed nature of sevelamer indicates that excretion of sevelamer in breast milk is unlikely. A decision on whether to continue/discontinue breast-feeding or to continue/discontinue therapy with Sevelamer should be made taking into account the benefit of breast-feeding to the child and the benefit of Sevelamer therapy to the woman.

Fertility

There are no data from the effect of sevelamer on fertility in humans. Studies in animals have shown that sevelamer did not impair fertility in male or female rats at exposures at a human equivalent dose 2 times the maximum clinical trial dose of 13 g/day, based on a comparison of relative body surface area.

4.7 Effects on ability to drive and use machines

Sevelamer has no or negligible influence on the ability to drive and use machines.

4.8 Undesirable effects

Summary of the safety profile

The most frequently occurring (≥ 5% of patients) adverse reactions were all in the gastrointestinal disorders system organ class. Most of these adverse reactions were mild to moderate in intensity.

Tabulated list of adverse reactions

The safety of sevelamer (as either carbonate and hydrochloride salts) has been investigated in numerous clinical trials involving a total of 969 haemodialysis patients with treatment duration of 4 to 50 weeks (724 patients treated with sevelamer hydrochloride and 245 with sevelamer carbonate), 97 peritoneal dialysis patients with treatment duration of 12 weeks (all treated with sevelamer hydrochloride) and 128 patients with CKD not on dialysis with treatment duration of 8 to 12 weeks (79 patients treatment with sevelamer hydrochloride and 49 with sevelamer carbonate).

Adverse reactions that occurred during clinical studies or that were spontaneously reported from post marketing experience are listed by frequency in the table below. The reporting rate is classified as very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1,000 to <1/100), rare (≥1/10,000 to <1/1,000), very rare (<1/10,000), not known (cannot be estimated from the available data).

*post-marketing experience

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product.

4.9 Overdose

Sevelamer hydrochloride, which contains the same active moiety as sevelamer carbonate, has been given to normal healthy volunteers in doses of up to 14 grams per day for eight days with no undesirable effects. In CKD patients, the maximum average daily dose studied was 14.4 grams of sevelamer carbonate in a single daily dose.

5. Pharmacological properties

5.1 Pharmacodynamic properties

Pharmacotherapeutic group: Treatment of hyperkalaemia and hyperphosphataemia.

Sevelamer contains sevelamer, a non-absorbed phosphate binding crosslinked polymer, free of metal and calcium. Sevelamer contains multiple amines separated by one carbon from the polymer backbone which become protonated in the stomach. These protonated amines bind negatively charged ions such as dietary phosphate in the intestine. By binding phosphate in the gastrointestinal tract and decreasing absorption, sevelamer lowers the phosphorus concentration in the serum. Regular monitoring of serum phosphorus levels is always necessary during phosphate binder administration.

In two randomised, cross over clinical studies, sevelamer carbonate in both tablet and powder formulations when administered three times per day has been shown to be therapeutically equivalent to sevelamer hydrochloride and therefore effective in controlling serum phosphorus in CKD patients on haemodialysis.

The first study demonstrated that sevelamer carbonate tablets dosed three times per day was equivalent to sevelamer hydrochloride tablets dosed three times per day in 79 haemodialysis patients treated over two randomised 8 week treatment periods (mean serum phosphorus time-weighted averages were 1.5 ± 0.3 mmol/l for both sevelamer carbonate and sevelamer hydrochloride). The second study demonstrated that sevelamer carbonate powder dosed three times per day was equivalent to sevelamer hydrochloride tablets dosed three times per day in 31 hyperphosphataemic (defined as serum phosphorus levels ≥ 1.78 mmol/l) haemodialysis patients over two randomised 4 week treatment periods (mean serum phosphorus time-weighted averages were 1.6 ± 0.5 mmol/l for sevelamer carbonate powder and 1.7 ± 0.4 mmol/l for sevelamer hydrochloride tablets).

In the clinical studies in haemodialysis patients, sevelamer alone did not have a consistent and clinically significant effect on serum intact parathyroid hormone (iPTH). In a 12 week study involving peritoneal dialysis patients however, similar iPTH reductions were seen compared with patients receiving calcium acetate. In patients with secondary hyperparathyroidism Sevelamer should be used within the context of a multiple therapeutic approach, which could include calcium as supplements, 1,25 – dihydroxy Vitamin D₃ or one of its analogues to lower the intact parathyroid hormone (iPTH) levels.

Sevelamer has been shown to bind bile acids in vitro and in vivo in experimental animal models. Bile acid binding by ion exchange resins is a well-established method of lowering blood cholesterol. In clinical trials of sevelamer, both the mean total-cholesterol and LDL-cholesterol declined by 15-39%. The decrease in cholesterol has been observed after 2 weeks of treatment and is maintained with long-term treatment. Triglycerides, HDL-cholesterol and albumin levels did not change following sevelamer treatment.

Because sevelamer binds bile acids, it may interfere with the absorption of fat soluble vitamins such as A, D, E and K.

Sevelamer does not contain calcium and decreases the incidence of hypercalcaemic episodes as compared to patients using calcium based phosphate binders alone. The effects of sevelamer on phosphorus and calcium were proven to be maintained throughout a study with one year follow-up. This information was obtained from studies in which sevelamer hydrochloride was used.

5.2 Pharmacokinetic properties

Pharmacokinetic studies have not been carried out with sevelamer carbonate. Sevelamer hydrochloride, which contains the same active moiety as sevelamer carbonate, is not absorbed from the gastrointestinal tract, as confirmed by an absorption study in healthy volunteers.

5.3 Preclinical safety data

Non-clinical data with sevelamer reveal no special hazard for humans based on conventional studies of safety pharmacology, repeated dose toxicity or genotoxicity.

Carcinogenicity studies with oral sevelamer hydrochloride were conducted in mice (doses of up to 9 g/kg/day) and rats (0.3, 1, or 3 g/kg/day). There was an increased incidence of urinary bladder transitional cell papilloma in male rats of the high dose group (human equivalent dose twice the maximum clinical trial dose of 14.4 g). There was no increased incidence of tumors observed in mice (human equivalent dose 3 times the maximum clinical trial dose).

In an in vitro mammalian cytogenetic test with metabolic activation, sevelamer hydrochloride caused a statistically significant increase in the number of structural chromosome aberrations. Sevelamer hydrochloride was not mutagenic in the Ames bacterial mutation assay.

In rats and dogs, sevelamer reduced absorption of fat soluble vitamins D, E and K (coagulation factors), and folic acid.

Deficits in skeletal ossification were observed in several locations in foetuses of female rats dosed with sevelamer at intermediate and high doses (human equivalent dose less than the maximum clinical trial dose of 14.4 g). The effects may be secondary to vitamin D depletion.

In pregnant rabbits given oral doses of sevelamer hydrochloride by gavage during organogenesis, an increase of early resorptions occurred in the high-dose group (human equivalent dose twice the maximum clinical trial dose).

Sevelamer hydrochloride did not impair the fertility of male or female rats in a dietary administration study in which the females were treated from 14 days prior to mating through gestation and the males were treated for 28 days prior to mating. The highest dose in this study was 4.5 g/kg/day (human equivalent dose 2 times the maximum clinical trial dose of 13 g/day, based on a comparison of relative body surface area).

6. Pharmaceutical particulars

6.1 List of excipients

Tablet core:

Lactose monohydrate, Silica, colloidal anhydrous, Zinc stearate,

Film-coating:

Hypromellose, Diacetylated monoglycerides

6.2 Incompatibilities

Not applicable.

6.3 Shelf life

3 years

6.4 Special precautions for storage

No special storage conditions.

6.5 Nature and contents of container

HDPE bottles with a polypropylene cap containing 180, 200 or 210 tablets per bottle (with and without outer carton)

Multipack containing two bottles with 180, 200 or 210 tablets per bottle (two bottles in one outer carton)

Multipack containing three bottles with 180, 200 or 210 tablets per bottle (three bottles in one outer carton)

The HDPE bottles contain a desiccant.

Not all pack sizes may be marketed.

6.6 Special precautions for disposal and other handling

No special requirements.

7. Manufactured in India By:
TAJ PHARMACEUTICALS LTD.
29, Xcelon Industrial Park-1,
Behind Intas Pharmaceuticals,
At & Po Vasna – Chacharwadi,
Tal- Sanand, Dist- Ahmedabad-382213,
Gujarat, India

Sevelamer Carbonate Tablets 800mg (Renasel) Taj Pharma

Package leaflet: Information for the user

Sevelamer carbonate 400mg (RENASEL) film-coated tablets

Sevelamer carbonate 800mg (RENASEL) film-coated tablets
sevelamer carbonate

Read all of this leaflet carefully before you start taking this medicine because it contains important information for you.

• Keep this leaflet. You may need to read it again.
• If you have further questions, ask your doctor or your pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet

1. What Sevelamer is and what it is used for
   2. What you need to know before you take Sevelamer
   3. How to take Sevelamer
   4. Possible side effects
   5. How to store Sevelamer
   6. Contents of the pack and other information
2. What Sevelamer is and what it is used for

Sevelamer contains sevelamer carbonate as the active ingredient. It binds phosphate from food in the digestive tract and so reduces serum phosphorus levels in the blood.

Sevelamer is used to control hyperphosphataemia (high blood phosphate levels) in:

• adult patients on dialysis (a blood clearance technique). It can be used in patients undergoing haemodialysis (using a blood filtration machine) or peritoneal dialysis (where fluid is pumped into the abdomen and an internal body membrane filters the blood);
• patients with chronic (long-term) kidney disease who are not on dialysis and have a serum (blood) phosphorus level equal to or above 1.78 mmol/l.

Sevelamer should be used with other treatments such as calcium supplements and vitamin D to prevent the development of bone disease. Increased levels of serum phosphorus can lead to hard deposits in your body called calcification. These deposits can stiffen your blood vessels and make it harder for blood to be pumped around the body. Increased serum phosphorus can also lead to itchy skin, red eyes, bone pain and fractures.

2. What you need to know before you take

Sevelamer

Do not take Sevelamer if:

• you have low levels of phosphate in your blood (your doctor will check this for you)
• you have bowel obstruction
• you are allergic to the active substance or to any of the other ingredients of this medicine (listed in section 6).

Warnings and Precautions

Talk to your doctor before taking Sevelamer if any of the following applies to you:

• swallowing problems
• problems with motility (movement) in your stomach and bowel
• being sick frequently
• active inflammation of the bowel
• have undergone major surgery on your stomach or bowel

Children and adolescents

The safety and efficacy in children (below the age of 18 years) has not been established. Therefore Sevelamer is not recommended for use in children.

Additional treatments:

Due to either your kidney condition or your dialysis treatment you may:

• develop low or high levels of calcium in your blood. Since sevelamer carbonate does not contain calcium your doctor might prescribe additional calcium tablets.
• have a low amount of vitamin D in your blood. Therefore, your doctor may monitor the levels of vitamin D in your blood and prescribe additional vitamin D as necessary. If you do not take multivitamin supplements you may also develop low levels of vitamins A, E, K and folic acid in your blood and therefore your doctor may monitor these levels and prescribe supplemental vitamins as necessary.

Special note for patients on peritoneal dialysis:

You may develop peritonitis (infection of your abdominal fluid) associated with your peritoneal dialysis. This risk can be reduced by careful adherence to sterile techniques during bag changes. You should tell your doctor immediately if you experience any new signs or symptoms of abdominal distress, abdominal swelling, abdominal pain, abdominal tenderness, or abdominal rigidity, constipation, fever, chills, nausea or vomiting. You should expect to be monitored more carefully for problems with low levels of vitamins A, D, E, K and folic acid.

Other medicines and Sevelamer

Tell your doctor if you are taking or have recently taken or might take any other medicines.

Sevelamer should not be taken at the same time as ciprofloxacin (an antibiotic).

If you are taking medicines for heart rhythm problems or for epilepsy, you should consult your doctor when taking Sevelamer.

The effects of medicines such as cyclosporin, mycophenolate mofetil and tacrolimus (medicines used to suppress the immune system) may be reduced by Sevelamer. Your doctor will advise you if you are taking these medicines.

Thyroid hormone deficiency may uncommonly be observed in certain people taking levothyroxine (used to treat low thyroid hormone levels) and Sevelamer. Therefore your doctor may monitor the levels of thyroid stimulating hormone in your blood more closely.

If you are taking medicine to treat heartburn, gastroesophageal reflux disease (GERO) or gastric ulcers, such as omeprazole, prantoprazole, or lansoprazole, you should consult your doctor when taking Sevelamer.

Your doctor will check for interactions between Sevelamer and other medicines on a regular basis.

In some cases where Sevelamer should be taken at the same time as another medicine. Your doctor may advise you to take this medicine 1 hour before or 3 hours after Sevelamer intake, or they may consider monitoring the blood levels of that medicine.

Sevelamer with food and drink

You must take Sevelamer tablets with meals.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. It is unknown whether Sevelamer has any affect on unborn babies.

Tell your doctor if you wish to breast-feed your baby. It is unknown whether Sevelamer may pass through breast milk and affect your baby.

Driving and using machines

Sevelamer is unlikely to affect your ability to drive or to use machines.

Sevelamer contains lactose

Sevelamer contains lactose (milk sugar). If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

3. How to take Sevelamer

You must take Sevelamer as prescribed by your doctor. They will base the dose on your serum phosphorus level.

The recommended starting dose of Sevelamer tablets for adults and the elderly (> 65 years) is one to two tablets of 800 mg with each meal, 3 times a day.

The tablets must be swallowed whole. Do not crush, chew or break into pieces.

Initially, your doctor will check the levels of phosphorus in your blood every 2-4 weeks and may adjust the dose of Sevelamer when necessary to reach an adequate phosphate level.

Patients taking Sevelamer should adhere to their prescribed diets.

If you take more Sevelamer than you should

In the event of a possible overdose you should contact your doctor immediately.

If you forget to take Sevelamer

If you have missed one dose, this dose should be omitted and the next dose should be taken at the usual time with a meal. Do not take a double dose to make up for a forgotten dose.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Since constipation may be an early symptom of a blockage in your intestine, please inform your doctor or pharmacist.

The following side effects have been reported in patients taking Sevelamer:

Very common (may affect more than 1 in 10 people):
vomiting, constipation, upper abdominal pain, nausea

Common (may affect up to 1 in 10 people):
diarrhoea, abdominal pain, indigestion, flatulence

Very rare (may affect up to 1 in 10000 people):
hypersensitivity

Not known (frequency cannot be estimated from the available data):
cases of itching, rash, slow intestine motility (movement)/blockages in the intestine, and perforation in the intestine wall have been reported.

Reporting of side effects

If you get any side effects, talk to your doctor. This includes any possible side effects not listed in this leaflet.

5. How to store Sevelamer

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date stated on the bottle and carton after the letters “EXP”. The expiry date refers to the last day of that month.

This medicinal product does not require any special storage conditions.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Sevelamer contains

• The active substance is sevelamer carbonate. Each tablet contains 800 mg of sevelamer carbonate.
• The other ingredients are lactose monohydrate, silica (colloidal anhydrous), zinc stearate. The tablet coating contains hypromellose (E464) and diacetylated monoglycerides.

What Sevelamer looks like and contents of the pack

Sevelamer are oval, white to off-white film-coated tablets with the inscription ‘SVL’ on one side.

HDPE bottles with a polypropylene cap.
Each bottle contains 180, 200 or 210 tablets.
Packs containing 1, 2 or 3 bottles are available.

The HDPE bottles contain a desiccant. Do not remove this desiccant from the bottle.

Not all pack sizes may be marketed.

7. Manufactured in India By:
TAJ PHARMACEUTICALS LTD.
29, Xcelon Industrial Park-1,
Behind Intas Pharmaceuticals,
At & Po Vasna – Chacharwadi,
Tal- Sanand, Dist- Ahmedabad-382213,
Gujarat, India