MDose · Veterinary drug reference
TIER2 TOPIC: PHOSPHATE BINDERS (ALUMINUM HYDROXIDE / LANTHANUM / SEVELAMER)
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Pending clinical review (PROPOSED)Rule-based (RULE_BASED)— applies to the facts and dose entries in this species selection; individual source records retain their own status.
Indications2
Hyperphosphatemia of CKD when dietary restriction alone fails
DogCatExtra-label (EXTRA_LABEL)2 source records · View provenance
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Original excerpt: Hyperphosphatemia of CKD when dietary restriction alone fails — Extra-label (aluminum OTC; others human drugs)
- Cat · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Original excerpt: Hyperphosphatemia of CKD when dietary restriction alone fails — Extra-label (aluminum OTC; others human drugs)
- Dog · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Indications table · Not applicable · Extra-label (EXTRA_LABEL) · Pending clinical review (PROPOSED) · Rule-based
Dose regimens0
No dose regimens recorded for this species selection.
Adverse effects5
Constipation — Aluminum's main effect
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Aluminum toxicity (chronic CKD use: encephalopathy, osteomalacia, myopathy) — The reason for alternatives
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Vomiting/nausea/inappetence — Lanthanum
CatNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Cat · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Fat-soluble vitamin depletion (esp. K → coagulation) — Sevelamer
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Electrolyte shifts (bicarbonate w/ sevelamer HCl) — Possible
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Side Effects / Adverse Effects table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Monitoring1
Serum phosphorus q2–4 wk titration (target toward normal range), calcium, potassium, bicarbonate; PCV (aluminum toxicity anemia); coagulation screen with sevelamer
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Monitoring Parameters · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Precautions5
Gastric outlet obstruction (aluminum antacids inhibit emptying); hypophosphatemia from over-bounding; GI obstruction strictures (sevelamer human warning)
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Contraindications & Warnings table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
A binder not given with the meal does nothing — it must be in the gut lumen with dietary phosphate; the timing rule IS the therapy.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Ladder logic: aluminum (cheap, effective, constipation + long-term toxicity) → lanthanum/sevelamer (safer chronic profile, expensive, feline-friendly formats like Renalzin food-gel).
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
CKD bone-mineral package: phosphate binder + renal diet (+ calcitriol when indicated) — phosphorus control outperforms almost every other CKD intervention for survival.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Separate other oral meds by ≥2 h — the binder doesn't discriminate between phosphate and your drug.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Clinical pearl · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Interactions3
Give WITH food, separate from other oral drugs (binders adsorb co-administered drugs) — Levothyroxine, fluoroquinolones, doxycycline, etc. — separate doses
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Vitamin K absorption (sevelamer) — Coagulation screening before/after starting
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Citrate (aluminum) — ↑ aluminum absorption — avoid aluminum + citrate salts together
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Drug Interactions table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Pharmacokinetics4
Mechanism — All: insoluble complexes with dietary phosphate in the gut lumen → fecal excretion
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Aluminum absorption — Minimal but accumulates with chronic renal failure → aluminum toxicity (bone, CNS)
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Lanthanum absorption — <0.002% — but tissue levels rise over time in lab animals
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Sevelamer — Non-absorbed polymer; also binds bile acids (↓cholesterol) and fat-soluble vitamins (K!)
Other speciesNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Other species · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Pharmacokinetics table · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Pregnancy / lactation considerations1
Not established; binder logic minimizes exposure.
Species not recordedNot applicable (NOT_APPLICABLE)1 source record · View provenance
- Species not recorded · Plumb's Veterinary Drug Handbook, 7th ed., p. 59–60 (aluminum), p. 708–709 (lanthanum), p. 1057–1058 (sevelamer) — Pregnancy & Lactation · Not applicable · Not applicable (NOT_APPLICABLE) · Pending clinical review (PROPOSED) · Rule-based
Sources: Plumb DC. Plumb's Veterinary Drug Handbook. 7th ed. PharmaVet Inc; 2011.
Owner information handout
Plain-language medication information to review with the owner. Open the handout to print it or download a PDF.