| Formulary Chapter 9: Nutrition and blood - Full Chapter
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| Chapter Links... |
 CUH Refeeding syndrome - reducing the risk |
| NICE CG32: Nutrition support for adults: - oral nutrition support, enteral tube feeding and parenteral nutrition |
| Details... |
| 09.05.02.02 |
Phosphate-binding agents |
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Calcium Acetate (Phosex®)
(Tablets)
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First Choice
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- Generally recommended as first line phosphate binder. More effective than calcichew and less elemental calcium.
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Calcium Carbonate (Calcichew®)
(Tablets)
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First Choice
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- Calcium-based phosphate binders may be used as the initial binder therapy for patients with chronic kidney disease as they are cheap and relatively efficacious, in conjunction with dietary phosphate restriction, to control phosphorus and parathyroid levels.
- If hypercalcaemia develops with the use of calcium carbonate, it may be necessary to convert to calcium acetate, a non calcium-containing phosphate binder, or a combination of both.
- Link to SPC
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Calcium Salts with magnesium (Osvaren®)
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Second Choice
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- Second line phosphate binder after Calcichew or Phosex.
- Can be prescribed in primary care on hospital initiation.
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Lanthanum (Fosrenol ®)
(Tablet (chewable), oral powder)
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 Restricted
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- Initiation and monitoring by consultant nephrologists in patients with ESRF as an alternative agent to sevelamer.
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Sevelamer Carbonate (Renvela®)
(Powder for oral suspension (sachets), Tablets)
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Restricted
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- Nephrologists - Renal patients only who require a phosphate-binder but have high serum calcium or Renal patients with vascular calcification (hydrochloride and carbonate salts are on formulary).
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Sevelamer Hydrochloride (Renagel®)
(Tablets)
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Restricted
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- Nephrologists - Renal patients only who require a phosphate-binder but have high serum calcium or Renal patients with vascular calcification (hydrochloride and carbonate salts are on formulary).
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Aluminium Hydroxide (Alu-Cap®)
(Capsules)
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Formulary
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- Generally reserved for short term use in patients with severe and difficult to control hyperphosphataemia.
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| Non Formulary Items |
Calcium Acetate (Renacet®)
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Non Formulary
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Calcium Salts
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Non Formulary
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Brands: Everose®, Osvaren®, Calcium 500® and Adcal® |
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sucroferric oxyhydroxide (Velphoro®)
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Non Formulary
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Key |
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Cytotoxic Drug
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Controlled Drug
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High Cost Medicine
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Cancer Drugs Fund
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NHS England |
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Homecare |
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CCG |
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Traffic Light Status Information
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Description |
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Available Over the Counter. Consider Self Care |
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Formulary - Can be prescribed in both secondary and primary care. |
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Formulary - Specialist Advice, secondary care advice provided for primary care initiation. |
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Formulary - Specialist initiation without shared care guidance. |
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Formulary - Specialist initiation with shared care guidance. |
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Restricted - Prescribing (and monitoring where applicable) to remain with the hospital or specialist service. Not to be prescribed in Primary Care |
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Not recommended for prescribing. Switch to alternative cost-effective option. |
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Not recommended for prescribing in primary or secondary care. |
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Not recommended as no formal application made for addition to the formulary. Contact relevant pharmacy team for further information.
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Non-Formulary (category under review). |
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