Phosphate Binders

What are phosphate binders?

Phosphate (phosphorus) binders are medications that help lower phosphate levels in your body. Phosphate is a mineral that helps with several functions in your body, but if you have too much of it in your bloodstream, it can cause problems. Your healthcare provider may recommend phosphate binders as treatment.

Phosphate binders are available over-the-counter or by prescription from a healthcare provider. You shouldn’t take phosphate binders without first talking to a healthcare provider.

Another name for phosphate binders is phosphorus binders.

What does phosphate do?

Phosphate is a type of electrolyte. Electrolytes are minerals that have a natural positive or negative charge when dissolved in water or other body fluids, such as blood. Your body needs phosphate to help form your bones and teeth. It also helps your cells produce energy and form cell membranes and deoxyribonucleic acid (DNA).

Your body gets phosphates through the foods or drinks you ingest. Whatever phosphates your body doesn’t absorb leaves your body through your urine (pee) or poop. If your body doesn’t release the extra phosphate, it can build up in your blood or kidneys and create issues.

Who needs to use phosphate binders?

Your healthcare provider may recommend phosphate binders if you have too much phosphate in your blood (hyperphosphatemia). You’re more likely to have hyperphosphatemia if you have chronic kidney disease (CKD) or kidney failure.

Why do dialysis patients take phosphate binders?

Hyperphosphatemia is a complication of CKD. Phosphate binders help prevent the progression of bone disorders that develop from hyperphosphatemia (chronic kidney disease-mineral and bone disorder, or CKD-MBD).

What is a typical phosphate level?

A typical phosphate level for adults is between 2.8 and 4.5 milligrams per deciliter (mg/dL). A typical phosphate level for children is between 4.0 to 7.0 mg/dL. However, different laboratories may use different measuring techniques. Ask your healthcare provider to explain your phosphate levels and their measuring techniques.

What foods are high in phosphate?

The following foods and drinks have high levels of phosphates:

• Dairy, including milk, processed cheeses and yogurt.
• Soda pop.
• Fast food.
• Snack foods.
• Processed meats.
• Nuts.
• Beans.
• Lentils.
• Whole grains, including wheat, oats and rice.

Are phosphate binders commonly prescribed?

Yes, healthcare providers commonly prescribe phosphate binders to treat hyperphosphatemia.

What drugs are phosphate binders?

There are many different types of phosphate binders. They include:

• Calcium carbonate (Alka-Seltzer® or Tums®).
• Sucroferric oxyhydroxide (Velphoro®).
• Sevelamer (Renvela® or Renagel®).
• Lanthanum carbonate (Fosrenol®).
• Calcium acetate (PhosLo®, Phoslyra®, Eliphos® or Calphron®).

What is a good phosphate binder?

Healthcare providers commonly recommend calcium carbonate. However, medical research suggests that phosphate binders that contain calcium may increase the risk of mineral deposits on the walls of your blood vessels (vascular calcifications). Vascular calcifications increase your risk of developing blood clots or strokes. Because of this risk, your provider may recommend a phosphate binder that doesn’t contain calcium, such as sevelamer.

What is a natural phosphate binder?

Healthcare providers once thought niacin (vitamin B3) and chitosan chewing gum could naturally reduce phosphates in your blood. But medical research shows that chitosan chewing gum doesn’t reduce phosphate levels, and niacin alone can’t adequately reduce phosphate absorption.

How do I take phosphate binders?

Before taking a phosphate binder, tell your healthcare provider about any prescription or over-the-counter medications you’re taking. These include herbal supplements and vitamin supplements. Combining these medications and phosphate binders may affect how well they work.

If your healthcare provider prescribes a phosphate binder, they’ll instruct you on how to take the medication, including how many to take. Depending on what type of phosphate binder you take, you may:

• Chew and swallow it 10 to 15 minutes before eating.
• Chew and swallow it immediately before eating.
• Swallow it whole within the first two to three bites of food.
• Mix a powder with water or another liquid and drink within the first two to three bites of food.
• Chew and swallow it immediately after eating.

How do phosphate binders work?

Your body absorbs phosphates in the jejunum (pronounced “juh-JOO-nuhm”). The jejunum is the middle part of your small intestine, after your stomach. When you take phosphate binders with meals or snacks, they attach (bind) to extra phosphates in your stomach before they reach your jejunum, which prevents some phosphates from entering your blood. The extra phosphate then leaves your body when you poop.

How long will I need to take phosphate binders?

Talk to a healthcare provider. You’re at a greater risk of hyperphosphatemia if you have CKD (chronic kidney disease), so you may need to take phosphate binders long term.

What are the advantages of phosphate binders?

The primary benefit of phosphate binders is that they lower the amount of phosphates in your body, which helps prevent hyperphosphatemia.

What are the risks or complications of phosphate binders?

Phosphate binder complications may include:

• Abdominal pain.
• Nausea and vomiting.
• Indigestion.
• Diarrhea.
• Constipation.
• Gas and gas pain.
• Change in the color of your poop.
• Some phosphorous binders can cause an increase in calcium levels.

What happens if I stop taking phosphate binders?

If you stop taking phosphate binders, you may experience the following symptoms:

• Itching.
• Tingling in your lips and fingers.
• Bone pain, especially in your hips or shoulders.
• Weakness.
• Red eyes.
• Increased risk of heart disease and stroke.
• Increased risk of bone fracture.

How long will it take for me to feel better?

Most people who have hyperphosphatemia don’t have any symptoms. However, phosphate binders start to lower your phosphate levels within 24 hours.

When should I see my healthcare provider?

Talk to your healthcare provider if any phosphate binder side effects become severe. Hyperphosphatemia can also remove calcium from your bones and blood, which may cause hypocalcemia. Talk to your provider if you have any hypocalcemia symptoms, including:

• Muscle cramps.
• Memory problems.
• Irritability.
• Tingling in your lips, tongue, fingers and/or feet.
• Seizures.
• Abnormal heart rhythms (arrhythmia).

What questions should I ask my healthcare provider about phosphate binders?

• What type of phosphate binder do you recommend?
• What are the potential side effects of the recommended phosphate binder?
• How do I take the recommended phosphate binder?
• How often should I take phosphate binders?
• How many phosphate binders should I take before a snack or a meal?
• Are there special instructions on taking phosphate binders, such as other medications to avoid while taking them?
• How long do I need to take phosphate binders?
• Will you do any tests or monitoring while I’m taking phosphate binders to show that they’re working?
• Do I need to see a special dietitian?

A note from Cleveland Clinic

Phosphate is a type of electrolyte that helps form bones, teeth, cell membranes and DNA. It also helps generate energy in your cells. But too much phosphate can damage your body. Phosphate binders can help lower your phosphate levels. Talk to a healthcare provider before you take phosphate binders. They’ll work with you to find the right type of phosphate binder to reduce your levels.