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Phosphate Binders

Medically Reviewed.Last updated on 08/06/2026.

Phosphate binders are medications that help remove extra phosphate from your body when you poop. Side effects may include digestive problems that affect your stomach. If you stop taking them before your healthcare provider tells you to, you’re at a greater risk for bone fractures, heart disease and stroke.

What Are Phosphate Binders?

Phosphate (phosphorus) binders are medications that help lower phosphate levels in your body. Your body absorbs phosphates in the intestines. When you take phosphate binders with meals or snacks, they attach (bind) to extra phosphates in your stomach before they reach your intestines. This helps prevent some phosphates from entering your blood. The extra phosphate then leaves your body when you poop.

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Phosphate is an electrolyte that helps build your bones and teeth. It also helps your cells produce energy and form cell membranes and DNA.

Your body gets phosphates through foods and drinks. Whatever your body doesn’t absorb goes out with your poop. A typical phosphate level for adults is between 2.8 and 4.5 milligrams per deciliter (mg/dL). A typical level for children is between 4.0 and 7.0 mg/dL.

If you have too much phosphate in your blood (hyperphosphatemia), it can build up in your bloodstream and can cause problems.

What drugs are phosphate binders?

There are many different phosphate binder medications, including:

Who needs to take them?

Healthcare providers commonly recommend phosphate binders if you have hyperphosphatemia. You’re more likely to have that if you have chronic kidney disease (CKD) or kidney failure.

Are there any risks?

Phosphate binder complications may include:

  • Abdominal pain
  • Nausea
  • Vomiting
  • Indigestion
  • Diarrhea
  • Constipation
  • Gas and gas pain
  • Change in the color of your poop

There’s also a risk that some phosphate binders can increase your calcium levels.

If you stop taking phosphate binders before your provider tells you to, your phosphorus levels can get abnormally high. Usually, high phosphorus levels don’t cause any noticeable symptoms. But there’s a chance that you may have:

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  • Itching
  • Tingling in your lips and fingers
  • Bone pain, especially in your hips or shoulders
  • Weakness

You also have an increased risk of heart disease, stroke and bone fractures.

Hyperphosphatemia can also remove calcium from your bones or blood. This may cause hypocalcemia. Some effects of low calcium levels include:

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

Treatment Details

How do I take a phosphate binder?

Depending on which type 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 it within the first two to three bites of food.
  • Chew and swallow it immediately after eating.

Your healthcare provider will tell you exactly how to take the phosphate binders, including how many to take.

Before starting on phosphate binders, tell your provider about all prescription and over-the-counter (OTC) medications you’re taking. These include herbal supplements and vitamin supplements. They could affect how well phosphate binders work.

How long will I need to take them?

Your healthcare provider will tell you how long you need to take phosphate binders. You’re at a greater risk of hyperphosphatemia if you have chronic kidney disease. You may need to take phosphate binders long term.

Recovery and Outlook

How long does it take for phosphate binders to work?

They start to lower your phosphate levels within 24 hours. For the best results, be sure to carefully follow your healthcare provider’s directions.

When should I call my healthcare provider?

Contact your provider if phosphate binder side effects bother you.

Additional Common Questions

What is the most commonly used phosphate binder?

Healthcare providers commonly recommend calcium carbonate or sevelamer.

Phosphate binders that contain calcium may increase the risk of mineral deposits building up on the walls of your blood vessels (vascular calcifications). This increases your risk of developing blood clots or having a stroke. Due to the risk, your provider may recommend a phosphate binder that doesn’t have calcium, like sevelamer.

What is a natural phosphate binder?

Experts once thought that niacin (vitamin B3) and chitosan chewing gum could help naturally reduce phosphates in your blood. Chitosan consists of chitin, which helps form the hard exoskeleton of crustaceans (for example, lobster, shrimp and crab). But further research shows that the gum doesn’t bring down phosphate levels. And niacin alone isn’t enough to reduce phosphate absorption.

A note from Cleveland Clinic

Your body needs phosphate to help form bones, teeth, cell membranes and DNA. Phosphate also helps generate energy in your cells. But having too much can damage your body. Phosphate binders can help lower your levels.

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Talk to your healthcare provider before you take these medications. They’ll work with you to find the right type and give you directions on how to take them so they’re most effective. Reach out if you have any questions or concerns.

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Medically Reviewed.Last updated on 08/06/2026.

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