How does this medication work? What will it do for me?

Sucroferric oxyhydroxide belongs to the class of medications called phosphate binders. Phosphate is made up mostly of the mineral phosphorus, which is an important component of normal bone structure, cell metabolism, and cell function.

In the body, the kidneys help keep the amount of phosphorus in the blood at a relatively constant level. For people with kidney problems, as their kidney function decreases, less phosphorus is removed from the body, potentially leading to a condition known as hyperphosphatemia (high phosphate levels in the blood). When taken with meals, sucroferric oxyhydroxide helps prevent the absorption of phosphates from food by binding to the phosphate. It is used to control high levels of phosphate (and therefore phosphorus) in the blood of people with severe kidney disease known as end stage renal disease (ESRD) who are receiving dialysis (hemodialysis or peritoneal dialysis).

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each brown, circular, bi-planar, chewable tablet, embossed with "PA 500" on one side, contains 500 mg of iron that is equivalent to 2,500 mg of sucroferric oxyhydroxide. Nonmedicinal ingredients: woodberry flavour, magnesium stearate, neohesperidin dihydrochalcone, and colloidal anhydrous silica.

Sucroferric oxyhydroxide is a mixture of polynuclear iron (III)-oxyhydroxide, sucrose, pregelatinised maize starch, and potato starch.

How should I use this medication?

The recommended starting dose of this medication is 1 tablet taken with meals, 3 times a day.

Your doctor will adjust the dose of medication every 2 to 4 weeks, based on the results of blood tests that identify the amount of phosphorus in your blood. The maximum recommended dose is 6 tablets daily, divided throughout the day, with meals.

Sucroferric oxyhydroxide tablets must be chewed or crushed. Do not swallow the tablets whole.

If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice .

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children. Use this medication within 90 days of opening the bottle.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you:

  • are allergic to sucroferric oxyhydroxide or any ingredients of the medication
  • have hemochromatosis or other iron accumulation disorder

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • acid reflux
  • black stools
  • bloating
  • change in tongue colour
  • constipation
  • diarrhea
  • gas
  • headache
  • heartburn
  • nausea
  • rash, itchiness
  • stained teeth
  • tiredness
  • trouble swallowing
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abdominal pain
  • bowel obstruction (e.g., abdominal discomfort or swelling, cramping, difficulty passing bowel movements, constipation, nausea, vomiting, burping, black stools)
  • difficulty swallowing
  • intestinal or stomach pain
  • shortness of breath
  • signs of high blood calcium levels (e.g., loss of appetite, nausea, vomiting, constipation, or stomach pain)
  • signs of low blood calcium levels (e.g., muscle spasms, tingling or numbness of the fingers and mouth, twitching, or memory loss)

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Galactose intolerance/glucose malabsorption:  Sucroferric oxyhydroxide tablets are prepared with starches that may be broken down by the body into glucose, fructose, and maltose. If you have hereditary problems of fructose intolerance or glucose-galactose malabsorption you should not take this medication.

Gastrointestinal disorders: If you have gastrointestinal disorders (e.g., difficulty swallowing), severe disorders of movement through the digestive tract (e.g., esophagus, stomach, or bowel) or you have had major gastrointestinal surgery, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Dark or black stools may also form, hiding bleeding from your stomach or intestines. If you experience symptoms of bleeding in the digestive tract, such as severe stomach pain, vomiting blood, or vomit that looks like coffee grounds, contact your doctor as soon as possible.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if sucroferric oxyhydroxide passes into breast milk. If you are breast-feeding and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

For a full list of interactions, use the Drug Interaction Checker available on the website.

If you are taking other medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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