Phosphate Binders: Uses, most common brand names, and safety information

Medically reviewed by  Jamie Winn, PharmD

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Phosphorous is an essential mineral found in a variety of foods that your body uses to build teeth and bones and turn food into energy. Healthy kidneys control the amount of phosphorus in your blood. People with chronic kidney disease (CKD) have trouble removing phosphorus, which results in increased levels of phosphorus in their blood and tissues. This can lead to phosphorus and calcium forming deposits in your skin or blood vessels, causing an increased risk of chronic renal failure, cardiovascular disease, and death. Phosphate binders, which are sometimes called phosphorus binders, are a class of medications used to treat high phosphate levels (hyperphosphatemia). Here we will discuss in more depth the properties, brand names, pricing, and safety of phosphate binders.

The list below includes FDA-approved Phosphate binders and their pricing:

List of phosphate binders

What are phosphate binders?

Phosphate binders are a class of medications used in the management of hyperphosphatemia (high phosphate levels). High phosphate levels in your blood and tissues can lead to bone loss and calcium deposits. The build-up of calcium and phosphorus can cause vascular calcification and coronary artery calcification. Phosphorus and calcium levels are managed by the parathyroid hormone (PTH) and vitamin D. PTH helps reduce phosphorus levels by increasing its excretion through your kidneys. Patients with CKD or end-stage renal disease (ESRD) do not remove phosphorus through their kidneys properly, leading to increased concentrations in their blood and tissues and secondary hyperparathyroidism. Phosphate binders are used to decrease the absorption of phosphate from food in your gastrointestinal tract. There are several types of phosphate binders, including calcium-based and calcium-free binders. Calcium-based phosphate binders include Tums (calcium carbonate) and PhosLo (calcium acetate), while calcium-free binders are typically based on metals such as aluminum, magnesium, and iron.

What is the mechanism of action of phosphate binders?

Phosphate binders work in your GI tract when you eat food containing phosphorus. Like a magnet, they attract and chemically bind to the phosphorus before it can get into your bloodstream. This forms an insoluble compound, making it unable to be absorbed from your intestinal tract. It is then passed out of your body in your stool.

What conditions are phosphate binders used to treat?

Phosphate binders are approved by the U.S. Food and Drug Administration (FDA) for the:

• Treatment of hyperphosphatemia in dialysis patients with chronic kidney disease (CKD), chronic renal disease (CRD), or end-stage renal disease (ESRD)
• Prevention and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD)
• Auryxia (ferric citrate) is approved to treat iron deficiency anemia in patients with CKD who are not on dialysis

Are phosphate binders safe?

The use of phosphate binders is relatively safe and effective when taken as prescribed. Before beginning treatment with phosphate binders, tell your healthcare provider if you have any of the following:

• Constipation or other digestive issues
• Bowel obstruction
• High serum calcium (hypercalcemia) or magnesium (hypermagnesemia) levels
• Are a hemodialysis patient
• Have a known allergy to a phosphate binder or any of the inactive ingredients in its formulation

What are some common side effects of phosphate binders?

The adverse effects you experience from phosphate binders will depend on several factors including the medication and dose. Some common side effects of phosphate binders seen in clinical trials when compared to placebo include:

• Abdominal pain
• Constipation
• Diarrhea
• Headache
• Hypertension
• Nausea
• Vomiting
• Discolored stool
• Gas
• Itching and rash
• Joint pain
• Cold symptoms

Phosphate binders can sometimes cause more serious side effects, including:

• Serious cases of gastrointestinal obstruction, ileus, gastrointestinal perforation, or fecal impaction
• Severe hypersensitivity reactions, including anaphylaxis
• Aluminum toxicity or other electrolyte imbalances
• Encephalopathy
• Osteomalacia (softening of your bones)

This is not a complete list of side effects, and we encourage you to consult with your healthcare professional for medical advice about any possible side effects.

What are some contraindications of phosphate binders?

Phosphate binders should be avoided if you have:

• A known hypersensitivity reaction to a phosphate binder or any of its inactive ingredients
• Bowel obstruction
• Ileus
• Fecal impaction
• Bone disease
• High levels of calcium, iron, magnesium, or aluminum

What are some drug interactions with phosphate binders?

The use of phosphate binders with certain foods or medications can affect how they work or increase the frequency and severity of side effects. Make sure your healthcare provider is aware of all the over-the-counter supplements and prescription medications you are taking. Phosphate binders can decrease the GI absorption of antiarrhythmic, fat-soluble vitamins, folic acid, and antiseizure medications.

What foods are high in phosphorus?

You should limit the amount of dietary phosphate to help control your serum phosphate levels. Avoid foods and drinks such as:

• Dairy products, including milk, cheese, yogurt, or cottage cheese
• Red meat
• Chicken
• Turkey
• Pork
• Organ meats, such as brain and liver
• Seafood
• Sunflower and pumpkin seeds
• Nuts such as brazil nuts, cashews, almonds, pine nuts, and pistachios
• Processed foods and beverages such as frozen meals, fast food, sodas, and snacks
• Beans and lentils
• Whole wheat

How can you control your phosphate levels?

Several ways you can help control high serum phosphorus levels include:

• Lower the amount of phosphorus in your diet
• Take a phosphate binder
• Take vitamin D (calcitriol)
• Take a calcimimetic medicine
• Stay on dialysis
• Exercise
• In some cases, your doctor may recommend surgery to remove part of your parathyroid gland

How much do phosphate binders cost?

Phosphate binders are very expensive with an average cost of around $10,000 per year.

You can purchase phosphate binders for $49 per month from NiceRx if eligible for assistance. Prices at the pharmacy vary by location, strength, and quantity, as well as your insurance status.

Related resources for phosphate binders

• https://www.drugs.com/drug-class/phosphate-binders.html
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313253/
• https://www.ccjm.org/content/85/8/629
• https://www.ouh.nhs.uk/patient-guide/leaflets/files/62922Pphosphate.pdf
• https://www.cochrane.org/CD006023/RENAL_phosphate-binders-prevent-complications-chronic-kidney-disease
• https://www.va.gov/EKIDNEYCLINIC/rooms/pharmacy/topics/phosphate-binders/index.asp
• https://www.nejm.org/doi/full/10.1056/nejmra0912522
• https://emedicine.medscape.com/article/241185-medication#showall
• https://www.medicalnewstoday.com/articles/320521