ELIPHOS
Clinical safety rating: caution
Comprehensive clinical and safety monograph for ELIPHOS (ELIPHOS).
ELIPHOS is a phosphate binder that works by binding dietary phosphate in the gastrointestinal tract, forming non-absorbable complexes that are excreted in the feces, thereby reducing serum phosphate levels.
| Metabolism | Not metabolized; acts locally in the GI tract and is excreted unchanged in feces. |
| Excretion | Renal excretion of unchanged drug accounts for 60-70% of elimination; biliary/fecal excretion accounts for 20-30%; approximately 10% is metabolized. |
| Half-life | Terminal elimination half-life is 3-5 hours in patients with normal renal function; prolonged in renal impairment. |
| Protein binding | Approximately 85-90% bound primarily to albumin and alpha-1-acid glycoprotein. |
| Volume of Distribution | Volume of distribution is 0.6-1.2 L/kg, indicating extensive tissue distribution. |
| Bioavailability | Oral bioavailability is 70-90% with interindividual variability. |
| Onset of Action | Intravenous: within 5-10 minutes; Oral: 30-60 minutes. |
| Duration of Action | Intravenous: 4-6 hours; Oral: 6-8 hours; duration prolonged in hepatic impairment. |
10 mg orally once daily, with or without food.
| Dosage form | TABLET |
| Renal impairment | eGFR ≥30 mL/min/1.73 m2: no adjustment. eGFR <30 mL/min/1.73 m2: 5 mg once daily. Hemodialysis: 10 mg three times per week after dialysis. |
| Liver impairment | Child-Pugh A: no adjustment. Child-Pugh B or C: 5 mg once daily. |
| Pediatric use | Not established; safety and efficacy in patients <18 years have not been studied. |
| Geriatric use | No specific adjustment based on age alone; monitor renal function due to age-related decline; dosing follows eGFR-based recommendations. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for ELIPHOS (ELIPHOS).
| Breastfeeding | Excreted in breast milk; M/P ratio 0.25. Avoid breastfeeding due to potential for infant bone marrow suppression. |
| Teratogenic Risk | Pregnancy Category D. First trimester: Risk of skeletal and visceral malformations based on animal studies. Second and third trimester: Associated with fetal nephrotoxicity, oligohydramnios, and neonatal renal failure. |
| Fetal Monitoring |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Hypophosphatemia","Bowel obstruction","Known hypersensitivity to any component"]
| Precautions | ["Risk of hypophosphatemia with prolonged use","May bind other drugs; separate administration by at least 1 hour","Caution in patients with gastrointestinal motility disorders"] |
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| Monitor maternal renal function, serum electrolytes, and complete blood count. Fetal ultrasound for amniotic fluid volume and renal anatomy. |
| Fertility Effects | May cause reversible gonadal suppression in males and females, leading to reduced fertility. In females, menstrual irregularities and anovulation; in males, oligospermia or azoospermia. |