Renagel vs. Renvela: Which Is Better for High Phosphates?
Key takeaways:
Renagel is the brand-name version of sevelamer hydrochloride. Renvela is the brand-name version of sevelamer carbonate.
Renagel and Renvela are prescription medications that treat high phosphate levels. They’re similar in regard to side effects, interactions, and dosing.
Renvela offers a few advantages over Renagel. It’s available in more dosage forms, it doesn’t cause metabolic acidosis as a side effect, and it’s approved for people ages 6 and older.
Table of contents
Your healthcare provider may have recently switched your Renagel prescription to Renvela. When looking at the medication you received from your pharmacy, you’ll notice that they’re both versions of sevelamer. Understandably, it may be confusing why your healthcare provider would make this change — especially if you’ve been tolerating Renagel without any problems.
Overall, Renagel and Renvela are comparable medications with similar goals. They contain the same active medication and are approved for similar uses, but they have a few important differences that may make one better for your lifestyle.
What is Renagel?
Renagel is a brand-name version of sevelamer hydrochloride, an oral phosphate-binding medication. It’s FDA approved to treat high phosphate levels in adults with chronic kidney disease (CKD) who are receiving dialysis. Renagel is available as a prescription-only oral tablet medication in both generic and brand-name versions.
What is Renvela?
Renvela (sevelamer carbonate) is another prescription-only phosphate-binding medication. It’s FDA approved to treat high phosphate levels in adults and kids, ages 6 and older, who have CKD and are receiving dialysis. Renvela is available as an oral tablet and oral powder that’s mixed with a food or drink. Like Renagel, Renvela is available in both generic and brand-name versions.
The main difference between Renagel and Renvela is what inactive ingredient is combined with sevelamer. Renagel comes as sevelamer hydrochloride, and Renvela comes as sevelamer carbonate.
How does sevelamer control high phosphate levels?
Phosphate, an electrolyte, plays a key role in how our bodies function. It’s a source of energy for our cells, it helps regulate our breathing, and it supports our brains’ ability to work. Most of our phosphate is supplied by the food we eat. However, some health conditions — such as CKD — can make our phosphate levels too high.
If your phosphate levels are too high, a healthcare provider might prescribe sevelamer to help lower the amount of phosphate in your blood. Sevelamer is often referred to as a “phosphate binder.” It binds to the phosphate from the food you eat. This stops you from absorbing it into your bloodstream, and helps you remove it from your body when you use the bathroom.
What causes high phosphates?
Most of the time, you don’t need to worry about having too much phosphate in your body. Your body should naturally hold on to as much phosphate as it needs, and your kidneys should remove whatever is left.
However, CKD can interfere with this process. It makes the kidneys less effective. And if your kidneys aren’t working as well as they could, they’ll have a harder time removing phosphate from your body. This can lead to elevated phosphate levels in your body, otherwise known as hyperphosphatemia.
How are Renagel and Renvela dosed and given?
Because of how they work, Renagel and Renvela are usually taken with a meal or snack. This helps them bind to the most amount of phosphate from your diet as possible.
Renagel is available as 400 mg and 800 mg tablets that are taken by mouth. Renvela is available as a tablet and a powder that’s mixed with water or a small amount of food. Renvela tablets come in an 800 mg strength. The powder packets are available in 800 mg and 2,400 mg strengths.
Healthcare providers will typically dose both Renagel and Renvela based on your phosphate level. The normal phosphate level is about 2.5 mg/dL to 4.5 mg/dL.
| Phosphate level | Typical Renagel and Renvela doses |
|---|---|
| Between 5.5 mg/dL and 7.5 mg/dL | 800 mg 3 times daily with meals |
| Between 7.5 mg/dL and 9.0 mg/dL | 1,200 mg (Renagel only) to 1,600 mg 3 times daily with meals |
| Greater than 9.0 mg/dL | 1,600 mg 3 times daily with meals |
What are the pros and cons of sevelamer HCl (Renagel) vs. carbonate (Renvela)?
There’s no difference in how well either of these medications work. However, there are some slight dosing and side effect differences between them. Renvela has some advantages over Renagel that are important to keep in mind.
Available dosage forms
As mentioned, Renvela is available as an oral tablet and a powder that you can mix with food or a liquid. If you need a phosphate binding medication like sevelamer, the powder may be a better option if you or a loved one have difficulty swallowing pills. Renagel is only available as a tablet.
Metabolic acidosis
Our bodies are made up of many chemical processes. One of them is the “acid-base buffer system.” This system helps keep our blood from being too acidic or basic.
If you or a loved one live with CKD, your body might be too acidic. This can lead to a health condition known as metabolic acidosis. What’s more, Renagel may also contribute to metabolic acidosis. This is because hydrochloride, an inactive ingredient in Renagel, is a type of acid.
On the flip side, the carbonate component of Renvela can help prevent metabolic acidosis. Carbonate acts like a base. This helps your body offset high acid levels.
Minimum age requirements
Renagel is only approved to be used by adults ages 18 and older. It hasn’t been proven safe and effective for kids or adolescents. Renvela, on the other hand, is approved to treat elevated phosphate levels for adults and kids ages 6 and older.
What are the known side effects of Renagel and Renvela?
Like all medications, Renagel and Renvela have a few possible side effects. But since they contain the same active ingredient, many of their side effects are similar. These include:
Nausea
Vomiting
Diarrhea
Indigestion
Stomach pain
Gassiness
Constipation
These side effects may occur when you begin taking Renagel or Renvela. As your body adjusts to your new medication, they may subside. But if you continue to have any of these side effects, discuss them with your healthcare provider.
What are the serious side effects of Renagel and Renvela?
In addition to what’s above, some rare but serious side effects are also important to be aware of. These include:
Stomach bleeds or stomach ulcers
Intestinal obstruction (bowel obstruction)
Ruptured intestines
Slower bowel movement
Severe constipation
If you’re experiencing possible symptoms of side effects like these, reach out to your healthcare provider right away. But if you suddenly experience significant abdominal pain or notice any blood in your stool after you go to the bathroom, it’s better to seek medical attention as soon as you can.
What interactions do Renagel and Renvela have?
Renagel and Renvela, like most medications, interact with certain other medications. For the most part, Renagel and Renvela will lower the effectiveness of other medications by lowering the amount of the other medication absorbed into your body.
Some of Renagel and Renvela’s more common drug interactions include:
Levothyroxine (Synthroid)
Mycophenolate (Myfortic)
Ciprofloxacin (Cipro)
Tacrolimus (Prograf)
Cyclosporine (Sandimmune)
This is not an exhaustive list. Talk to your healthcare provider or pharmacist to see if any of your other medications interact with Renagel or Renvela. If so, they can step in and help you manage any serious interactions. Make sure to give them an updated list of medications you take to help streamline the process.
How to save on Renagel and Renvela
Renagel and Renvela are available as brand-name medications. But you can also find them as lower-cost generics. GoodRx can help you navigate ways to save on your prescription.
Save with GoodRx. GoodRx can help you save over 71% and 93% off the average retail price of the generic versions of Renagel and Renvela, respectively. Generic Renagel at certain pharmacies is less than $165 with a free GoodRx discount. Generic Renvela at certain pharmacies is less than $28 with a free GoodRx discount.
Save with a copay savings card. If you have commercial insurance and meet eligibility requirements, brand-name Renvela is as little as $5 if you use the manufacturer’s savings card.
Can you take Renagel and Renvela together?
No. You shouldn’t take Renagel and Renvela together. Both contain the same active ingredient, and taking them together wouldn’t provide any additional benefits. This would increase your risk for side effects.
The bottom line
Renagel and Renvela are different versions of sevelamer. They’re both phosphate binders, they have similar side effects, and they’re dosed in similar ways. However, they come in different dosage forms. Renvela is approved for kids as young as 6 and it’s less likely to cause metabolic acidosis. Your healthcare provider can tell you which one may be a better option for you.
Why trust our experts?
References
Genzyme Corporation. (2021). Renvela [package insert].
Goyal, R., et al. (2022). Hyperphosphatemia. StatPearls.
Hopkins, E., et al. (2021). Physiology, acid base balance. StatPearls.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. (2017). KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease–mineral and bone disorder (CKD-MBD). Kidney International Supplements.
Lupin Pharmaceuticals, Inc. (2022). Sevelamer hydrochloride [package insert].
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Hemodialysis.
Pai, A. B., et al. (2009). Comparison of sevelamer hydrochloride and sevelamer carbonate: risk of metabolic acidosis and clinical implications. Pharmacotherapy
Qadeer, H., et al. (2021). Physiology, phosphate. StatPearls.