Xphozah (tenapanor) is a prescription medication used to lower phosphate levels in adults with chronic kidney disease (CKD) on dialysis. It's approved to take alone or with phosphate binders. But unlike traditional phosphate binders, Xphozah (tenapanor) works by blocking phosphate from being absorbed in your intestines instead of binding it in your gut. The usual dose is one tablet by mouth twice a day, typically before breakfast and dinner. The most common side effect is diarrhea.
Lower phosphate levels in adults with chronic kidney disease (CKD) on dialysis who haven't responded well to or can't take phosphate binders
Xphozah (tenapanor) is a sodium/hydrogen exchanger 3 (NHE3) inhibitor. It works by blocking a protein in your intestines called NHE3, which usually helps your body absorb phosphate from food.
By blocking NHE3, Xphozah (tenapanor) keeps some phosphate from being absorbed, which lowers the phosphate levels in your blood. This helps protect your kidneys and bones from damage due to phosphate buildup in CKD.
Source: DailyMed
Side effects that you should report to your care team as soon as possible:
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
Tablet taken by mouth
Helpful when phosphate binders alone aren't enough
Starts working within the first week
Must take before breakfast and dinner
Diarrhea is a very common side effect
Only available through specialty pharmacies
Take Xphozah (tenapanor) 5 to 10 minutes before breakfast and dinner. This timing helps the medication work best.
Don’t take Xphozah (tenapanor) right before dialysis since it can cause diarrhea. Instead, take it right before your next meal.
If you miss a dose of Xphozah (tenapanor), skip it and take your next dose at the regular time. Don't take two doses at the same time.
Avoid taking Xphozah (tenapanor) within 3 hours of sodium polystyrene sulfonate (SPS). SPS can make Xphozah (tenapanor) work less well.
Don't take Xphozah (tenapanor) with stool softeners or laxatives. That's because Xphozah (tenapanor) can sometimes cause diarrhea, and these medications might make it worse.
Store Xphozah (tenapanor) in a dry place in its original bottle. Keep the bottle tightly closed and don't remove the desiccant inside.
Xphozah (tenapanor) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk factors: People under 6 years of age
Diarrhea is the most common side effect of Xphozah (tenapanor). In studies, more than half of people taking it had diarrhea. It typically started soon after treatment began but could happen at any time. Most cases were mild to moderate and got better as treatment continued or after the dose was lowered.
Some people had severe diarrhea, which can cause dehydration or low sodium levels. Let your prescriber know right away if your diarrhea doesn't improve after 2 days, if you have severe stomach pain, or notice blood in your stool. You might have to stop taking Xphozah (tenapanor).
The typical dose is 30 mg by mouth twice a day, before morning and evening meals.
Children under 6 years old because of the risk of diarrhea and serious dehydration
Blockage in the gut
Lower phosphate levels in adults with chronic kidney disease (CKD) on dialysis who haven't responded well to or can't take phosphate binders
High blood phosphate levels in people ages 6 years and older with chronic kidney disease (CKD) on dialysis
High blood phosphate levels in people with advanced kidney disease on dialysis
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Ardelyx, Inc. (2023). FDA approves Xphozah®, a first-in-class phosphate absorption inhibitor. Globe Newswire.
Ardelyx, Inc. (2025). Xphozah 10 mg- tenapanor tablet, film coated; Xphozah 20 mg- tenapanor tablet, film coated; Xphozah 30 mg- tenapanor tablet, film coated [package insert]. DailyMed.
Block, G. A., et al. (2021). Safety and efficacy of tenapanor for long-term serum phosphate control in maintenance dialysis: A 52-week randomized phase 3 trial (PHREEDOM). Kidney360.
Pergola, P. E., et al. (2021). A randomized trial of tenapanor and phosphate binders as a dual-mechanism treatment for hyperphosphatemia in patients on maintenance dialysis (AMPLIFY). Journal of the American Society of Nephrology.
Shaman, A. M., et al. (2016). Hyperphosphatemia management in patients with chronic kidney disease. Saudi Pharmaceutical Journal.
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