Xphozah (tenapanor) is a prescription medication that's used to lower blood phosphate levels in adults with chronic kidney disease (CKD) on dialysis. It's the first and only FDA-approved phosphate absorption inhibitor of its kind; it prevents your gut from absorbing phosphate into your blood. Xphozah (tenapanor) is a tablet that's taken by mouth twice a day, before breakfast and dinner. A common side effect is diarrhea, but it usually goes away as you continue treatment.
Add-on treatment for lowering blood phosphorus 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 NHE3, which is a protein in your gut that regulates the amount of fluids and electrolytes (like phosphorous) in your body.
By blocking NHE3, the medication prevents some of the phosphorus from food from being absorbed into your body. This helps lower your blood phosphate levels, which is important for protecting 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):
Might work well for people who didn’t see benefits with other medications that help lower blood phosphate levels
Can take during pregnancy
Taken before breakfast and dinner every day
High risk of diarrhea
Not safe for use in children under 6 years old and hasn't been well-studied in children of all ages
Take Xphozah (tenapanor) 5 to 10 minutes before breakfast and dinner. This can help the medication work best for you.
Try to take Xphozah (tenapanor) around the same times every day. If you accidentally forgot to take the medication, then skip the missed dose and take the medication at your next regularly scheduled dose.
On your dialysis days, take Xphozah (tenapanor) right before the next meal you have after your dialysis session. Xphozah (tenapanor) can commonly cause diarrhea, which can lead to dehydration (low fluids in the body) and low levels of sodium. This is especially dangerous during your dialysis session.
Avoid taking Xphozah (tenapanor) within 3 hours of sodium polystyrene sulfonate (SPS), a medication that helps lower blood potassium levels. Sodium polystyrene sulfonate (SPS) might cause Xphozah (tenapanor) to work less well in your body.
Don't take Xphozah (tenapanor) with stool softeners or laxatives. Xphozah (tenapanor) can sometimes cause diarrhea, which can worsen with these medications.
Let your provider or pharmacist know what medications you're taking or planning to take, including over-the-counter products and supplements. Your providers can check for drug interactions with Xphozah (tenapanor) and make sure all your medications are safe to take together.
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 | History of irritable bowel syndrome (IBS)
People on dialysis who take Xphozah (tenapanor) commonly experience diarrhea as a side effect. Severe diarrhea can even lead to dehydration and low sodium levels, which can be dangerous.
In clinical studies, more than half of the people who took Xphozah (tenapanor) had diarrhea. People typically reported diarrhea soon after they started taking the medication, but it can happen at any time during treatment. Most cases of diarrhea were mild to moderate and went away as treatment continued or after the dose was lowered.
Let your provider know right away if you have diarrhea that doesn't improve after 2 days, severe belly pain, or bloody stool. Your provider might ask you to stop 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
Add-on treatment for lowering blood phosphorus 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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American Kidney Fund. (2024). High phosphorus (hyperphosphatemia).
Ardelyx, Inc. (2023). FDA approves Xphozah®, a first-in-class phosphate absorption inhibitor. Globe Newswire.
Ardelyx, Inc. (2023). 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.
King, A. J., et al. (2018). Inhibition of sodium/hydrogen exchanger 3 in the gastrointestinal tract by tenapanor reduces paracellular phosphate permeability. Science Translational Medicine.
National Kidney Foundation. (n.d.). Dialysis.
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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