Sevelamer side effects: what 572 FDA adverse event reports show
Drug class
Not stated in label
Label matched
Sevelamer Hydrochloride (Sevelamer Hydrochloride)
Who reports
572 reports · 91% serious · 102 with death outcome · 42% female
Used for
Sevelamer hydrochloride tablets are indicated for the control of serum phosphorus in patients with chronic kidney disease (CKD) on dialysis. The safety and efficacy of sevelamer hydrochloride tablets in CKD patients who are not on dialysis have not been studied. • Sevelamer hydrochloride tablets are a phosphate binder indicated for the control of serum phosphorus in patients with chronic kidney disease on dialysis.
What it is
The active ingredient in Sevelamer Hydrochloride Tablets is sevelamer hydrochloride, a polymeric amine that binds phosphate and is meant for oral administration. Sevelamer hydrochloride is poly(allylamine hydrochloride) crosslinked with epichlorohydrin in which 40% of the amines are protonated.
Boxed warning
None in the current label
Causality screen of the 9 strongest signals
What the badges mean
- Labeled adverse reaction The exact term appears in the label's warnings or adverse-reactions sections: a known, expected effect. The FAERS signal confirms the label rather than discovering anything.
- Likely indication confounding The term appears in the label's indications: reports probably describe the disease being treated (or its progression), not a drug effect. Classic confounding by indication.
- Reporting / coding artifact An administrative, monitoring or exposure term (product issue, off-label use, 'test normal', overdose...). Not a biological reaction; a high PRR here reflects how reports are coded.
- Not in label — unassessed Not found in the label text, not an artifact pattern. This is a genuine candidate for a formal causality assessment (Bradford Hill / WHO-UMC); it has NOT had one here.
Strongest disproportionality signals
Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 2 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.
| Reaction | Reports | PRR 95% CI · ROR · χ²/p | EBGM EB05 · IC025 | Label screen | Serious-only & strata | Trial cross-check |
|---|---|---|---|---|---|---|
| Melaena (black stool) | 16 | 26.6 16.4–43.1ROR 27.3 · χ² 369 / p 1e-82 | 25.8 EB05 16.8 · IC025 +3.1 3/3 methods agree | Not in label — unassessed | serious PRR 17.1 | no trial data cached |
| Angina pectoris | 20 | 25.4 16.5–39.1ROR 26.3 · χ² 446 / p 3e-99 | 24.9 EB05 17.0 · IC025 +3.2 3/3 methods agree | Not in label — unassessed | serious PRR 16.5 | no trial data cached |
| Hypercalcaemia | 8 | 23.8 12.0–47.4ROR 24.1 · χ² 153 / p 2e-35 | 22.0 EB05 11.0 · IC025 +2.1 3/3 methods agree | Not in label — unassessed | serious PRR 14.0 | no trial data cached |
| Fluid overload | 9 | 22.4 11.7–42.8ROR 22.7 · χ² 163 / p 1e-37 | 20.9 EB05 10.9 · IC025 +2.3 3/3 methods agree | Not in label — unassessed | serious PRR 18.2 | no trial data cached |
| Peritonitis bacterial | 5 | 18.2 7.6–43.6ROR 18.4 · χ² 65 / p 4e-16 | 13.8 EB05 4.5 · IC025 +1.3 3/3 methods agree | Not in label — unassessed | serious PRR 11.5 | no trial data cached |
| Dialysis | 7 | 18.0 8.6–37.7ROR 18.3 · χ² 96 / p 5e-23 | 15.5 EB05 6.3 · IC025 +1.8 3/3 methods agree | Likely indication confounding term in indications; also in warnings | serious PRR 11.9 | no trial data cached |
| Peritonitis | 8 | 14.2 7.1–28.2ROR 14.4 · χ² 85 / p 1e-20 | 11.7 EB05 5.2 · IC025 +1.8 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 8.9 | no trial data cached |
| Fracture | 7 | 13.6 6.5–28.3ROR 13.7 · χ² 69 / p 4e-17 | 10.5 EB05 4.5 · IC025 +1.6 3/3 methods agree | Not in label — unassessed | serious PRR 9.4 | no trial data cached |
| Hospitalisation | 46 | 11.1 8.4–14.6ROR 12.0 · χ² 414 / p 2e-92 | 10.7 EB05 8.2 · IC025 +2.8 3/3 methods agree | Reporting / coding artifact | serious PRR 7.1 · 91% clinician | no trial data cached |
Trial evidence (ClinicalTrials.gov)
Most frequently reported reactions
By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.
| Reaction | Reports | PRR 95% CI · ROR · χ²/p | EBGM EB05 · IC025 | Label screen | Serious-only & strata | Trial cross-check |
|---|---|---|---|---|---|---|
| Hospitalisation | 46 | 11.1 8.4–14.6ROR 12.0 · χ² 414 / p 2e-92 | 10.7 EB05 8.2 · IC025 +2.8 3/3 methods agree | Reporting / coding artifact | serious PRR 7.1 · 91% clinician | no trial data cached |
| Angina pectoris | 20 | 25.4 16.5–39.1ROR 26.3 · χ² 446 / p 3e-99 | 24.9 EB05 17.0 · IC025 +3.2 3/3 methods agree | Not in label — unassessed | serious PRR 16.5 | no trial data cached |
| Melaena (black stool) | 16 | 26.6 16.4–43.1ROR 27.3 · χ² 369 / p 1e-82 | 25.8 EB05 16.8 · IC025 +3.1 3/3 methods agree | Not in label — unassessed | serious PRR 17.1 | no trial data cached |
| Fluid overload | 9 | 22.4 11.7–42.8ROR 22.7 · χ² 163 / p 1e-37 | 20.9 EB05 10.9 · IC025 +2.3 3/3 methods agree | Not in label — unassessed | serious PRR 18.2 | no trial data cached |
| Peritonitis | 8 | 14.2 7.1–28.2ROR 14.4 · χ² 85 / p 1e-20 | 11.7 EB05 5.2 · IC025 +1.8 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 8.9 | no trial data cached |
| Hypercalcaemia | 8 | 23.8 12.0–47.4ROR 24.1 · χ² 153 / p 2e-35 | 22.0 EB05 11.0 · IC025 +2.1 3/3 methods agree | Not in label — unassessed | serious PRR 14.0 | no trial data cached |
| Fracture | 7 | 13.6 6.5–28.3ROR 13.7 · χ² 69 / p 4e-17 | 10.5 EB05 4.5 · IC025 +1.6 3/3 methods agree | Not in label — unassessed | serious PRR 9.4 | no trial data cached |
| Dialysis | 7 | 18.0 8.6–37.7ROR 18.3 · χ² 96 / p 5e-23 | 15.5 EB05 6.3 · IC025 +1.8 3/3 methods agree | Likely indication confounding term in indications; also in warnings | serious PRR 11.9 | no trial data cached |
| Peritonitis bacterial | 5 | 18.2 7.6–43.6ROR 18.4 · χ² 65 / p 4e-16 | 13.8 EB05 4.5 · IC025 +1.3 3/3 methods agree | Not in label — unassessed | serious PRR 11.5 | no trial data cached |
| Posterior reversible encephalopathy syndrome | 4 | 15.4 5.8–40.9ROR 15.5 · χ² 40 / p 1e-10 | 9.7 EB05 3.0 · IC025 +0.8 3/3 methods agree | Not in label — unassessed | serious PRR 9.7 | no trial data cached |
| Caesarean section | 3 | 9.4 3.0–28.9ROR 9.4 · χ² 15 / p 6e-5 | 4.8 EB05 1.7 · IC025 +0.0 | Not in label — unassessed | serious PRR 6.1 | no trial data cached |
Unlabeled candidate signals
These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.
- Angina pectoris — n=20, PRR 25.4
Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.
Common questions
What are the most reported side effects of Sevelamer?
In FDA FAERS, the most frequently co-reported reaction terms for Sevelamer are angina pectoris, melaena, fluid overload, peritonitis, hypercalcaemia, fracture. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.
Does Sevelamer have an FDA boxed warning?
No. The FDA label retrieved for Sevelamer has no boxed warning; see the label's Warnings and Precautions for the recognised risks.
Do FAERS signals prove that Sevelamer causes these side effects?
No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.
Sources & methods
- FDA label via openFDA (set ID 35337152-9b92-40c0-e063-6294a90a8dd5, effective 20250515; matched on
openfda.generic_name.exact:"SEVELAMER HYDROCHLORIDE") - Bayesian shrinkage measures computed offline over all 1,317,300 cached pairs: BCPNN information component (IC, with Norén closed-form IC025) and MGPS empirical-Bayes geometric mean (EBGM, EB05) with a two-component gamma prior fitted by maximum marginal likelihood (α₁=0.57, β₁=0.02, α₂=1.42, β₂=0.70, w=0.17); unstratified
- FAERS pair statistics from the OpenPV build of 2026-09-14 (openFDA
count=aggregation, fieldpatient.drug.openfda.generic_name.exact, 11 reaction terms, min 3 co-reports); PRR/ROR with 95% CI, chi-square with Yates correction - Serious-only and stratified counts (serious:1, patient.patientsex, primarysource.qualification) from openFDA count queries; serious-only PRR uses the drug serious report total and the term global serious total (N_serious=11,882,979); strata shown only when n ≥ 20
- Seriousness and sex counts from openFDA
count=serious,patient.patientsex,seriousnessdeath
Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.