Sucroferric Oxyhydroxide side effects: what 3,001 FDA adverse event reports show

Sucroferric Oxyhydroxide · Velphoro · 25 reaction terms · 1,791 drug–reaction co-reports · data 2026-09-14

Drug class

Phosphate Binder

FDA label (Established Pharmacologic Class)

Brand names

Velphoro

openFDA label

Who reports

3,001 reports · 73% serious · 1,290 with death outcome · 38% female

openFDA FAERS counts, all years, deduplication not applied

Used for

Velphoro is indicated for the control of serum phosphorus levels in adults and pediatric patients 9 years of age and older with chronic kidney disease (CKD) on dialysis. Velphoro is a phosphate binder indicated for the control of serum phosphorus levels in adult and pediatric patients 9 years of age and older with chronic kidney disease on dialysis. ( 1 )

FDA label, Indications and Usage

What it is

The Velphoro drug substance is a mixture of polynuclear iron(III)-oxyhydroxide, sucrose, and starches. The active moiety of Velphoro, polynuclear iron(III)-oxyhydroxide, is practically insoluble and cannot be absorbed.

FDA label, Description section

Boxed warning

None in the current label

How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 17 strongest signals

Labeled adverse reaction 1Likely indication confounding 2Reporting / coding artifact 6Outcome field, not a reaction 1Not in label — unassessed 7

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.
Outcome field, not a reaction Death is a report outcome, not a reaction term. It is dominated by the underlying illness; see the seriousness profile and the boxed warning instead.
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. 8 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show: hide coding/lab/outcome terms hide indication terms unlabeled only hide PRR-only

Reaction	Reports	PRR 95% CI · ROR · χ²/p	EBGM EB05 · IC025	Label screen	Serious-only & strata	Trial cross-check
Product taste abnormal	59	30.8 23.9–39.6ROR 31.4 · χ² 1,663 / p <1e-300	30.4 EB05 24.4 · IC025 +4.2 3/3 methods agree	Reporting / coding artifact	serious n=3 · 92% clinician	no trial data cached
Faeces discoloured	83	26.8 21.7–33.2ROR 27.6 · χ² 2,034 / p <1e-300	26.6 EB05 22.1 · IC025 +4.2 3/3 methods agree	Not in label — unassessed	serious PRR 11.6	no trial data cached
End stage renal disease	52	19.8 15.1–25.9ROR 20.1 · χ² 906 / p 2e-199	19.6 EB05 15.5 · IC025 +3.6 3/3 methods agree	Not in label — unassessed	serious PRR 15.3	no trial data cached
Peritonitis bacterial	18	12.5 7.9–19.8ROR 12.6 · χ² 179 / p 4e-41	11.6 EB05 7.2 · IC025 +2.5 3/3 methods agree	Not in label — unassessed	serious PRR 9.9	no trial data cached
Death	1,145	9.3 8.9–9.7ROR 14.4 · χ² 8,822 / p <1e-300	9.3 EB05 8.8 · IC025 +3.1 3/3 methods agree	Outcome field, not a reaction	serious PRR 7.4	no trial data cached
Dialysis	17	8.4 5.2–13.4ROR 8.4 · χ² 103 / p 2e-24	7.2 EB05 4.6 · IC025 +2.0 3/3 methods agree	Likely indication confounding term in indications; also in warnings	serious PRR 5.7	no trial data cached
Economic problem	15	6.8 4.1–11.3ROR 6.8 · χ² 69 / p 6e-17	5.8 EB05 3.7 · IC025 +1.6 3/3 methods agree	Reporting / coding artifact	serious PRR 5.9	no trial data cached
Peritonitis	18	6.1 3.8–9.6ROR 6.1 · χ² 71 / p 2e-17	5.3 EB05 3.6 · IC025 +1.6 3/3 methods agree	Labeled adverse reaction exact term	serious PRR 4.8	no trial data cached
Melaena (black stool)	17	5.4 3.4–8.7ROR 5.4 · χ² 56 / p 3e-14	4.7 EB05 3.1 · IC025 +1.4 3/3 methods agree	Not in label — unassessed	serious PRR 4.4	no trial data cached
Quality of life decreased	10	5.2 2.8–9.7ROR 5.2 · χ² 30 / p 2e-8	4.3 EB05 2.5 · IC025 +1.0 3/3 methods agree	Not in label — unassessed	serious PRR 5.1	no trial data cached
Treatment noncompliance	40	5.1 3.8–7.0ROR 5.2 · χ² 130 / p 2e-30	4.9 EB05 3.7 · IC025 +1.8 3/3 methods agree	Reporting / coding artifact	serious PRR 2.7	no trial data cached
Drug intolerance	66	4.8 3.8–6.1ROR 4.9 · χ² 195 / p 1e-44	4.6 EB05 3.8 · IC025 +1.8 3/3 methods agree	Reporting / coding artifact	serious PRR 1.2	no trial data cached
Anhedonia	18	4.7 3.0–7.5ROR 4.8 · χ² 50 / p 9e-13	4.3 EB05 2.9 · IC025 +1.3 3/3 methods agree	Not in label — unassessed	serious PRR 4.2	no trial data cached
Chronic kidney disease	50	4.6 3.5–6.0ROR 4.6 · χ² 136 / p 1e-31	4.4 EB05 3.5 · IC025 +1.7 3/3 methods agree	Likely indication confounding term in indications	serious PRR 3.7	no trial data cached
Product physical issue	12	4.2 2.4–7.4ROR 4.2 · χ² 26 / p 2e-7	3.7 EB05 2.3 · IC025 +0.9 3/3 methods agree	Reporting / coding artifact	serious n=7	no trial data cached
Hospitalisation	87	4.0 3.2–4.9ROR 4.1 · χ² 193 / p 3e-44	3.9 EB05 3.3 · IC025 +1.6 3/3 methods agree	Reporting / coding artifact	serious PRR 3.2	no trial data cached
Gastrointestinal haemorrhage	36	3.0 2.2–4.1ROR 3.0 · χ² 46 / p 6e-12	2.9 EB05 2.2 · IC025 +1.0 3/3 methods agree	Not in label — unassessed	serious PRR 2.4	no trial data cached

Trial evidence (ClinicalTrials.gov)

Trial cross-check not yet run for this drug (ClinicalTrials.gov pull covers the 800 most-reported drugs first).

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
Death	1,145	9.3 8.9–9.7ROR 14.4 · χ² 8,822 / p <1e-300	9.3 EB05 8.8 · IC025 +3.1 3/3 methods agree	Outcome field, not a reaction	serious PRR 7.4	no trial data cached
Hospitalisation	87	4.0 3.2–4.9ROR 4.1 · χ² 193 / p 3e-44	3.9 EB05 3.3 · IC025 +1.6 3/3 methods agree	Reporting / coding artifact	serious PRR 3.2	no trial data cached
Faeces discoloured	83	26.8 21.7–33.2ROR 27.6 · χ² 2,034 / p <1e-300	26.6 EB05 22.1 · IC025 +4.2 3/3 methods agree	Not in label — unassessed	serious PRR 11.6	no trial data cached
Drug intolerance	66	4.8 3.8–6.1ROR 4.9 · χ² 195 / p 1e-44	4.6 EB05 3.8 · IC025 +1.8 3/3 methods agree	Reporting / coding artifact	serious PRR 1.2	no trial data cached
Product taste abnormal	59	30.8 23.9–39.6ROR 31.4 · χ² 1,663 / p <1e-300	30.4 EB05 24.4 · IC025 +4.2 3/3 methods agree	Reporting / coding artifact	serious n=3 · 92% clinician	no trial data cached
End stage renal disease	52	19.8 15.1–25.9ROR 20.1 · χ² 906 / p 2e-199	19.6 EB05 15.5 · IC025 +3.6 3/3 methods agree	Not in label — unassessed	serious PRR 15.3	no trial data cached
Chronic kidney disease	50	4.6 3.5–6.0ROR 4.6 · χ² 136 / p 1e-31	4.4 EB05 3.5 · IC025 +1.7 3/3 methods agree	Likely indication confounding term in indications	serious PRR 3.7	no trial data cached
Treatment noncompliance	40	5.1 3.8–7.0ROR 5.2 · χ² 130 / p 2e-30	4.9 EB05 3.7 · IC025 +1.8 3/3 methods agree	Reporting / coding artifact	serious PRR 2.7	no trial data cached
Gastrointestinal haemorrhage	36	3.0 2.2–4.1ROR 3.0 · χ² 46 / p 6e-12	2.9 EB05 2.2 · IC025 +1.0 3/3 methods agree	Not in label — unassessed	serious PRR 2.4	no trial data cached
Anhedonia	18	4.7 3.0–7.5ROR 4.8 · χ² 50 / p 9e-13	4.3 EB05 2.9 · IC025 +1.3 3/3 methods agree	Not in label — unassessed	serious PRR 4.2	no trial data cached
Peritonitis	18	6.1 3.8–9.6ROR 6.1 · χ² 71 / p 2e-17	5.3 EB05 3.6 · IC025 +1.6 3/3 methods agree	Labeled adverse reaction exact term	serious PRR 4.8	no trial data cached
Peritonitis bacterial	18	12.5 7.9–19.8ROR 12.6 · χ² 179 / p 4e-41	11.6 EB05 7.2 · IC025 +2.5 3/3 methods agree	Not in label — unassessed	serious PRR 9.9	no trial data cached
Melaena (black stool)	17	5.4 3.4–8.7ROR 5.4 · χ² 56 / p 3e-14	4.7 EB05 3.1 · IC025 +1.4 3/3 methods agree	Not in label — unassessed	serious PRR 4.4	no trial data cached
Dialysis	17	8.4 5.2–13.4ROR 8.4 · χ² 103 / p 2e-24	7.2 EB05 4.6 · IC025 +2.0 3/3 methods agree	Likely indication confounding term in indications; also in warnings	serious PRR 5.7	no trial data cached
Economic problem	15	6.8 4.1–11.3ROR 6.8 · χ² 69 / p 6e-17	5.8 EB05 3.7 · IC025 +1.6 3/3 methods agree	Reporting / coding artifact	serious PRR 5.9	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.

Faeces discoloured — n=83, PRR 26.8
End stage renal disease — n=52, PRR 19.8
Gastrointestinal haemorrhage — n=36, PRR 3.0

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 Sucroferric Oxyhydroxide?

In FDA FAERS, the most frequently co-reported reaction terms for Sucroferric Oxyhydroxide are faeces discoloured, end stage renal disease, chronic kidney disease, gastrointestinal haemorrhage, anhedonia, peritonitis. 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 Sucroferric Oxyhydroxide have an FDA boxed warning?

No. The FDA label retrieved for Sucroferric Oxyhydroxide has no boxed warning; see the label's Warnings and Precautions for the recognised risks.

Do FAERS signals prove that Sucroferric Oxyhydroxide 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 237da26c-f38c-4faa-93ad-735e71c9d0c1, effective 20260401; matched on openfda.generic_name.exact:"SUCROFERRIC OXYHYDROXIDE")
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, field patient.drug.openfda.generic_name.exact, 25 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.