Sucroferric oxyhydroxide

Sucroferric oxyhydroxide is a compound used as a medication to keep phosphorus levels low or maintained in the patients who are having chronic Kidney disease or renal failure and when the patient is on dialysis. It binds with the phosphate in the gastro intestinal tract and avoids absorption of the same in the intestine.  This, therefore, increases calcium levels in the blood and avoids hypocalcemia.

It is advised for patients with kidney disorders because excess phosphate leads to secondary complications in the already immunocompromised body of the patient. The complications are described in detail further.

It is available under the name velphoro. This medication is non calcium based. It has an iron base in it.

Why should patients on dialysis use sucroferric oxyhydroxide or velphoro?

  • It is the duty of kidneys to keep phosphorus levels adequate in the body. It plays an important role in the elimination of excess phosphorus from the body in the form of urine.
  • When kidneys are affected by any of the diseases, it loses their ability to carry out their functions. This leads to a complication of excess phosphate absorption from the food that is consumed.
  • Excess phosphate in chronic Kidney disease or renal failure leads to other complications like pathological fractures, bone abnormalities, cardiac abnormalities, stroke, etc.
  • So, in CKD patients who are on dialysis make use of sucroferric oxyhydroxide to have a controlled level of phosphorus. It carries out this task of kidneys in their state of inactivity.
  • Hence, velphoro is used.

How does velphoro or sucroferric oxyhydroxide work?

  • Sucroferric oxyhydroxide acts in the intestine.
  • It binds with the phosphorus that is present in the food and does not allow its absorption by the villi present in the intestinal. 
  • Villi are supplied with an excessive amount of blood vessels or which is called highly vascular.
  • So phosphorus absorbed in the intestine goes into the blood and increases the blood levels of phosphorus.
  • Velphoro cuts this process of phosphorus utilization at the level of the intestine itself.
  • In CKD patients phosphorus should be kept low to avoid complications. 
  • Phosphate and calcium are contradictory to each other in the body. So when phosphorus levels are reduced in the body, calcium levels increase and thus making your bone stronger and avoiding a lot of complications.
  • As it is taken orally, velphoro dissociates in the saliva and absorption is quick from the sublingual region as it is highly vascular.
  • Hence, velphoro is consumed with food so that binding occurs at this stage in the intestine, and absorption is avoided.

What is the dosage of velphoro?

  • 1000-1500 or up to 2000mg is recommended as the initial dose per day.
  • It has to be taken in 3 to 4 doses each of 500mg.
  • If doses are missed do not take a double dose at one time.
  • Take the medicine at proper intervals with food.
  • The dose is reduced with the effect when seen. It can be reduced to one dose of 500mg per day.
  • The dose should be strictly changed and maintained as per your doctor or nephrologist.

How to consume velphoro?

  • It is consumed in chewable tablet form.
  • The dose should be as per directed by your nephrologist.
  • The dose shouldn’t be changed frequently.
  • It should be consumed with food or immediately after food.
  • It should be stored in air tight container away from the sunlight.
  • Chew or crush the medicine or tablet in the mouth properly.

What are the uses of velphoro?

    • Maintain calcium levels and avoid hypocalcemia in CKD and renal failure: reducing phosphorus levels in the blood, in turn, increase the calcium levels in the blood. And thus maintaining normal cardiac functions, muscle contractions, and bone morphology.
  • Lower the levels of serum phosphorus in CKD and renal failure: action on the gastrointestinal tract and inhibiting the absorption of phosphate in the intestine keeps the phosphorus levels low and thereby keeping away from further complications.

What are the complications of excess phosphorus in the blood which you prevent by taking velphoro?

  • Cardiac arrhythmias and myocardial infarction: for normal heart rhythm calcium is required. If phosphorus in the blood increase, calcium decreases and therefore leads to arrhythmias and infarction.
  • Pathological fractures: lower calcium levels lead to brittle bones and thus very low strain on the bone causes it to break.
  • Fatigue and muscle weakness: calcium is required to generate an action potential in the neuromuscular junction to produce muscle contraction. Low calcium levels and high phosphorus levels inhibit it.
  • Other complications are noted based on various organ systems.

What are the adverse effects of velphoro or sucroferric oxyhydroxide?

  • Frequently noted side effects include: discoloration of stools or feces, loose stools or diarrhea, vomiting, and nausea.
  • Other side effects include altered appetite, loss of taste sensation, rashes, etc.
  • Generalized headaches, dizziness, and drowsiness may be seen in some cases.
  • Any adverse effects in very severe form should be informed to your doctor.

What are the drug and disease interactions of velphoro?

  • It has a major interaction with the disease called hemochromatosis.
  • It has drug interactions with levothyroxine, vitamin D3, etc.

What should your doctor know before starting you on velphoro treatment?

  • About your previous treatment protocol.
  • Iron supplement allergies or problems you faced earlier.
  • Allergy to any content of this medicine.
  • Your history of illness and duration of dialysis.


  • Sucroferric oxyhydroxide is used to reduce phosphorus levels in blood in patients with kidney issues and on dialysis.
  • It is sold as velphoro in the market.
  • Velphoro works by increasing calcium and decreasing phosphorus in the blood.
  • It is consumed orally in the form of chewable tablets.
  • It should be consumed with food.
  • It avoids the complications of heart, bone, and muscles in CKD patients and renal failure.
  • The dose should be taken as directed by your nephrologist.
  • It acts on the intestine and inhibits the absorption of phosphate by binding to the phosphate present in food thereby avoiding its absorption.
  • Keep your doctor updated about your allergies and other health conditions.
  • Keep your doctor updated with the effects you notice.


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