Cipro and Renvela/Renagel

[Restorer]

Just wanted to let everyone know about something I found out today. Reading the instructions that came with my prescription of Cipro today (exit site infection), I found that you're not supposed to take Cipro within 4 hours before or after taking Renagel or Renvela (sevelamer), because the binders reduce the effectiveness of the Cipro - they probably bind it to some degree just like they bind phosphorus.

The big problem is that, with 4 hours before and after taking binders, if you're taking Renvela/Renagel with each meal, you never get a chance to take the Cipro, unless you wake up in the middle of the night. My PD nurse didn't know about this, and the prescribing neph probably didn't either. He told me to "do the best I can" (which I interpret as taking the Cipro as far from the binders as I reasonably can), and if it doesn't help me in a couple days, he'd switch me to Keflex as an antibiotic.

[Rerun]

They tell us that if we forget our binders 10 minutes after eating to just forget it.  Hmmm I guess they work for a lot longer. 

If you have to get up in the middle of the night then you have to.  Do they want you to take them with food?  Then we are really in trouble.

[Zach]

Renvela may react with vitamins as well:

5 WARNINGS AND PRECAUTIONS
5.3 Monitor for Reduced Vitamins D, E, K (clotting factors) and Folic Acid Levels

12.2 Pharmacodynamics
In addition to effects on serum phosphate levels, sevelamer hydrochloride has been
shown to bind bile acids in vitro and in vivo in experimental animal models. Bile acid
binding by ion exchange resins is a well-established method of lowering blood
cholesterol. Because sevelamer binds bile acids, it may interfere with normal fat
absorption and thus may reduce absorption of fat soluble vitamins such as A, D and K.
In clinical trials of sevelamer hydrochloride, both the mean total and LDL cholesterol
declined by 15-31%. This effect is observed after 2 weeks. Triglycerides, HDL cholesterol
and albumin did not change.
 
7. DRUG INTERACTIONS
... When administering an oral medication where a reduction in the bioavailability of that medication would have a clinically significant effect on its safety or efficacy, the drug should be administered at least one hour before or three hours after Renvela, or the physician should consider monitoring blood levels of the drug. Patients taking antiarrhythmic medications for the control of arrhythmias and anti-seizure medications for the control of seizure disorders were excluded from the clinical trials. Special precautions should be taken when prescribing Renvela to patients also taking these medications.

http://www.renvela.com/docs/renvela_PI.pdf

Just remember, we always need to weight the "good and not so good" aspects of the phosphate binders we use.

[RightSide]

One solution, which I employ, is to eat just two meals a day:  Breakfast in the morning and dinner in the evening.  That way I can take  the med at noontime and at bedtime.