Sevelamer and Breastfeeding

Summary of use during lactation

Because sevelamer is not orally absorbed, sevelamer does not reach the breastmilk or adversely affect the breastfed infant after maternal administration. A suspension of sevelamer has been added directly to breastmilk to lower the phosphorus concentration of milk. This could be a useful maneuver for breastmilk use in infants with renal impairment; however, clinical use has not been reported. In addition to lowering average phosphorus content by 65% to over 80%, the calcium content of breastmilk was reduced by almost as much and the casein content also decreased somewhat. With sevelamer hydrochloride, the chloride content increased by 60% and the pH changed from 6.8 to 7.8, although pH appears to rebound over time.[1,2] Addition of large amounts of sevelamer to artificial formula also lowers the copper, magnesium, manganese, potassium, sulfur and zinc concentrations by about 20%.[3] Similar reductions might occur with breastmilk.

Drug levels in milk and infant serum

### Summary of Use during Lactation Because sevelamer is not orally absorbed, sevelamer does not reach the breastmilk or adversely affect the breastfed infant after maternal administration. A suspension of sevelamer has been added directly to breastmilk to lower the phosphorus concentration of milk. This could be a useful maneuver for breastmilk use in infants with renal impairment; however, clinical use has not been reported. In addition to lowering average phosphorus content by 65% to over 80%, the calcium content of breastmilk was reduced by almost as much and the casein content also decreased somewhat. With sevelamer hydrochloride, the chloride content increased by 60% and the pH changed from 6.8 to 7.8, although pH appears to rebound over time.[1,2] Addition of large amounts of sevelamer to artificial formula also lowers the copper, magnesium, manganese, potassium, sulfur and zinc concentrations by about 20%.[3] Similar reductions might occur with breastmilk. ### Effects in Breastfed Infants Relevant published information was not found as of the revision date. ### Effects on Lactation and Breastmilk Relevant published information was not found as of the revision date. ### References

Effects in breastfed infants

Relevant published information was not found as of the revision date.

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

References

1. FerraraE LemireJ ReznikVM Dietary phosphorus reduction by pretreatment of human breast milk with sevelamer. Pediatr Nephrol 2004 19 775 9 15103549 PubMed
2. RaaijmakersR HoukesLM SchroderCH Pre-treatment of dairy and breast milk with sevelamer hydrochloride and sevelamer carbonate to reduce phosphate. Perit Dial Int 2013 33 565 72 23636435 PubMed
3. TaylorJM OladitanL CarlsonS Renal formulas pretreated with medications alters the nutrient profile. Pediatr Nephrol 2015 30 1815 23 25930981 PubMed