Table. Characteristics of oral phosphate binders available in Australia .

Phosphate binders	Mechanism of action	Form, strength	Initial dose	Maximum recommended dose	Cost per tablet	Advantages	Disadvantages
Aluminium hydroxide	Forms insoluble phosphate complexes in the gut	600 mg tablets	1 tablet 3 times a day with meals	2 tablets 3 times a day with meals	20 cents	Inexpensive, calcium-free, binds phosphate at wide range of pH	No safe dose established, significant adverse effects (e.g. potential central nervous system toxicity, microcytic anaemia, osteomalacia, gastrointestinal upset), requires regular monitoring of serum aluminium
Calcium carbonate	Forms insoluble phosphate complexes in the gut	Chewable tablets, 500 mg, 600 mg elemental calcium	1 tablet 3 times a day with meals	1 tablet 3 times a day with meals	17 cents	Moderately effective, relatively inexpensive	Hypercalcaemia, large doses required to be effective, possible vascular calcification, unpalatable
Sevelamer hydrochloride	An anion exchange resin	800 mg tablets	1–3 tablets a day with meals	0.3 g/kg/day	$1.72	Calcium-free, lipid-lowering effect	Expensive, high pill burden, gastrointestinal adverse effects (bloating)
Lanthanum carbonate	Forms insoluble phosphate complexes in the gut	500 mg, 750 mg, 1000 mg chewable tablets	500–750 mg 3 times a day with meals	1000 mg 3 times a day with meals	500 mg $2.91, 750 mg $4.39, 1000 mg $4.94	Low pill burden, high efficacy, works in wide range of pH, no negative changes on bone histology	Expensive, gastrointestinal adverse effects, uncertain long-term effects
Sucroferric oxyhydroxide	A ligand exchange iron-based compound	500 mg chewable tablets	1 tablet 3 times a day with meals	6 tablets per day	$4.19	Low pill burden, works in wide range of pH, minimal systemic absorption	Expensive, gastrointestinal adverse effects (stool discoloration)