I was recommend Alu-caps over Ipakitine as it is supposed to be more effective at binding the phosphorous, there is also the risk of increasing calcium lvels with the Ipakitine which is not a good thing. As regards aluminium causing dementia.... from the CRF site - You may have read that there is a risk of aluminium toxicity from the aluminium in aluminium hydroxide medications but this refers to human patients on dialysis (because aluminium is used in the dialysis process) which is not a concern for cats; plus it takes years before it becomes a problem for humans, so all in all it is not something you need to worry about.
The dosage depends on the current phosphorous levels and weight of the cat. Each capsule (which I pulled open and left on a teaspoon) was 475mg, Tiggy only weighed 5 pounds so her dosage was 125mg per day. That's roughly a quarter of what's *on* the teaspoon (not a 1/4 *of * a teaspoon) which I just shared out between each meals. I didn't need to measure it as Tiggy's dose was literally a pinch per meal. It doesn't have to mixed in just sprinkled on the top, it's odourless and tasteless just think of it as seasoning!
Between 1.6 and 1.9 mmol/L - 25 mg per lb (0.5kg) of cat per day, divided and given with food 2-3 times a day*
Between 1.9 and 2.6 mmol/L - 50 mg per lb (0.5kg) of cat per day, divided and given with food 2-3 times a day.
Over 2.6 mmol/L - 100 mg per lb (0.5kg) of cat per day, divided and given with food 2-3 times a day.
*Not everybody chooses to start binders if phosphorus levels are in this range - most people only start binders once phosphorus levels are over 6. However, if your cat has previously had high phosphorus levels which you have reduced with binders, you will probably need to continue to give binders, either at this dosage or even higher, otherwise your cat's values will probably rise over 6 again.
Aluminium hydroxide is a safe product, so it does not have to be measured too precisely, but as a rough guide, if you are using powdered aluminium hydroxide, such as the Spectrum brand sold by Goolricks, a quarter of a teaspoon of powder contains approximately 300mg of aluminium hydroxide. If you are using a liquid type of binder, as a guide, a teaspoon of Alternagel contains approximately 600mg of aluminium hydroxide.
Phosphorus binders must be given with food so they can bind with the phosphorus in it. For tinned food, if you are using tablets, you can simply crush them up and add them to the food; while capsules can be opened and the tasteless contents mixed with the food. One retailer recommends adding a teaspoon of water to tinned food and letting it stand for ten minutes before serving in order to let the binder mix thoroughly. If you are using dry food, you may wish to try putting the food in a freezer bag together with the crushed binder and leave them to mingle overnight.
It does not matter if your non-CRF cats eat food mixed with phosphorus binders, though obviously you should try to give them some food free of binders too, particularly kittens.
Cautions
Sometimes phosphorus binders may cause constipation, so watch for this when you first start them.
Phosphorus binders should be given two hours apart from Baytril (an antibiotic), Pepcid (famotidine) or ACE inhibitors, because they may interfere with the absorbtion of these treatments, which would make them less effective.
Medline Plus mentions that Vitamin C may interact adversely with products containing aluminium, such as phosphorus binders.
Phosphorus binders should ideally be given separately from iron, because the binders may reduce the absorption of the iron. Drugstore has some information about this interaction.
