100 Binders Used in Humans: What They Bind, Clinical Uses, and Evidence
Clinical toxicology • Gastrointestinal binding • Bile-acid sequestration • Metals • Phosphate • Microbial and dietary compounds
A key distinction for this list is that a substance’s ability to bind something in a laboratory does not prove that it removes that substance from the human body. Binding can occur in the gut, blood, tissues, or laboratory solutions, and those are very different situations.
I’ll distinguish established human-use binders from investigational or primarily laboratory-supported materials. “What it binds” refers to the best-established target or proposed target, not a guarantee of clinical detoxification.
1. Established gastrointestinal adsorbents and pharmaceutical binders
| No. | Binder | What it binds or sequesters | Human-use context and evidence |
|---|---|---|---|
| 1 | Activated charcoal | Many organic molecules and drugs in the GI tract | Selected acute poisonings; does not bind every toxin |
| 2 | Cholestyramine | Bile acids | Established treatment for selected bile-acid disorders; can also reduce absorption of some drugs |
| 3 | Colestipol | Bile acids | Hyperlipidemia and selected bile-acid disorders |
| 4 | Colesevelam | Bile acids | Hyperlipidemia and selected bile-acid disorders |
| 5 | Sevelamer carbonate | Dietary phosphate in the GI tract | Hyperphosphatemia in chronic kidney disease |
| 6 | Sevelamer hydrochloride | Dietary phosphate | Hyperphosphatemia; metabolic acidosis may be a concern |
| 7 | Lanthanum carbonate | Dietary phosphate | Hyperphosphatemia in chronic kidney disease |
| 8 | Calcium acetate | Dietary phosphate | Phosphate control in chronic kidney disease |
| 9 | Calcium carbonate | Dietary phosphate; also gastric acid | Phosphate binding in selected patients; calcium loading matters |
| 10 | Ferric citrate | Dietary phosphate; provides absorbable iron | Chronic kidney disease with hyperphosphatemia, with indication-specific monitoring |
| 11 | Sucroferric oxyhydroxide | Dietary phosphate | Phosphate control in dialysis patients |
| 12 | Sodium zirconium cyclosilicate | Potassium in the GI tract | Hyperkalemia treatment |
| 13 | Patiromer | Potassium in the GI tract | Chronic hyperkalemia management |
| 14 | Sodium polystyrene sulfonate | Potassium in exchange for sodium | Hyperkalemia; significant gastrointestinal safety limitations |
| 15 | Colesevelam hydrochloride | Bile acids | Same active binder as No. 4; formulation/name variant |
| 16 | Polystyrene sulfonate resins | Potassium and, depending on resin, other cations | Ion-exchange treatment; clinical formulation determines use |
| 17 | Calcium polystyrene sulfonate | Potassium | Hyperkalemia in countries where approved |
| 18 | Aluminum hydroxide | Dietary phosphate; gastric acid | Selected phosphate-binding uses; aluminum accumulation is a concern in kidney disease |
| 19 | Magnesium hydroxide | Gastric acid; can affect phosphate binding | Primarily an antacid/laxative, not a general detoxification agent |
| 20 | Sucralfate | Binds to damaged mucosal surfaces and interacts with proteins at ulcer sites | Local mucosal protection; not a systemic toxin binder |
These agents have specific pharmacologic targets. For example, phosphate binders reduce intestinal phosphate absorption, whereas potassium binders exchange or trap potassium. They should not be treated as interchangeable general-purpose detoxification products.
2. Chelators and specific antidotal binders
These agents bind selected metals or radionuclides and are used in defined poisoning or overload conditions. Unlike most oral adsorbents, some form complexes with substances that are already absorbed into the body.
| No. | Binder / chelator | What it binds | Human-use context |
|---|---|---|---|
| 21 | Succimer (DMSA) | Lead; also binds certain other metals to varying degrees | Selected lead poisoning cases |
| 22 | Calcium disodium EDTA | Lead | Chelation for significant lead poisoning |
| 23 | Dimercaprol (BAL) | Arsenic, inorganic mercury, and certain other metals | Selected severe poisonings; specialist use |
| 24 | Dimercaptosuccinic acid (DMSA) | Lead and some other metals | Same active compound as No. 21; alternate chemical name |
| 25 | DMPS (unithiol) | Mercury and arsenic compounds | Used in some countries; availability and approvals vary |
| 26 | Penicillamine | Copper | Wilson disease; also selected other indications |
| 27 | Trientine | Copper | Wilson disease |
| 28 | Deferoxamine | Iron; also aluminum in selected settings | Iron poisoning and selected iron-overload conditions |
| 29 | Deferasirox | Iron | Chronic iron overload |
| 30 | Deferiprone | Iron | Selected iron-overload disorders |
| 31 | Prussian blue (insoluble ferric hexacyanoferrate) | Thallium and radioactive cesium in the gut | Specific poisonings and internal contamination |
| 32 | DTPA (pentetate calcium trisodium) | Certain transuranic radioactive elements | Specific internal radionuclide contamination |
| 33 | DTPA (pentetate zinc trisodium) | Plutonium, americium, and curium | Specific radionuclide contamination |
| 34 | Deferasirox dispersible tablets | Iron | Formulation of No. 29, not a different active chelator |
| 35 | Calcium disodium EDTA injection | Lead | Formulation of No. 22 |
| 36 | Succimer capsules | Lead | Formulation of No. 21 |
| 37 | Trientine hydrochloride | Copper | Formulation of trientine |
| 38 | Trientine tetrahydrochloride | Copper | Formulation of trientine; product-specific prescribing applies |
| 39 | Penicillamine capsules | Copper | Formulation of No. 26 |
| 40 | Deferoxamine mesylate | Iron | Formulation of No. 28 |
Clinical caution: Chelation can cause serious adverse effects and may remove essential minerals as well as the intended target. Chelation should be based on a defined exposure or medical indication, not on nonspecific symptoms or an unvalidated toxin panel.
3. Additional oral adsorbents and intestinal sequestrants
| No. | Binder | What it binds or may adsorb | Human evidence / limitation |
|---|---|---|---|
| 41 | AST-120 (spherical carbon adsorbent) | Indole and other gut-derived precursors of uremic toxins | Used in some countries for selected kidney-disease settings; outcomes vary |
| 42 | Enterosgel (polymethylsiloxane polyhydrate) | Selected compounds in the intestinal lumen; in vitro binding of bacterial toxins and bile acids | Clinical use varies by country; in vitro binding is not proof of systemic detoxification |
| 43 | Calcium montmorillonite clay (NovaSil) | Aflatoxin B1 in the GI tract | Human studies have investigated reduced aflatoxin exposure; not a universal mycotoxin binder |
| 44 | Bentonite clay | Adsorption of selected compounds in laboratory systems | Oral detoxification claims lack adequate clinical validation; contamination risk |
| 45 | Kaolin | Water and selected charged or polar materials on mineral surfaces | Historical gastrointestinal adsorbent; limited modern evidence for many claims |
| 46 | Attapulgite (palygorskite) | Water and selected compounds in the gut | Used in some antidiarrheal products internationally; evidence and regulation vary |
| 47 | Diosmectite (smectite clay) | Mucosal and luminal compounds; may interact with toxins in the gut | Used for diarrhea in some countries; not a general systemic toxin remover |
| 48 | Hydrotalcite | Gastric acid; layered mineral structure can interact with selected anions | Primarily an antacid, not a broad detox binder |
| 49 | Polymethylsiloxane adsorbent materials | Selected organic molecules in laboratory testing | Binding depends on the specific material and target |
| 50 | Medical-grade activated carbon granules | Many adsorbable organic drugs and chemicals | Established adsorbent class; product and indication matter |
| 51 | Multiple-dose activated charcoal | Selected drugs, including carbamazepine, phenobarbital, and theophylline | Used for selected poisonings under medical supervision |
| 52 | Oral charcoal suspension | Adsorbable drugs and chemicals in the gut | Formulation of activated charcoal, not a distinct active substance |
| 53 | Cellulose-based enterosorbent materials | Selected molecules through surface interactions | Evidence is material-specific; not established for general detoxification |
| 54 | Hemicellulose-rich fiber | Water and some dietary compounds; may affect intestinal transit | Primarily a dietary fiber, not a specific toxin antidote |
| 55 | Psyllium husk | Water, gel-forming contents, and some bile acids | Established soluble fiber; not a universal toxin binder |
| 56 | Beta-glucan | Bile acids and selected compounds in the intestinal environment | Established cholesterol-lowering dietary fiber; binding is only one part of its effects |
| 57 | Oat bran | Bile acids and other intestinal contents, partly through beta-glucan | Dietary approach to cholesterol reduction |
| 58 | Barley beta-glucan | Bile acids and intestinal contents | Dietary cholesterol reduction; not a general poison treatment |
| 59 | Guar gum | Water and bile acids; increases intestinal viscosity | Fiber used in selected metabolic and gastrointestinal contexts |
| 60 | Glucomannan | Water and intestinal contents; may affect nutrient absorption | Fiber supplement; can cause obstruction if used improperly |
Enterosorbent research includes activated carbon, mineral clays, and polymeric materials, but their binding selectivity differs substantially. Enterosgel’s adsorption of certain bacterial toxins, bile acids, and drugs has been demonstrated in vitro; those findings do not establish that it removes toxins already stored in tissues.
4. Dietary fibers, food-derived materials, and other intestinal binding approaches
| No. | Binder / material | What it binds or affects | Human-use context and limitation |
|---|---|---|---|
| 61 | Inulin | Fermentable substrate; affects microbial metabolites rather than acting as a universal adsorbent | Prebiotic fiber |
| 62 | Fructooligosaccharides (FOS) | Fermentable carbohydrates; alters microbiome activity | Prebiotic; may worsen bloating in sensitive individuals |
| 63 | Galactooligosaccharides (GOS) | Fermentable substrate | Prebiotic; not a direct toxin antidote |
| 64 | Resistant starch | Fermented by gut microbes, producing short-chain fatty acids | Dietary intervention, not a conventional adsorbent |
| 65 | Wheat bran | Water and intestinal contents; affects transit | Fiber source |
| 66 | Cellulose | Water and bulk in stool | Dietary fiber; direct toxin binding is not established |
| 67 | Methylcellulose | Water and stool contents | Bulk-forming laxative |
| 68 | Calcium polycarbophil | Water in the intestine | Bulk-forming agent; can alter stool consistency |
| 69 | Hydroxypropyl cellulose | Water and some bile acids | Fiber-like material; limited evidence for bile-acid diarrhea |
| 70 | Chitosan | Negatively charged fatty acids and selected compounds in laboratory settings | Human lipid-lowering results are inconsistent; not a validated heavy-metal detoxifier |
| 71 | Plant sterols and stanols | Compete with cholesterol for incorporation into intestinal micelles | Established dietary approach to lowering LDL cholesterol; not a toxin-removal treatment |
| 72 | Oat beta-glucan concentrate | Bile-acid and cholesterol-related intestinal pathways | Cholesterol reduction; effects depend on dose and food matrix |
| 73 | Barley fiber concentrate | Bile-acid and cholesterol-related pathways | Dietary intervention |
| 74 | Citrus pectin | May interact with some metals in laboratory settings; also forms dietary fiber | Evidence for meaningful systemic heavy-metal removal is insufficient |
| 75 | Modified citrus pectin | Marketed for metal binding; studied for selected biomarkers | Evidence remains preliminary; not a substitute for approved chelation |
| 76 | Apple pectin | Gel formation and interactions with intestinal contents | Dietary fiber; specific toxin-removal claims are unproven |
| 77 | Alginate | Gel formation; can interact with selected cations and bind some materials under laboratory conditions | Used in some gastrointestinal products and food applications |
| 78 | Sodium alginate | Forms a physical barrier in the stomach; interacts with gastric contents | Used in reflux products; not a systemic detox binder |
| 79 | Calcium alginate | Gel formation and ion interactions | Used in wound dressings and selected medical materials; not an oral systemic binder |
| 80 | Chlorella biomass | Can bind some metals in laboratory experiments; nutritional constituents also contribute to its effects | Human evidence for clinically significant detoxification is limited and inconsistent |
5. Additional pharmaceutical resins, clinical adsorbents, and specialized systems
| No. | Binder / system | What it binds or removes | Human-use context and limitation |
|---|---|---|---|
| 81 | Sevelamer hydrochloride | Dietary phosphate | Established phosphate binder; same active resin family as No. 6 |
| 82 | Ferric citrate hydrate | Dietary phosphate | Phosphate binding with iron delivery; formulation of No. 10 |
| 83 | Sucroferric oxyhydroxide chewable tablets | Dietary phosphate | Clinical formulation of No. 11 |
| 84 | Sodium zirconium cyclosilicate powder | Potassium | Clinical formulation of No. 12 |
| 85 | Patiromer sorbitex calcium | Potassium | Clinical formulation of No. 13 |
| 86 | Calcium acetate capsules | Dietary phosphate | Formulation of No. 8 |
| 87 | Lanthanum carbonate chewable tablets | Dietary phosphate | Formulation of No. 7 |
| 88 | Calcium carbonate chewable preparations | Gastric acid; dietary phosphate in appropriate formulations | Formulation and indication determine its use |
| 89 | Aluminum hydroxide gel | Gastric acid and dietary phosphate | Formulation of No. 18; long-term aluminum exposure is a concern |
| 90 | Sodium polystyrene sulfonate suspension | Potassium | Formulation of No. 14; serious GI risks must be considered |
| 91 | Calcium polystyrene sulfonate powder | Potassium | Formulation of No. 17 |
| 92 | Colesevelam tablets | Bile acids | Formulation of No. 4 |
| 93 | Colestipol granules | Bile acids | Formulation of No. 3 |
| 94 | Cholestyramine powder | Bile acids | Formulation of No. 2 |
| 95 | Insoluble Prussian blue capsules | Thallium and radioactive cesium | Formulation of No. 31 for specific poisonings |
| 96 | DTPA injection | Specific radionuclides, including selected actinides | Medical treatment for defined internal radioactive contamination |
| 97 | Hemoperfusion cartridges containing activated charcoal | Selected drugs and toxins in circulating blood | Specialized extracorporeal treatment for selected poisonings |
| 98 | Resin-based hemoperfusion cartridges | Selected circulating drugs and toxic compounds | Target depends on cartridge; specialist use |
| 99 | Polymyxin-B hemoperfusion systems | Intended endotoxin adsorption | Investigational or limited indication-specific use; clinical outcome evidence is mixed |
| 100 | Albumin-based liver-support dialysis systems | Albumin-bound substances, including selected bilirubin and bile-acid-related compounds | Specialized extracorporeal liver support; not a general detoxification treatment |
Several entries in this inventory are formulations or different delivery systems for the same active binder. They are included because formulation and route matter clinically, but they should not be counted as 100 distinct chemical entities.
Full references
The references below support the major classes of human-use binders, chelators, adsorbents, phosphate binders, and dietary sequestrants. Where a table entry is a formulation variant, the same reference may support several entries.
A. Activated charcoal and intestinal adsorbents
1. Chyka PA, Seger D, Krenzelok EP, Vale JA. Position paper: Single-dose activated charcoal. Clinical Toxicology. 2005;43(2):61–87. doi:10.1081/CLT-200051867. PubMed (opens in new tab).
2. Hoegberg LCG, Gosselin S, Roberts DM, et al. Extracorporeal treatment for salicylate poisoning: systematic review and recommendations from the EXTRIP workgroup. Annals of Emergency Medicine. 2016;68(2):154–165. doi:10.1016/j.annemergmed.2015.12.005.
3. Gosselin S, Juurlink DN, Kielstein JT, et al. Extracorporeal treatment for lithium poisoning: systematic review and recommendations from the EXTRIP workgroup. Clinical Journal of the American Society of Nephrology. 2015;10(5):875–887. doi:10.2215/CJN.10021014.
4. Chiew AL, Gluud C, Brok J, Buckley NA. Interventions for paracetamol (acetaminophen) overdose. Cochrane Database of Systematic Reviews. 2018;2:CD003328. doi:10.1002/14651858.CD003328.pub3.
5. Howell CA, Mikhalovsky SV, Markaryan EN, et al. Investigation of the adsorption capacity of the enterosorbent Enterosgel for a range of bacterial toxins, bile acids and pharmaceutical drugs. Scientific Reports. 2019;9:5629. doi:10.1038/s41598-019-42176-z. Full text (opens in new tab).
6. Fatullayeva S, Tagiyev D, Zeynalov N. A review on enterosorbents and their application in clinical practice: removal of toxic metals. Colloid and Interface Science Communications. 2021;45:100545. doi:10.1016/j.colcom.2021.100545. Article (opens in new tab).
7. Juurlink DN. Activated charcoal for acute overdose: a reappraisal. British Journal of Clinical Pharmacology. 2016;81(3):482–487. Full text (opens in new tab).
B. Bile-acid binders
8. Sadowski DC, Camilleri M, Chey WD, et al. Canadian Association of Gastroenterology Clinical Practice Guideline on the Management of Bile Acid Diarrhea. Journal of the Canadian Association of Gastroenterology. 2020;3(1):e10–e27. doi:10.1093/jcag/gwz038. Full text (opens in new tab).
9. Camilleri M. Bile acid diarrhea: prevalence, pathogenesis, and therapy. Gut and Liver. 2015;9(3):332–339. doi:10.5009/gnl14397.
10. American College of Gastroenterology. IBS Treatment: Bile acid binders. Clinical information on cholestyramine, colestipol, and colesevelam. ACG resource (opens in new tab).
C. Phosphate and potassium binders
11. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease–Mineral and Bone Disorder. Kidney International Supplements. 2017;7(1):1–59. doi:10.1016/j.kisu.2017.04.001.
12. U.S. Food and Drug Administration. DailyMed: Official Drug Labels. Prescribing information for sevelamer, lanthanum carbonate, ferric citrate, sucroferric oxyhydroxide, patiromer, sodium zirconium cyclosilicate, and sodium polystyrene sulfonate. Search official labels (opens in new tab).
13. National Kidney Foundation. Phosphorus and Your CKD Diet. Information about dietary phosphate and phosphate management. Kidney Foundation (opens in new tab).
D. Chelation and specific toxic-metal or radionuclide binding
14. Kosnett MJ. The role of chelation in the treatment of arsenic and mercury poisoning. Journal of Medical Toxicology. 2013;9(4):347–354. doi:10.1007/s13181-013-0344-5.
15. Bradberry S, Vale A. A comparison of sodium calcium edetate and succimer in the treatment of inorganic lead poisoning. Clinical Toxicology. 2009;47(9):841–858.
16. World Health Organization. WHO Guideline for Clinical Management of Exposure to Lead. Geneva: World Health Organization; 2021. WHO publication (opens in new tab).
17. Agency for Toxic Substances and Disease Registry (ATSDR). Medical Management Guidelines for Acute Chemical Exposures. U.S. Centers for Disease Control and Prevention. ATSDR resources (opens in new tab).
18. U.S. Food and Drug Administration. Radiogardase (Prussian Blue Insoluble): Prescribing Information. Treatment of known or suspected internal contamination with radioactive cesium or thallium. FDA drug database (opens in new tab).
19. U.S. Food and Drug Administration. Pentetate Calcium Trisodium and Pentetate Zinc Trisodium (DTPA): Prescribing Information. Treatment of internal contamination with selected radioactive elements. FDA drug database (opens in new tab).
E. Clay and mycotoxin adsorption
20. Phillips TD, Afriyie-Gyawu E, Williams J, et al. Reducing human exposure to aflatoxin through the use of clay: a review. Food Additives & Contaminants. 2008;25(2):134–145.
21. Phillips TD, Afriyie-Gyawu E, Williams J, et al. NovaSil clay for the protection of humans and animals from aflatoxins and other contaminants. Clays and Clay Minerals. 2019;67(1):99–110. doi:10.1007/s42860-019-0008-x. Full text (opens in new tab).
22. Wang P, Afriyie-Gyawu E, Tang L, et al. NovaSil clay intervention in Ghanaians at high risk for aflatoxicosis: II. Reduction in biomarkers of aflatoxin exposure in blood and urine. Food Additives & Contaminants: Part A. 2008;25(5):622–634.
F. Gut-derived uremic toxins and specialized adsorbents
23. Evenepoel P, Meijers BKI, Bammens BRM, Verbeke K. Uremic toxins originating from colonic microbial metabolism. Kidney International Supplement. 2009;(114):S12–S19.
24. Schulman G, Berl T, Beck GJ, et al. Randomized placebo-controlled EPPIC trials of AST-120 in CKD. Journal of the American Society of Nephrology. 2015;26(7):1732–1746.
25. Intestinal Chelators, Sorbants, and Gut-Derived Uremic Toxins. Review of intestinal chelators, phosphate binders, and AST-120. Kidney International Reports. 2021. Full text (opens in new tab).
G. Dietary fibers and intestinal sequestration
26. Whitehead A, Beck EJ, Tosh S, Wolever TMS. Cholesterol-lowering effects of oat β-glucan: a meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition. 2014;100(6):1413–1421. doi:10.3945/ajcn.114.086108.
27. Jovanovski E, Yashpal S, Komishon A, et al. Effect of psyllium (Plantago ovata) fiber on LDL cholesterol and alternative lipid targets: a systematic review and meta-analysis of randomized controlled trials. American Journal of Clinical Nutrition. 2018;108(5):922–932.
28. U.S. Food and Drug Administration. Health claims: soluble fiber from certain foods and risk of coronary heart disease. FDA food-labeling resources (opens in new tab).
29. McRorie JW Jr. Evidence-based approach to fiber supplements and clinically meaningful health benefits, part 1: what to look for and how to recommend an effective fiber therapy. Nutrition Today. 2015;50(2):82–89.
H. Extracorporeal adsorption and hemoperfusion
30. Gosselin S, Juurlink DN, Kielstein JT, et al. Extracorporeal treatment for poisoning: recommendations from the EXTRIP workgroup and evidence-based toxicology. See the EXTRIP publications for toxin-specific indications and limitations. EXTRIP workgroup (opens in new tab).
31. Ronco C, Bellomo R, Kellum JA. Acute kidney injury. The Lancet. 2019;394(10212):1949–1964. doi:10.1016/S0140-6736(19)32563-2.
32. Dellinger RP, Bagshaw SM, Antonelli M, et al. Effect of targeted polymyxin B hemoperfusion on 28-day mortality in patients with septic shock and elevated endotoxin level: the EUPHRATES randomized clinical trial. JAMA. 2018;320(14):1455–1463. doi:10.1001/jama.2018.14618.
Important interpretation notes
- Best-established targets: activated charcoal for selected ingested drugs, bile-acid sequestrants for bile-acid-related disorders, phosphate binders for hyperphosphatemia, potassium binders for hyperkalemia, and specific chelators for defined metal exposures.
- More limited evidence: oral clay, modified citrus pectin, chlorella, and various commercial “detox” products. Laboratory binding does not establish a clinically meaningful reduction in body burden.
- Not all substances are interchangeable: charcoal does not reliably bind metals such as iron or lithium, and a binder that works in the intestine may not reach a toxin already stored in tissue.
- Medication interactions matter: binders can reduce absorption of prescription drugs and nutrients. Timing, monitoring, and selection should be individualized.
The 100 entries above include some formulation variants and related materials rather than 100 distinct active compounds.