Generic
Calcium Acetate
5 brands available in the market
At a glance
Calcium Acetate is a phosphate binder used for the control of hyperphosphatemia in end stage renal disease (ESRD). It does not promote aluminum absorption. When taken with meals, it binds with dietary phosphate to form insoluble calcium phosphate which is excreted in the feces, thereby reducing serum phosphate levels.
Description
Calcium Acetate is a phosphate binder used for the control of hyperphosphatemia in end stage renal disease (ESRD). It does not promote aluminum absorption.
Calcium Acetate, when taken with meals, combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the feces. Maintaining serum phosphorus below 6.0 mg/dL is generally considered a clinically acceptable outcome. Calcium Acetate is highly soluble at neutral pH, making calcium readily available for binding to phosphate in the proximal small intestine.
Orally administered Calcium Acetate is systemically absorbed up to approximately 40% under fasting conditions and up to approximately 30% under non-fasting conditions. This range represents data from both healthy subjects and renal dialysis patients under various conditions.
Indications
- Control of hyperphosphatemia in end stage renal disease (ESRD)
Therapeutic class
Phosphate Binder
Pharmacological class
Calcium Salt Phosphate Binder
Pharmacology
Calcium Acetate combines with dietary phosphate in the intestine to form insoluble calcium phosphate which is excreted in the feces, thereby reducing serum phosphate levels and secondary hyperparathyroidism.
Mechanism of action
Calcium Acetate sequesters phosphate in the intestine by forming insoluble phosphates that are excreted fecally, thus reducing serum phosphate concentration and secondary hyperparathyroidism.
Dosage
Adults (Dialysis patients): Initial dose: 2 tablets with each meal. The dosage may be increased gradually to bring serum phosphate below 6 mg/dL (as long as hypercalcemia does not develop). Most patients require 3-4 tablets with each meal.
Children: Safety and efficacy have not been established.
Elderly: Clinical studies showed no overall differences in safety or effectiveness between elderly and younger subjects.
Note: Start with a low dose and increase gradually with careful monitoring of serum calcium.
Administration
Take with meals (to bind with dietary phosphate). Follow the dose and duration as advised by your physician. Monitor serum calcium and phosphate levels regularly.
Missed dose
If you miss a dose, take it as soon as you remember. If it is almost time for your next meal, skip the missed dose. Do not double the dose.
Side effects
Common side effects: Nausea, constipation, anorexia, vomiting.
Hypercalcemia (Ca >10.5 mg/dL): May be asymptomatic or manifest as constipation, anorexia, nausea, and vomiting.
Severe hypercalcemia (Ca >12 mg/dL): Associated with confusion, delirium, stupor, and coma.
Other: Arrhythmias, hypomagnesemia, hypophosphatemia, hypotension, pruritus (rare), weakness.
Isolated cases of pruritus have been reported which may represent allergic reactions.
Precautions & warnings
- Excessive dosage induces hypercalcemia; serum calcium should be determined twice weekly during dose adjustment.
- If hypercalcemia develops, reduce the dose or discontinue treatment immediately depending on severity.
- Do not give to patients on digitalis (hypercalcemia may precipitate cardiac arrhythmias).
- Always start with a low dose and do not increase without careful monitoring of serum calcium.
- Patients should be informed about compliance with dosage instructions, diet adherence, and avoidance of nonprescription antacids.
- Patients should be informed about the symptoms of hypercalcemia.
- Caution/avoid in renal impairment, diseases associated with hypercalcemia (sarcoidosis, malignancies), and calcium renal calculi or history of renal calculi.
Contraindications
- Hypercalcemia
Drug interactions
- Tetracycline antibiotics: Calcium Acetate may decrease the bioavailability of tetracycline.
- Thiazide diuretics: Reduce calcium excretion; risk of hypercalcemia.
- Vitamin D, corticosteroids: May increase calcium absorption.
- Bisphosphonates, fluoride, some fluoroquinolones: Interactions may occur.
Food interactions
Take with meals. Foods containing oxalic acid and phytic acid may reduce calcium absorption.
Use in pregnancy
May be unsafe during pregnancy (Category C). Animal reproduction studies have not been conducted. Maintenance of normal serum calcium levels is important for maternal and fetal well-being. Hypercalcemia during pregnancy may increase risk for maternal and neonatal complications (e.g., stillbirth, preterm delivery, neonatal hypocalcemia and hypoparathyroidism). Use only if clearly needed.
Pregnancy Category: C — always consult a doctor before taking during pregnancy.
Use in lactation
Unknown if excreted in human milk. Use with caution.
Pediatric use
Safety and efficacy in children have not been established.
Geriatric use
Clinical studies showed no overall differences in safety or effectiveness between elderly and younger subjects. However, greater sensitivity of some older individuals cannot be ruled out.
Renal / hepatic impairment
Hepatic impairment: No special precautions required, but consult your physician.
Overdose effects
Excessive dosage can cause severe hypercalcemia. Mild hypercalcemia is easily controlled by reducing the dose or temporarily discontinuing therapy. Severe hypercalcemia can be treated by acute hemodialysis and discontinuing Calcium Acetate therapy.
Storage conditions
Store below 30°C, away from light and moisture. Keep out of reach of children.
Chemical structure
Calcium Acetate