Calcium acetate
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rabin Bista, M.B.B.S. [2]
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Overview
Calcium acetate is a Genitourinary Agent that is FDA approved for the treatment of hyperphosphatemia in end stage renal failure. Common adverse reactions include Hypercalcemia, Nausea, Vomiting.
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
Indications
- Calcium Acetate Capsules are indicated for the control of hyperphosphatemia in end stage renal failure and do not promote aluminum absorption.
Dosage
- The recommended initial dose of calcium acetate capsules for the adult dialysis patient is 2 capsules with each meal. The dosage may be increased gradually to bring the serum phosphate value below 6 mg/dl, as long as hypercalcemia does not develop. Most patients require 3 to 4 capsules with each meal.
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Calcium acetate in adult patients.
Non–Guideline-Supported Use
There is limited information regarding Off-Label Non–Guideline-Supported Use of Calcium acetate in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
There is limited information regarding FDA-Labeled Use of Calcium acetate in pediatric patients.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Calcium acetate in pediatric patients.
Non–Guideline-Supported Use
There is limited information regarding Off-Label Non–Guideline-Supported Use of Calcium acetate in pediatric patients.
Contraindications
- Patients with hypercalcemia.
Warnings
- Patients with end stage renal failure may develop hypercalcemia when given calcium with meals. No other calcium supplements should be given concurrently with calcium acetate capsules. Progressive hypercalcemia due to overdose of calcium acetate may be severe as to require emergency measures. Chronic hypercalcemia may lead to vascular calcification, and other soft-tissue calcification. The serum calcium level should be monitored twice weekly during the early dose adjustment period. Theserum calcium times phosphate(CaXP) product should not be allowedto exceed 66. Radiographic evaluation of suspect anatomical region may be helpful in early detection of soft-tissue calcification.
Precautions
General
- Excessive dosage of calcium acetate induces hypercalcemia; therefore, early in the treatment during dosage adjustment serum calcium should be determined twice weekly. Should hypercalcemia develop, the dosage should be reduced or the treatment discontinued immediately depending on the severity of hypercalcemia. Calcium acetate should not be given to patients on digitalis, because hypercalcemia may precipitate cardiac arrhythmias. Calcium acetate therapy should always be started at low dose and should not be increased without careful monitoring of serum calcium. An estimate of daily calcium intake should be made initially and the intake adjusted as needed. Serum phosphorus should also be determined periodically.
Adverse Reactions
Clinical Trials Experience
- In clinical studies, patients have occasionally experienced nausea during calcium acetate therapy. Hypercalcemia may occur during treatment with calcium acetate. Mild hypercalcemia (Ca>10.5 mg/dl) may be asymptomatic or manifest itself as constipation, anorexia, nausea and vomiting. More severe hypercalcemia (Ca>12 mg/dl) is associated with confusion, delirium, stupor and coma. Mild hypercalcemia is easily controlled by reducing the calcium acetate dose or temporarily discontinuing therapy. Severe hypercalcemia can be treated by acute hemodialysis and discontinuing calcium acetate therapy. Decreasing dialysate calcium concentration could reduce the incidence and severity of calcium acetate induced hypercalcemia. The long-term effect of calcium acetate on the progression of vascular or soft-tissue calcification has not been determined. Isolated cases of pruritus have been reported which may represent allergic reactions.
Postmarketing Experience
There is limited information regarding Postmarketing Experience of Calcium acetate in the drug label.
Drug Interactions
There is limited information regarding Calcium acetate Drug Interactions in the drug label.
Use in Specific Populations
Pregnancy
- Animal reproduction studies have not been conducted with calcium acetate. It is not known whether calcium acetate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Calcium acetate should be given to a pregnant woman only if clearly needed.
- Australian Drug Evaluation Committee (ADEC) Pregnancy Category
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Calcium acetate in women who are pregnant.
Labor and Delivery
There is no FDA guidance on use of Calcium acetate during labor and delivery.
Nursing Mothers
There is no FDA guidance on the use of Calcium acetate with respect to nursing mothers.
Pediatric Use
- Safety and effectiveness in pediatric patients have not been established.
Geriatic Use
- Of the total number of subjects in clinical studies of calcium acetate (N=91), 25 percent were 65 and over, while 7 percent were 75 and over. No overall differences in safety or effectiveness were
observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out.
Gender
There is no FDA guidance on the use of Calcium acetate with respect to specific gender populations.
Race
There is no FDA guidance on the use of Calcium acetate with respect to specific racial populations.
Renal Impairment
There is no FDA guidance on the use of Calcium acetate in patients with renal impairment.
Hepatic Impairment
There is no FDA guidance on the use of Calcium acetate in patients with hepatic impairment.
Females of Reproductive Potential and Males
There is no FDA guidance on the use of Calcium acetate in women of reproductive potentials and males.
Immunocompromised Patients
There is no FDA guidance one the use of Calcium acetate in patients who are immunocompromised.
Administration and Monitoring
Administration
- Oral
Monitoring
- The serum calcium level should be monitored twice weekly during the early dose adjustment period.
- Calcium acetate therapy should always be started at low dose and should not be increased without careful monitoring of serum calcium.
IV Compatibility
There is limited information regarding IV Compatibility of Calcium acetate in the drug label.
Overdosage
- Administration of calcium acetate in excess of the appropriate daily dosage can cause severe hypercalcemia
Pharmacology
This image is provided by the Wikipedia.
Mechanism of Action
- Patients with advanced renal insufficiency (creatinine clearance less than 30 mL/min) exhibit phosphate retention and some degree of hyperphosphatemia. The retention of phosphate plays a pivotal role in causing secondary hyperparathyroidism associated with osteodystrophy, and soft-tissue calcification. The mechanism by which phosphate retention leads to hyperparathyroidism is not clearly delineated. Therapeutic efforts directed toward the control of hyperphosphatemia include reduction in the dietary intake of phosphate, inhibition of absorption of phosphate in the intestine with phosphate binders, and removal of phosphate from the body by more efficient methods of dialysis. The rate of removal of phosphate by dietary manipulation or by dialysis is insufficient. Dialysis patients absorb 40% to 80% of dietary phosphorus. Therefore, the fraction of dietary phosphate absorbed from the diet needs to be reduced by using phosphate binders in most renal failure patients on maintenance dialysis.
Structure
- Each white opaque/blue opaque gelcap contains 667 mg of calcium acetate, (anhydrous; Ca(CH3COO)2; MW=158.17 grams) equal to 169 mg (8.45 mEq) calcium. Each capsule also contains FD and C blue No 1, FD and C red No 3, gelatin, magnesium stearate, polyethylene glycol 8000, and titanium dioxide. In addition to the ingredients listed above, each capsule contains Opacode (Black) monogrammingink. Opacode (Black) contains ethanol, FD and C blue No 2, FD and C red No 40, FD and C yellow No 6, iron oxide black, Nbutyl alcohol, propylene glycol, and shellac. Calcium Acetate Capsules are administered orally for the control of hyperphosphatemia in end stage renal failure.
Pharmacodynamics
There is limited information regarding Pharmacodynamics of Calcium acetate in the drug label.
Pharmacokinetics
- Calcium acetate when taken with meals, combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the feces. Maintenance of serum phosphorus below 6.0 mg/dl is generally considered as a clinically acceptable outcome of treatment with phosphate binders. Calcium acetate is highly soluble at neutral pH, making the calcium readily available for binding to phosphate in the proximal small intestine. Orally administered calcium acetate from pharmaceutical dosage forms has been demonstrated to be systemically absorbed up to approximately 40% under fasting conditions and up to approximately 30% under nonfasting conditions. This range represents data from both healthy subjects and renal dialysis patients under various conditions.
Nonclinical Toxicology
There is limited information regarding Nonclinical Toxicology of Calcium acetate in the drug label.
Clinical Studies
There is limited information regarding Clinical Studies of Calcium acetate in the drug label.
How Supplied
- Calcium Acetate Capsules are supplied as white opaque/blue opaque capsules imprinted with54 215on the cap and body.
0054-0088-26 667 mg, white opaque/ blue opaque capsule, bottle of 200
Storage
- Store at 20to 25(68to 77
Images
Drug Images
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Package and Label Display Panel
PACKAGE LABEL.PRINCIPAL DISPLAY PANEL SECTION
This image is provided by the National Library of Medicine.
Ingredients and Appearance
This image is provided by the National Library of Medicine.
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Patient Counseling Information
There is limited information regarding Patient Counseling Information of Calcium acetate in the drug label.
Precautions with Alcohol
- Alcohol-Calcium acetate interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Brand Names
- ®[1]
Look-Alike Drug Names
- A® — B®[2]
Drug Shortage Status
Price
References
The contents of this FDA label are provided by the National Library of Medicine.
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- ↑ "http://www.ismp.org". External link in
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