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Calcium Acetate (Phos Binder)
Calcium acetate, commonly known as a phosphate binder, is used to manage hyperphosphatemia (high phosphate levels) in patients with chronic kidney disease (CKD), especially those undergoing dialysis. In CKD, the kidneys' ability to filter out excess phosphate is reduced, leading to elevated levels that can contribute to bone and cardiovascular complications. Calcium acetate helps control phosphate levels by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption and thereby lowering serum phosphate levels.
Calcium acetate is available by prescription only and is available in several oral forms, including tablets, capsules, and oral solutions, with tablets and capsules being the most common.
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Frequently Asked Questions
How long does it take for calcium acetate to start working?
Calcium acetate begins working to reduce phosphate levels as soon as it is taken with meals. The effectiveness in lowering blood phosphate levels will be seen over several days to weeks, depending on dietary phosphate intake and kidney function.
Can calcium acetate be used with other phosphate binders?
Yes, in some cases, calcium acetate may be used in combination with other phosphate binders, particularly if additional phosphate control is needed. However, this should be done under the guidance of a healthcare provider.
What should I do if I miss a dose of calcium acetate?
If you miss a dose, take it as soon as you remember with your next meal. If it’s close to the time for your next dose, skip the missed dose and continue with your regular schedule. Do not take two doses at once.
Is calcium acetate safe to use during pregnancy?
Calcium acetate should be used during pregnancy only if the potential benefits justify the potential risks. Pregnant women should consult their healthcare provider before starting or continuing this medication.
Can calcium acetate cause weight gain?
Weight gain is not a common side effect of calcium acetate. However, changes in diet and fluid retention associated with kidney disease can influence weight. If you notice significant weight changes, consult your healthcare provider.
Comprehensive Drug Guide
How Does Calcium Acetate (Phos Binder) Work?
Calcium acetate works by binding to dietary phosphate in the gastrointestinal tract, forming an insoluble complex that is excreted in the feces. This action reduces the absorption of phosphate into the bloodstream, thereby lowering serum phosphate levels. Additionally, the calcium component of calcium acetate can help supplement calcium intake in patients who require it.
What is Calcium Acetate (Phos Binder) Used For?
Calcium acetate belongs to the class of phosphate binders. These medications are designed to reduce phosphate absorption in the digestive tract, helping to manage phosphate levels in patients with impaired kidney function.
Common Dosages
The typical dosage of calcium acetate for adults with hyperphosphatemia is:
- Initial Dose: 2 capsules or tablets (each containing 667 mg of calcium acetate) with each meal.
- Maintenance Dose: The dosage may be adjusted based on the patient's serum phosphate levels. The goal is to maintain serum phosphate levels within the target range, which is usually 3.5 to 5.5 mg/dL for patients on dialysis.
Administration: Calcium acetate should be taken with meals to maximize its phosphate-binding effect. Each dose should be taken with the first bite of food, ensuring it is present in the stomach when dietary phosphate is being absorbed. If taking other medications, they should be spaced out to prevent interactions.
Duration of Use: Calcium acetate is used long-term in patients with CKD to manage phosphate levels. Regular monitoring of serum phosphate and calcium levels is necessary to adjust the dosage as needed and prevent complications such as hypercalcemia.
Typical Dosing
FDA Approved Indications
Calcium acetate is FDA-approved for:
Hyperphosphatemia in Chronic Kidney Disease: To control elevated phosphate levels in patients with end-stage renal disease (ESRD) on dialysis. Proper management of phosphate levels is crucial to preventing complications such as bone disorders and cardiovascular disease.
Who Shouldn't Take Calcium Acetate (Phos Binder)?
Calcium acetate is contraindicated in patients with:
- Hypercalcemia (high levels of calcium in the blood).
- Hypersensitivity to calcium acetate or any component of the formulation.
Advice From The Pharmacist
Patients using calcium acetate should be advised to:
- Take the medication exactly as prescribed and always with meals to ensure it effectively binds phosphate.
- Monitor their calcium intake from other sources, such as supplements and diet, to avoid excessive calcium intake, which can lead to hypercalcemia.
- Be aware of the symptoms of hypercalcemia, such as nausea, vomiting, constipation, muscle weakness, confusion, and fatigue. If these symptoms occur, contact your healthcare provider immediately.
- Follow any dietary restrictions or recommendations provided by their healthcare provider, particularly regarding foods high in phosphate, such as dairy products, meats, and processed foods.
- Attend regular follow-up appointments to monitor phosphate and calcium levels, which will help guide appropriate dosage adjustments.
Side Effects of Calcium Acetate (Phos Binder)
Common Side Effects
Gastrointestinal discomfort: Such as nausea, vomiting, and constipation.
Hypercalcemia: Symptoms include weakness, headache, confusion, and arrhythmias.
Uncommon/Severe Side Effects
Serious side effects can include:
Severe hypercalcemia: Can lead to serious complications like cardiac arrhythmias, renal stones, and tissue calcification, particularly in the blood vessels and heart valves.
Allergic reactions: Rarely, patients may experience rash, itching, swelling, or difficulty breathing, which require immediate medical attention.
Risks and Warnings of Calcium Acetate (Phos Binder)
Risk of Hypercalcemia: Calcium acetate increases the risk of hypercalcemia, especially in patients also taking other calcium supplements or vitamin D analogs. Regular monitoring of calcium levels is essential to prevent complications.
Drug Interactions: Calcium acetate can interact with certain medications, including tetracycline and quinolone antibiotics, and certain medications that need an acidic environment for absorption. Patients should space out the administration of these medications and calcium acetate by at least 1 to 2 hours.
Caution in Patients with Kidney Stones: Patients with a history of kidney stones should be monitored closely, as calcium acetate can increase calcium levels, potentially leading to stone formation.
Interactions with Calcium Acetate (Phos Binder)
Common Drug Interactions
Antibiotics: Such as tetracyclines and quinolones, where calcium acetate may reduce their absorption. Take these medications at least 1 to 2 hours before or after calcium acetate.
Digitalis Glycosides (e.g., Digoxin): Hypercalcemia can increase the risk of digitalis toxicity.
Thiazide Diuretics: Can increase the risk of hypercalcemia when used with calcium acetate.
Alternatives to Calcium Acetate (Phos Binder)
Alternative treatments for managing hyperphosphatemia include:
- Sevelamer (Renvela, Renagel): A non-calcium-based phosphate binder that does not increase calcium levels.
- Lanthanum Carbonate (Fosrenol): Another non-calcium phosphate binder.
- Aluminum-Based Phosphate Binders: Used less frequently due to concerns about aluminum toxicity with long-term use.
The choice of treatment depends on the individual's overall health, the severity of hyperphosphatemia, and the risk of side effects like hypercalcemia.
