Calcium acetate

Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Rabin Bista, M.B.B.S. [2]

## Disclaimer

WikiDoc MAKES NO GUARANTEE OF VALIDITY. WikiDoc is not a professional health care provider, nor is it a suitable replacement for a licensed healthcare provider. WikiDoc is intended to be an educational tool, not a tool for any form of healthcare delivery. The educational content on WikiDoc drug pages is based upon the FDA package insert, National Library of Medicine content and practice guidelines / consensus statements. WikiDoc does not promote the administration of any medication or device that is not consistent with its labeling. Please read our full disclaimer here.

## 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

Pregnancy Category (FDA): C

* 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.

Pregnancy Category (AUS):

* 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

Drug Name: Calcium acetate
Ingredient(s): CALCIUM ACETATE[CALCIUM CATION]
Imprint: 54215
Dosage: 667 mg
Color(s): White
Shape: Capsule
Size (mm): 22
Score: 1
NDC:00540088

Drug Label Author: Roxane Laboratories, Inc

This pill image is provided by the National Library of Medicine's PillBox.

Drug Name: Calcium acetate
Ingredient(s): CALCIUM ACETATE[CALCIUM CATION]
Imprint: P113
Dosage: 667 mg
Color(s): White
Shape: Round
Size (mm): 13
Score: 1
NDC:05740113

Drug Label Author: Paddock Laboratories, LLC

This pill image is provided by the National Library of Medicine's PillBox.

Drug Name: Calcium acetate
Ingredient(s): CALCIUM ACETATE[CALCIUM CATION]
Imprint: SANDOZ;576
Dosage: 667 mg
Color(s): White, Blue
Shape: Capsule
Size (mm): 21
Score: 1
NDC:07812081

Drug Label Author: Sandoz Inc

This pill image is provided by the National Library of Medicine's PillBox.

Drug Name: Calcium acetate
Ingredient(s): CALCIUM ACETATE[CALCIUM CATION]
Imprint: SANDOZ;576
Dosage: 667 mg
Color(s): White, Blue
Shape: Capsule
Size (mm): 21
Score: 1
NDC:07812672

Drug Label Author: Sandoz Inc

This pill image is provided by the National Library of Medicine's PillBox.

Drug Name: Eliphos
Ingredient(s): Calcium Acetate[Calcium Cation]
Imprint: CYP910
Dosage: 667 mg
Color(s): White
Shape: Round
Size (mm): 2
Score: 1
NDC:637170910

Drug Label Author: Hawthorn Pharmaceutical, Inc.

This pill image is provided by the National Library of Medicine's PillBox.

Drug Name: Calcium acetate
Ingredient(s): CALCIUM ACETATE[CALCIUM CATION]
Imprint: PhosLo;667mg
Dosage: 667 mg
Color(s): White, Blue
Shape: Capsule
Size (mm): 21
Score: 1
NDC:492300640

Drug Label Author: Fresenius Medical Care North America

This pill image is provided by the National Library of Medicine's PillBox.

### 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.

## 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.

1. ↑ Empty citation (help)
2. ↑ "http://www.ismp.org". External link in `|title=` (help)