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Pronunciation |
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(KAL
see um AS e
tate) |
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U.S. Brand
Names |
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Calphron®;
PhosLo® |
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Generic
Available |
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No |
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Pharmacological Index |
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Antidote; Calcium Salt; Electrolyte Supplement, Oral |
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Use |
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Oral: Control of hyperphosphatemia in end-stage renal failure; calcium
acetate binds to phosphorus in the GI tract better than other calcium salts due
to its lower solubility and subsequent reduced absorption and increased
formation of calcium phosphate; calcium acetate does not promote aluminum
absorption
I.V.: Calcium supplementation in parenteral nutrition therapy
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Pregnancy Risk
Factor |
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C |
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Contraindications |
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Hypercalcemia, renal calculi, hypophosphatemia |
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Warnings/Precautions |
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Calcium absorption is impaired in achlorhydria (common in elderly - try
alternate salt, administer with food); administration is followed by increased
gastric acid secretion within 2 hours of administration; while hypercalcemia and
hypercalciuria may result when therapeutic replacement amounts are given for
prolonged periods, they are most likely to occur in hypoparathyroid patients
receiving high doses of vitamin D |
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Adverse
Reactions |
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Mild hypercalcemia (calcium: >10.5 mg/dL) may be asymptomatic or manifest
itself as constipation, anorexia, nausea, and vomiting
More severe hypercalcemia (calcium: >12 mg/dL) is associated with
confusion, delirium, stupor, and coma
<1%: Headache, hypophosphatemia, hypercalcemia, nausea, anorexia,
vomiting, abdominal pain, constipation, thirst |
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Overdosage/Toxicology |
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Acute single ingestions of calcium salts may produce mild gastrointestinal
distress, but hypercalcemia or other toxic manifestations are extremely unlikely
Treatment is supportive |
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Drug
Interactions |
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Decreased effect:
Calcium acetate may significantly decrease the bioavailability of
tetracyclines
Large intakes of dietary fiber may decrease calcium absorption due to a
decreased GI transit time and the formation of fiber-calcium complexes
Increased effect: Calcium acetate may increase the effects of quinidine
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Stability |
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Admixture incompatibilities: Carbonates, phosphates, sulfates,
tartrates |
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Mechanism of
Action |
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Combines with dietary phosphate to form insoluble calcium phosphate which is
excreted in feces |
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Pharmacodynamics/Kinetics |
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Absorption: From the GI tract requires vitamin D; minimal absorption unless
chronic, high doses are given; calcium is absorbed in soluble, ionized form;
solubility of calcium is increased in an acid environment
Distribution: Crosses the placenta; appears in breast milk
Elimination: Mainly in feces as unabsorbed calcium with 20% eliminated by the
kidneys |
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Usual Dosage |
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Oral: Adults, on dialysis: Initial: 2 tablets with each meal, can be
increased gradually to 3-4 tablets with each meal to bring the serum phosphate
value <6 mg/dL as long as hypercalcemia does not develop
I.V.: Dose is dependent on the requirements of the individual patient; in
central venous total parental nutrition (TPN), calcium is administered at a
concentration of 5 mEq (10 mL)/L of TPN solution; the additive maintenance dose
in neonatal TPN is 0.5 mEq calcium/kg/day (1.0 mL/kg/day)
Neonates: 70-200 mg/kg/day
Infants and Children: 70-150 mg/kg/day
Adolescents: 18-35 mg/kg/day |
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Dietary
Considerations |
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Tablets must be administered with meals to be effective |
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Reference Range |
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Serum calcium: 8.4-10.2 mg/dL
Due to a poor correlation between the serum ionized calcium (free) and total
serum calcium, particularly in states of low albumin or acid/base imbalances,
direct measurement of ionized calcium is recommended
In low albumin states, the corrected total serum calcium may be
estimated by this equation (assuming a normal albumin of 4 g/dL)
Corrected total calcium = total serum calcium + 0.8 (4.0 - measured serum
albumin)
or
Corrected calcium = measured calcium - measured albumin + 4.0
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Test
Interactions |
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calcium (S);
magnesium |
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Mental Health: Effects
on Mental Status |
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May cause confusion and delirium (as a consequence of
hypercalcemia) |
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Mental Health:
Effects on Psychiatric
Treatment |
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None reported |
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Dental Health: Local
Anesthetic/Vasoconstrictor
Precautions |
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No information available to require special precautions |
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Dental Health:
Effects on Dental Treatment |
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No effects or complications reported |
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Patient
Information |
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Can take with food; do not take calcium supplements within 1-2 hours of
taking other medicine by mouth or eating large amounts of fiber-rich foods; do
not use nonprescription antacids or drink large amounts of alcohol,
caffeine-containing beverages, or use tobacco |
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Nursing
Implications |
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12.7 mEq/g; 250 mg/g elemental calcium (25% elemental
calcium) |
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Dosage Forms |
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Elemental calcium listed in brackets
Injection, 0.5 mEq calcium/mL (39.55 mg calcium acetate/mL) 10 mL vial
Tablet:
Calphron®: 667 mg [169 mg]
PhosLo®: 667 mg [169 mg] |
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References |
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Kaiser W, Biesenbach G, Kramar R, et al,
"Calcium Free Hemodialysis: An Effective Therapy in Hypercalcemic Crisis - Report of Four Cases,"
Intensive Care Med, 1989, 15(7):471-4.
Texier D, Chevallier P, Perrotin D, et al,
"Hypercalcemia Associated With Resorbable Haemostatic Compresses,"
Lancet, 1982, 1(8273):688-9. |
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