calcium acetate

calcium acetate

Phos-Ex (UK), PhosLo, PhosLo Gelcap

Pharmacologic class: Mineral

Therapeutic class: Dietary supplement, electrolyte replacement agent

Pregnancy risk category C (calcium acetate, chloride, glubionate, gluceptate, phosphate), NR (calcium carbonate, citrate, gluconate, lactate)

Action

Increases serum calcium level through direct effects on bone, kidney, and GI tract. Decreases osteoclastic osteolysis by reducing mineral release and collagen breakdown in bone.

Availability

Calcium acetate -

Gelcaps: 667 mg

Tablets: 667 mg

Calcium carbonate -

Capsules: 1,250 mg

Lozenges: 600 mg

Oral suspension: 1,250 mg

Powder: 6.5 g

Tablets: 650 mg, 1,250 mg, 1,500 mg

Tablets (chewable): 750 mg, 1,000 mg, 1,250 mg

Tablets (gum): 300 mg, 450 mg, 500 mg

Calcium chloride -

Injection: 10% solution

Calcium citrate -

Tablets: 950 mg

Calcium glubionate -

Syrup: 1.8 g/5 ml (contains 115 mg of elemental calcium)

Calcium gluceptate -

Injection: 22% solution

Calcium gluconate -

Injection: 10% solution

Tablets: 500 mg, 650 mg, 975 mg

Calcium lactate -

Tablets: 325 mg, 500 mg, 650 mg

Tricalcium phosphate -

Tablets: 600 mg

⊘Indications and dosages

➣ Hypocalcemic emergency

Adults: 7 to 14 mEq I.V. of 10% calcium gluconate solution, 2% to 10% calcium chloride solution, or 22% calcium gluceptate solution

Children: 1 to 7 mEq calcium gluconate I.V.

Infants: Up to 1 mEq calcium gluconate I.V.

➣ Hypocalcemic tetany

Adults: 4.5 to 16 mEq calcium gluconate I.V., repeated as indicated until tetany is controlled

Children: 0.5 to 0.7 mEq/kg calcium gluconate I.V. three to four times daily as indicated until tetany is controlled

Neonates: 2.4 mEq/kg calcium gluconate I.V. daily in divided doses

➣ Cardiac arrest

Adults: 0.027 to 0.054 mEq/kg calcium chloride I.V., 4.5 to 6.3 mEq calcium gluceptate I.V., or 2.3 to 3.7 mEq calcium gluconate I.V.

Children: 0.27 mEq/kg calcium chloride I.V., repeated in 10 minutes if needed. Check calcium level before giving additional doses.

➣ Magnesium intoxication

Adults: Initially, 7 mEq I.V.; subsequent dosages based on patient response

➣ Exchange transfusions

Adults: 1.35 mEq calcium gluconate I.V. with each 100 ml of citrated blood

➣ Hyperphosphatemia in patients with end-stage renal disease

Adults: Two tablets P.O. daily, given in divided doses t.i.d. with meals. May increase gradually to bring serum phosphate level below 6 mg/dl, provided hypercalcemia doesn't develop.

➣ Dietary supplement

Adults: 500 mg to 2 g P.O. daily

Off-label uses

• Osteoporosis

Contraindications

• Hypersensitivity to drug
• Ventricular fibrillation
• Hypercalcemia and hypophosphatemia
• Cancer
• Renal calculi
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• renal insufficiency, pernicious anemia, heart disease, sarcoidosis, hypercrenal insufficiency, pernicious anemia, heart disease, sarcoidosis, hyperparathyroidism, hypoparathyroidism
• history of renal calculi
• children.

Administration

☞ When infusing I.V., don't exceed a rate of 200 mg/minute.
• Keep patient supine for 15 minutes after I.V. administration to prevent orthostatic hypotension.
• Administer P.O. doses 1 to 1½ hours after meals.
• Know that I.M. or subcutaneous administration is never recommended.
• Be aware that I.V. route is preferred in children.
• Be alert for extravasation, which causes tissue necrosis.

Route	Onset	Peak	Duration
P.O.	Unknown	Unknown	Unknown
I.V.	Immediate	Immediate	0.5-2 hr

Adverse reactions

CNS: headache, weakness, dizziness, syncope, paresthesia

CV: mild blood pressure decrease, bradycardia, arrhythmias, cardiac arrest (with rapid I.V. injection)

GI: nausea, vomiting, diarrhea, constipation, epigastric pain or discomfort

GU: urinary frequency, renal calculi

Metabolic: hypercalcemia

Musculoskeletal: joint pain, back pain

Respiratory: dyspnea

Skin: rash

Other: altered or chalky taste, excessive thirst, allergic reactions (including facial flushing, swelling, tingling, tenderness in hands, and anaphylaxis )

Interactions

Drug-drug. Atenolol, fluoroquinolones, tetracycline: decreased bioavailability of these drugs

Calcium channel blockers: decreased calcium effects

Cardiac glycosides: increased risk of cardiac glycoside toxicity

Iron salts: decreased iron absorption

Sodium polystyrene sulfonate: metabolic alkalosis

Verapamil: reversal of verapamil effects

Drug-diagnostic tests. Calcium: increased level

Drug-food. Foods containing oxalic acid (such as spinach), phytic acid (such as whole grain cereal), or phosphorus (such as dairy products): interference with calcium absorption

Patient monitoring

• Monitor calcium levels frequently, especially in elderly patients.

Patient teaching

• Instruct patient to consume plenty of milk and dairy products during therapy.
• Refer patient to dietitian for help in meal planning and preparation.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.