Remophos 667

Indications

Remophos is primarily prescribed for managing hyperphosphatemia in patients with end-stage renal disease (ESRD). It effectively controls phosphate levels without contributing to aluminum absorption.
Consult with a registered healthcare provider before using this medication.

Pharmacology

Calcium Acetate works by binding dietary phosphate during meals to form insoluble calcium phosphate, which is then excreted via the feces. Maintaining a serum phosphorus level below 6.0 mg/dl is often the desired therapeutic outcome when using phosphate binders. Calcium Acetate is highly soluble in neutral pH, allowing it to readily bind to phosphate in the proximal small intestine. When taken orally, it is absorbed systemically up to 40% in fasting conditions and approximately 30% in non-fasting conditions, based on studies conducted in both healthy individuals and renal dialysis patients.

Dosage & Administration

For adult dialysis patients, the initial recommended dose is 2 tablets with each meal. Dosage can be gradually adjusted to maintain phosphate levels under 6 mg/dl, ensuring no onset of hypercalcemia. Typically, patients require 3-4 tablets per meal.

Pediatric Use: The safety and efficacy of Calcium Acetate have not been established in children.

Geriatric Use: Clinical studies show no significant differences in safety or effectiveness between elderly and younger individuals, though older patients may show increased sensitivity.

Consult with a registered healthcare provider before using this medication.

Drug Interactions

Remophos may reduce the bioavailability of tetracycline.

Contraindications

Calcium Acetate is contraindicated in individuals with hypercalcemia.

Side Effects

While Remophos therapy is generally well-tolerated, some patients may experience nausea. Hypercalcemia is a possible side effect, which can present with symptoms such as constipation, anorexia, nausea, and vomiting if mild (Ca >10.5 mg/dl). In more severe cases (Ca >12 mg/dl), symptoms can include confusion, delirium, stupor, and coma. Mild hypercalcemia can typically be controlled by adjusting the dose or temporarily halting the medication. Severe hypercalcemia may require acute hemodialysis. Reducing the calcium concentration in dialysate may help mitigate the severity of hypercalcemia. The long-term impact of Remophos on vascular or soft tissue calcification remains undetermined. Rare cases of pruritus have been reported, potentially indicating allergic reactions.

Pregnancy & Lactation

Teratogenic Effects: Category C. Animal studies on the reproductive effects of Calcium Acetate have not been conducted. It is unknown whether it can cause harm to the fetus or affect reproductive capacity in humans. Use during pregnancy should only be considered if absolutely necessary.

Precautions & Warnings

To prevent hypercalcemia, it is crucial to monitor serum calcium levels during dosage adjustments, especially in the initial treatment phase. If hypercalcemia occurs, reduce the dosage or discontinue treatment. Remophos should be avoided in patients on digitalis as hypercalcemia may induce cardiac arrhythmias. Begin treatment with a low dose and gradually increase, with regular monitoring of serum calcium levels. Patients should be educated about proper dosage, dietary restrictions, and avoiding over-the-counter antacids. Symptoms of hypercalcemia should also be discussed with patients.

Overdose Effects

Taking Remophos beyond the recommended dose can lead to severe hypercalcemia.

Storage Instructions

Store Remophos below 30°C, away from light and moisture. Keep out of reach of children.