Phoslyra (calcium acetate)
Last reviewed · Source: First Databank (FDB) drug data
Overview
Calcium salts are used as a source of calcium, an essential nutrient cation.
Calcium salts are used as a source of calcium cation for the treatment or prevention of calcium depletion in patients in whom dietary measures are inadequate. Conditions that may be associated with calcium deficiency include hypoparathyroidism, achlorhydria, chronic diarrhea, vitamin D deficiency, steatorrhea, sprue, pregnancy and lactation, menopause, pancreatitis, renal failure, alkalosis, and hyperphosphatemia. Administration of certain drugs (e.g., some diuretics, anticonvulsants) may sometimes result in hypocalcemia which may warrant calcium replacement therapy.
Calcium should be administered in long-term electrolyte replacement regimens and is also recommended for the routine prophylaxis of hypocalcemia during transfusions with citrated blood. Administration of calcium salts should not preclude the use of other measures intended to correct the underlying cause of calcium depletion.
Generic name: calcium acetate
Pronunciation: (KAL-see-um AS-e-tate)
Reference product & biosimilars
No reference, biosimilar or interchangeable associated with this drug.
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Indications
The following indications are listed for Phoslyra:
- Renal Osteodystrophy With Hyperphosphatemia
Also known as: Renal Osteodystrophy With Hyperphospheremia.
Dosing
Dosage of the oral calcium supplements is usually expressed in grams or mg of elemental calcium and depends on the requirements of the individual patient. Dosage of parenteral calcium replacements is usually expressed as mEq of calcium and depends on individual patient requirements. One mEq of elemental calcium is equivalent to 20 mg. See Table 1 for the approximate calcium content of the various calcium salts.
Table 1.
Calcium Salt Calcium Content calcium acetate 253 mg (12.7 mEq) per g calcium carbonate 400 mg (20 mEq) per g calcium chloride 270 mg (13.5 mEq) per g calcium citrate 211 mg (10.6 mEq) per g calcium gluceptate 82 mg (4.1 mEq) per g calcium gluconate 90 mg (4.5 mEq) per g calcium glycerophosphate 191 mg (9.6 mEq) per g calcium lactate 130 mg (6.5 mEq) per g calcium phosphate dibasic anhydrous 290 mg (14.5 mEq) per g calcium phosphate dibasic dihydrate 230 mg (11.5 mEq) per g calcium phosphate tribasic 400 mg (20 mEq) per g
Oral calcium supplements usually are administered in 3 or 4 divided doses daily. Optimum calcium absorption may require supplemental vitamin D in individuals with inadequate vitamin D intake, those with impaired renal activation of the vitamin, or those not receiving adequate exposure to sunlight.
The acetate, carbonate, citrate, gluconate, lactate, and phosphate salts of calcium are administered orally. It has been recommended that most oral calcium supplements be administered 1-1.5 hours after meals or with a demulcent (e.g., milk). However, calcium carbonate powder (i.e., CAL CARB-HD(R)) should generally be administered with meals, since the manufacturer recommends mixing the powder with food for administration. Calcium salts used to bind dietary phosphate in patients with end-stage renal disease should be administered with meals (e.g., 10-15 minutes before, or during, the meal).
Calcium chloride and calcium gluconate may be administered IV. Calcium chloride also may be administered by intraosseous (IO) injection+ in the setting of pediatric resuscitation; onset of action and systemic concentrations are comparable to those achieved with venous administration. Parenteral calcium salts may be administered in large volume IV infusion fluids.
IV calcium injections must be administered slowly at a rate not exceeding 0.7-1.8 mEq/minute, and the injection should be stopped if the patient complains of discomfort. Following IV injection, the patient should remain recumbent for a short time. Close monitoring of serum calcium concentrations is essential during IV administration of calcium. Calcium chloride should not be injected IM or into subcutaneous or perivascular tissue, since severe necrosis and sloughing may occur. Although other calcium salts may cause mild to severe local reactions, they are generally less irritating than calcium chloride. (See Cautions.) The fixed combination of calcium glycerophosphate and calcium lactate is injected IM. Although some manufacturers previously stated that calcium gluconate could be injected IM when IV administration was not possible, manufacturers of calcium gluconate currently state that the drug should not be injected IM or into subcutaneous tissue because of the potential for severe local reactions. In children, calcium salts should not be administered through scalp veins. Oral administration of calcium supplements or calcium-rich foods should replace parenteral calcium therapy as soon as possible.
The interaction of calcium and phosphate in parenteral nutrition solutions is a complex phenomenon; various factors have been identified as playing a role in the solubility or precipitation of a given combination. Calcium salts are conditionally compatible with phosphate in parenteral nutrition solutions; incompatibility is dependent on a solubility and concentration phenomenon and is not entirely predictable. Precipitation may occur during compounding or at some time after compounding is completed. Specialized references should be consulted for specific compatibility information.
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Drug interactions
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Contraindications
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Adverse reactions
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Precautions
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ICD codes
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Last reviewed · Source: First Databank (FDB) drug data
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