PhosLo (calcium acetate)
To reduce serum P in patients with end-stage renal disease.
In Patients w/ ESRD:
Initial: 2 caps w/ each meal
Titrate: Increase gradually to lower serum phosphorus levels to the target range, as long as hypercalcemia does not develop
Usual: 3-4 caps w/ each meal
Start at lower end of dosing range
Cap: 667mg (169mg Ca2+)
Hypercalcemia reported. Monitor serum Ca2+ levels twice weekly, early in the treatment phase during the dosage adjustment period. If hypercalcemia develops, reduce dose or d/c therapy, depending on severity. Chronic hypercalcemia may lead to vascular calcification and other soft-tissue calcification; radiographic evaluation of suspected anatomical region may be helpful in early detection of soft-tissue calcification. Maintain serum Ca x P product <55mg2/dL2. Hypercalcemia may aggravate digitalis toxicity. Caution in elderly.
Avoid with Ca2+ supplements, including Ca2+-based nonprescription antacids. May decrease bioavailability of fluoroquinolones (eg, ciprofloxacin) or tetracyclines. Administer oral medication, where reduction in bioavailability would have a clinically significant effect on its safety and efficacy, 1 hr before or 3 hrs after dosing. Monitor blood levels of concomitant drugs that have a narrow therapeutic range.
PREGNANCY AND LACTATION
Category C, safety not known in nursing.
MECHANISM OF ACTION
Phosphate binder; combines with dietary phosphate to form an insoluble calcium phosphate complex, which is excreted in the feces, resulting in decreased serum P concentration.
Assess for hypercalcemia, pregnancy status, and possible drug interactions.
Monitor for hypercalcemia and other adverse reactions. Monitor serum Ca x P product.
Advise adherence to prescribed diets. Instruct to avoid use of Ca2+ supplements, including nonprescription antacids. Inform about symptoms of hypercalcemia.
25°C (77°F); excursions permitted to 15-30°C (59-86°F).
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