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What is calcium acetate? Calcium is a mineral that is needed for many functions of the body, especially bone formation and maintenance. Calcium can also bind to other minerals such as phosphate, and aid in their removal from the body. Calcium acetate is used to control phosphate levels to keep them from getting too high in people with kidney failure who are on dialysis. Calcium acetate may also be used for purposes not listed in this medication guide. Warnings You should not use calcium acetate if you have high levels of calcium in your blood. Before taking this medicine You should not use calcium acetate if you are allergic to it, or if you have high levels of calcium in your blood. Tell your doctor if: your kidney disease gets worse; or you also take digoxin (digitalis, Lanoxin). Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether calcium acetate will harm an unborn baby, but having kidney failure or developing hypercalcemia during pregnancy may cause complications in the baby and the mother. The benefit of using calcium acetate during pregnancy may outweigh any risks.. Tell your doctor if you are breastfeeding. Calcium acetate is not approved for use by anyone younger than 18 years old. How should I take calcium acetate? Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon). Take the capsule with food. You may need to keep a food diary to measure how much calcium you are getting in your diet. You may need frequent medical tests. Even if you have no symptoms, tests can help your doctor determine if calcium acetate is effective. Store at room temperature away from moisture and heat. What happens if I miss a dose? Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking calcium acetate? Do not take additional calcium supplements unless your doctor has told you to. Ask your doctor before using an antacid, and use only the type your doctor recommends. Some antacids contain calcium. Calcium acetate side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using calcium acetate and call your doctor at once if you have: high levels of calcium in your blood--nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, confusion, lack of energy, or tired feeling. Common side effects may include: increased calcium in the blood nausea; or diarrhea. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Calcium acetate dosing information Usual Adult Dose for Hyperphosphatemia: Initial dose: 1334 mg (2 tablets/capsules, or 10 mL), orally, with each meal Maintenance dose: 2001 to 2668 mg (3 to 4 tablets/capsules, or 15 to 20 mL) with each meal Comments: -Titrate dose every 2 to 3 weeks until an acceptable serum phosphorous level is reached. Use: Reduce serum phosphorous levels in patients with end stage renal disease. What other drugs will affect calcium acetate? If you take any of the following medicines, take them separately from your dose of calcium acetate: A fluoroquinolone antibiotic: Take your calcium acetate dose 6 hours before or 2 hours after you take an antibiotic such as ciprofloxacin, moxifloxacin, levofloxacin, Cipro, or Levaquin. A tetracycline antibiotic: Take your calcium acetate dose 1 hour before or 1 hour after you take an antibiotic such as doxycycline, minocycline, tetracycline, Doryx, or Oracea. Thyroid medication: Take your calcium acetate dose 4 hours before or 4 hours after you take the thyroid medicine. Other drugs may affect calcium acetate, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell your doctor about all your current medicines and any medicine you start or stop using.
What is sevelamer? Sevelamer is a phosphate binder. Sevelamer helps prevent hypocalcemia (low levels of calcium in the body) caused by elevated phosphorus. Sevelamer is used to control phosphorus levels in people with chronic kidney disease who are on dialysis. Sevelamer may also be used for purposes not listed in this medication guide. Warnings You should not take sevelamer if you have a bowel obstruction. Before taking this medicine You should not take sevelamer if you are allergic to it, or if you have a bowel obstruction. To make sure sevelamer is safe for you, tell your doctor if you have: trouble swallowing; severe constipation; a blockage in your intestines; slow digestion; a stomach or intestinal disorder; or if you have recently had stomach or intestinal surgery. It is not known whether this medicine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant. Your dose needs may be different during pregnancy. Taking sevelamer while you are pregnant can lower your blood levels of certain vitamins or folic acid. Follow your doctor's instructions about taking vitamins or mineral supplements during pregnancy. Because sevelamer is not absorbed into the bloodstream, it is not expected to be harmful to a nursing baby. Sevelamer is not approved for use by anyone younger than 6 years old. How should I take sevelamer? Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not use sevelamer in larger or smaller amounts or for longer than recommended. Take sevelamer with meals. Sevelamer powder must be dissolved in water before you take it. The 0.8-gram packet should be mixed with at least 1 ounce (2 tablespoons) of water. The 2.4-gram packet should be mixed with at least 2 ounces (4 tablespoons) of water. Stir the powder in water until it is completely dissolved. Stir and drink this mixture right away. To get the entire dose, add a little more water to the same glass, swirl gently and drink right away. While using sevelamer, you may need frequent blood tests. Call your doctor if you have have trouble swallowing the tablet, or if it feels like it gets stuck in your esophagus after you swallow it. Sevelamer may be only part of a complete program of treatment that also includes a special diet. It is very important to follow the diet plan created for you by your doctor or nutrition counselor. You should become very familiar with the list of foods you must eat or avoid to help control your condition. Store at room temperature away from moisture and heat. What happens if I miss a dose? Take the missed dose as soon as you remember. Be sure to take the missed dose with food. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. What should I avoid while taking sevelamer? You may be taking other medicines that should not be taken at the same time. Taking sevelamer can make it harder for your body to absorb certain drugs, making them less effective: ciprofloxacin (Cipro) should be taken at least 2 hours before or 6 hours after you take sevelamer; mycophenolate mofetil (CellCept) should be taken at least 2 hours before you take sevelamer. Sevelamer side effects Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Stop using sevelamer and call your doctor at once if you have: choking, or trouble swallowing; black, bloody, or tarry stools; severe constipation with stomach pain; or constipation that gets worse or does not clear up. Common side effects may include: nausea, vomiting, stomach pain, loss of appetite; upset stomach, gas, bloating; diarrhea, constipation; tired feeling; itching; or joint pain. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Sevelamer dosing information Usual Adult Dose for Hyperphosphatemia of Renal Failure: Initial Dosing for patients not on a phosphate binder: 800 mg to 1600 mg orally 3 times a day with meals Based on serum phosphorus level: -Phosphorus greater than 5.5 to less than 7.5 mg/dL: 800 mg 3 times a day with meals -Phosphorus greater than or equal to 7.5 mg/dL: 1600 mg 3 times a day with meals -Titrate in increments of 800 mg 3 times a day at 2-week intervals with the goal of controlling serum phosphorus within target range. Average prescribed dose: 7.2 g/day (2.4 g with each meal) Maximum studied dose: 14 g per day (carbonate); 13 g per day (hydrochloride) Switching from the hydrochloride salt to carbonate: Use the same dose, however further titration may be necessary to achieve desired phosphorus levels. Switching from calcium acetate: Substitute approximately mg for mg Comment: Treatment of hyperphosphatemia includes reduction in dietary intake of phosphate, inhibition of intestinal phosphate absorption with phosphate binders, and removal of phosphate with dialysis. Use: To control serum phosphorus levels in patients with chronic kidney disease on dialysis. What other drugs will affect sevelamer? Other drugs may interact with sevelamer, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.