ABYRA

Calcium acetate acts as a phosphate binder.

Its chemical name is calcium acetate.

Its molecular formula is

C 4 H 6 CaO 4, and its molecular weight is 158.17.

Its structural formula is

Each capsule is of size ‘00el’ hard gelatin capsule shell with blue opaque cap and white opaque body imprinted with “667 mg” on cap and “IG 377” on body in black ink filled with white to off white powder.

Each capsule contains 667 mg calcium acetate, USP (anhydrous; Ca(CH 3 COO) 2; MW=158.17 grams) equal to 169 mg (8.45 mEq) calcium.

Each capsule contains the following inactive ingredients: Sodium Lauryl Sulfate and Sodium Stearyl Fumarate.

The gelatin cap and body have the following inactive ingredients: FD&C blue #1, FD&C red #3, titanium dioxide, USP, gelatin, USP and iron oxide black.

Calcium acetate capsules, USP are administered orally for the control of hyperphosphatemia in end stage renal failure. “the drug product meets USP Dissolution Test 4” calcium acetate Chemical structure.

Calcium acetate is a phosphate binder indicated to reduce serum phosphorus in patients with end stage renal disease (ESRD).

Calcium acetate is a phosphate binder indicated for the reduction of serum phosphorus in patients with end stage renal disease.

Patients with

ESRD retain phosphorus and can develop hyperphosphatemia.

High serum phosphorus can precipitate serum calcium resulting in ectopic calcification.

Hyperphosphatemia also plays a role in the development of secondary hyperparathyroidism in patients with ESRD. 12.1 Mechanism of Action Calcium acetate, when taken with meals, combines with dietary phosphate to form an insoluble calcium phosphate complex, which is excreted in the feces, resulting in decreased serum phosphorus concentration. 12.2 Pharmacodynamics Orally administered calcium acetate from pharmaceutical dosage forms is systemically absorbed up to approximately 40% under fasting conditions and up to approximately 30% under nonfasting conditions.

This range represents data from both healthy subjects and renal dialysis patients under various conditions.

Mechanism of action Hydroxocobalamine is the natural form of vitamin B 12.

In nutrition, vitamin B is absorbed at the terminal ileum by two mechanisms, a passive mechanism when the quantities are large, and an active mechanism that allows the absorption of physiological doses and for which the presence of the intrinsic factor is indispensable.

The serum peak is reached one hour after the intramuscular injection.

Excretion is mainly by urinary route.

In toxicology, the action of hydroxocobalamine for the treatment of cyanide poisoning is based on its ability to bind strongly to cyanide ions.

Each molecule of hydroxocobalamine can bind to a cyanide ion by substitution of the trivalent cobalt ion ligand hydroxo to form cyanocobalamine.

Cyanocobalamine is a stable and nontoxic compound, excreted in urine.

Mucous colouration (Very common) Skin colouring (Very common) Pustulous eruption Rash Pruritus Urticaria Chest damage Peripheral edema Lymphopenia Hypersensitivity Oedema of Quincke Injection site reaction Dysphagia Eye edema Eye irritation Eye redness Dry pharyngee Sensation of pharyngeal constriction Vertigo Agitation Blood pressure (increase) Ventricular extrasystole Hot flash Blood pressure (decrease) Vomiting Nausea Diarrhoea Dyspepsia Abdominal discomfort Memory Disorder Headache Pleural effusion Dyspnoea Oxalic lithiasis Acute tubular necrosis Acute renal impairment Urine colour (change).

Administration of calcium acetate in excess of the appropriate daily dosage may result in hypercalcemia.

Patients with hypercalcemia.

The recommended initial dose of calcium acetate for the adult dialysis patient is 2 capsules with each meal.

Increase the dose gradually to lower serum phosphorus levels to the target range, as long as hypercalcemia does not develop.

Most patients require 3-4 capsules with each meal.

Starting dose is 2 capsules with each meal.

Titrate the dose every 2-3 weeks until acceptable serum phosphorus level is reached.

Each capsule is of size ‘00el’ hard gelatin capsule shell with blue opaque cap and white opaque body imprinted with “667 mg” on cap and “IG 377” on body in black ink filled with white to off white powder.

Supplied in

Bottles of 60 (NDC 69097-862-03) and 200 (NDC 69097-862-83).

Store at 20° to 25°C (68° to 77°F) .

Calcium acetate capsules contain calcium acetate.

Animal reproduction studies have not been conducted with calcium acetate, and there are no adequate and well controlled studies of calcium acetate use in pregnant women.

Patients with end stage renal disease may develop hypercalcemia with calcium acetate treatment.

Maintenance of normal serum calcium levels is important for maternal and fetal well being.

Hypercalcemia during pregnancy may increase the risk for maternal and neonatal complications such as stillbirth, preterm delivery, and neonatal hypocalcemia and hypoparathyroidism.

Calcium acetate treatment, as recommended, is not expected to harm a fetus if maternal calcium levels are properly monitored during and following treatment.

A calcium acetate capsule contains calcium acetate and is excreted in human milk.

Human milk feeding by a mother receiving calcium acetate is not expected to harm an infant, provided maternal serum calcium levels are appropriately monitored.

Safety and effectiveness in pediatric patients have not been established.

Clinical studies of calcium acetate did not include sufficient numbers of subjects aged and over to determine whether they respond differently from younger subjects.

Other clinical experience has not identified differences in responses between elderly and younger patients.

In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.