Remophos is prescribed to control hyperphosphatemia (elevated blood phosphate levels) in patients with end-stage renal disease (ESRD). Unlike aluminum-based phosphate binders, it does not contribute to aluminum absorption.
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Mechanism of Action: When taken with meals, Calcium Acetate binds dietary phosphate in the intestine to form insoluble calcium phosphate, which is then excreted in the feces.
Therapeutic Goal: Maintaining serum phosphate levels below 6.0 mg/dL is considered an acceptable treatment outcome.
Absorption: Calcium Acetate is highly soluble at neutral pH, making calcium readily available to bind phosphate in the proximal small intestine. Oral calcium acetate is absorbed systemically at rates up to 40% (fasting) and 30% (non-fasting) in both healthy subjects and dialysis patients.
Adults (Dialysis patients):
Recommended starting dose: 2 tablets with each meal.
Dose may be increased gradually to achieve serum phosphate <6 mg/dL, provided hypercalcemia does not occur.
Most patients require 3–4 tablets per meal.
Pediatric Use: Safety and effectiveness not established.
Geriatric Use: No major differences noted in clinical response compared to younger adults, but elderly patients may have greater sensitivity.
Common: Nausea.
Hypercalcemia (dose-related):
Mild (>10.5 mg/dL): May be asymptomatic or cause constipation, anorexia, nausea, or vomiting.
Severe (>12 mg/dL): May lead to confusion, delirium, stupor, or coma.
Management: Mild cases resolve by reducing or pausing therapy. Severe hypercalcemia may require acute hemodialysis and discontinuation of therapy. Lowering dialysate calcium concentration can reduce risk.
Others: Rare reports of pruritus suggest possible allergic reactions.
May reduce the bioavailability of tetracycline antibiotics.
Contraindicated in patients with hypercalcemia.
Category C (Teratogenic risk not ruled out):
No animal reproductive studies available.
Unknown if it causes fetal harm or affects fertility.
Should only be used in pregnancy if clearly necessary.
Store below 30°C, protected from light and moisture.
Keep out of reach of children.
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