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

The recommended initial dose of calcium acetate capsules 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.

Capsule:  667 mg calcium acetate, USP per capsule.

Patients with hypercalcemia.

Hypercalcemia is discussed elsewhere [see Warnings and Precautions (5.1)].

The drug interaction of calcium acetate capsules is characterized by the potential of calcium to bind to drugs with anionic functions (e.g., carboxyl and hydroxyl groups).  Calcium acetate capsules may decrease the bioavailability of tetracyclines or fluoroquinolones via this mechanism.

There are no empirical data on avoiding drug interactions between calcium acetate or calcium acetate capsules and most concomitant drugs.  When administering an oral medication with calcium acetate capsules where a reduction in the bioavailability of that medication would have a clinically significant effect on its safety or efficacy, administer the drug one hour before or three hours after calcium acetate capsules or calcium acetate.  Monitor blood levels of the concomitant drugs that have a narrow therapeutic range.  Patients taking anti-arrhythmic medications for the control of arrhythmias and anti-seizure medications for the control of seizure disorders were excluded from the clinical trials with all forms of calcium acetate.

Administration of calcium acetate capsules in excess of the appropriate daily dosage may result in hypercalcemia [see Warnings and Precautions (5.1)].

Calcium acetate capsules, USP act as a phosphate binder.  Its chemical name is calcium acetate.  Its molecular formula is C 4H 6CaO 4, and its molecular weight is 158.17.  Its structural formula is:

Each capsule for oral administration contains 667 mg of calcium acetate, USP (anhydrous; Ca(CH 3COO) 2; MW=158.17 grams) equivalent to 169 mg (8.45 mEq) of calcium and and the inactive ingredients magnesium stearate and polyethylene glycol.

The capsules are size 00EL with light green opaque cap and white opaque body with black imprint on cap “NC” above “667”. The gelatin capsules contain D&C Yellow #10, FD&C Blue #1, FD&C Red # 40, titanium dioxide and gelatin

The imprinting ink contains the following: black iron oxide, D&C Yellow # 10 Aluminium Lake, FD&C Blue #1/ Brilliant Blue FCF Aluminum Lake, FD&C Blue #2/ Indigo Carmine Aluminum Lake, FD&C Red # 40/ Allura Red AC Aluminum Lake, propylene glycol and shellac glaze.

USP dissolution test is pending.

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.

Effectiveness of calcium acetate in decreasing serum phosphorus has been demonstrated in two studies of the calcium acetate solid oral dosage form.

Ninety-one patients with end-stage renal disease who were undergoing hemodialysis and were hyperphosphatemic (serum phosphorus >5.5 mg/dL) following a 1-week phosphate binder washout period contributed efficacy data to an open-label, non-randomized study.

The patients received calcium acetate 667 mg tablets at each meal for a period of 12 weeks.  The initial starting dose was 2 tablets per meal for 3 meals a day, and the dose was adjusted as necessary to control serum phosphorus levels.  The average final dose after 12 weeks of treatment was 3.4 tablets per meal.  Although there was a decrease in serum phosphorus, in the absence of a control group the true magnitude of effect is uncertain.

The data presented in Table 2 demonstrate the efficacy of calcium acetate in the treatment of hyperphosphatemia in end-stage renal disease patients.  The effects on serum calcium levels are also presented.

There was a 30% decrease in serum phosphorus levels during the 12 week study period (p<0.01).  Two-thirds of the decline occurred in the first month of the study.  Serum calcium increased 9% during the study mostly in the first month of the study.

Treatment with the phosphate binder was discontinued for patients from the open-label study, and those patients whose serum phosphorus exceeded 5.5 mg/dL were eligible for entry into a double-blind, placebo-controlled, cross-over study.  Patients were randomized to receive calcium acetate or placebo, and each continued to receive the same number of tablets as had been individually established during the previous study.  Following 2 weeks of treatment, patients switched to the alternative therapy for an additional 2 weeks.

The phosphate binding effect of calcium acetate is shown in the Table 3.

Overall, 2 weeks of treatment with calcium acetate statistically significantally (p<0.01) decreased serum phosphorus by a mean of 19% and increased serum calcium by a statistically significant (p<0.01) but clinically unimportant mean of 7%.

Each calcium acetate capsule USP, for oral administration contains 667 mg of Calcium Acetate, USP (anhydrous Ca(CH 3COO) 2; MW=158.17 grams) equivalent to 169 mg (8.45 mEq) of calcium. The capsules are size 00EL with light green opaque cap and white opaque body with black imprint on cap “NC” above “667”.

NDC 60429-491-02 Bottles of 200

STORAGE: Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F) [See USP “Controlled Room Temperature”].

Inform patients to take calcium acetate capsules with meals, adhere to their prescribed diets, and avoid the use of calcium supplements including nonprescription antacids. Inform the patients about the symptoms of hypercalcemia [see Warnings and Precautions (5.1) and Adverse Reactions (6.1)]

Advise patients who are taking an oral medication where reduction in the bioavailability of that medication would have clinically significant effect on its safety and efficacy to take the drug one hour before or three hours after calcium acetate capsules.

Manufactured by:

Nostrum Laboratories Inc.

Kansas City, MO 64120

Aug 2020

Marketed/Packaged by:

GSMS, Inc.

Camarillo, CA USA 93012

PACKAGE LABEL.PRINCIPAL DISPLAY PANEL