What is the dosing for Phoslo (calcium acetate)?

From the Guidelines

Phoslo (calcium acetate) should be dosed at 667 mg (2 capsules) taken three times daily with meals for adults with end-stage renal disease to control phosphate levels, with a goal of maintaining phosphorus between 3.5-5.5 mg/dL, and the dosage may be adjusted based on serum phosphorus levels, as suggested by the Kidney Disease: Improving Global Outcomes 2017 clinical practice guideline update 1.

Key Considerations

• The maximum recommended daily dose is generally 1,334 mg (4 capsules) per meal or 12 capsules daily.
• Phoslo works by binding to dietary phosphate in the gastrointestinal tract, forming an insoluble compound that is eliminated in feces, thus reducing phosphate absorption.
• It's essential to take Phoslo with meals to maximize phosphate binding and minimize hypercalcemia risk.
• Regular monitoring of serum calcium, phosphorus, and calcium-phosphorus product is necessary to prevent complications, as supported by the Annals of Internal Medicine study 1.

Important Safety Information

• Patients should be aware that common side effects include hypercalcemia, nausea, and constipation.
• If hypercalcemia develops, the medication should be temporarily discontinued until calcium levels normalize, as recommended by the clinical practice guideline update 1.

Dosing Adjustments

• Decisions about phosphate-lowering treatment should be based on progressively or persistently elevated serum phosphate, as stated in the guideline update 1.
• In adult patients with CKD G3a to G5D receiving phosphate-lowering treatment, the dose of calcium-based phosphate binders should be restricted, as suggested by the Grade 2B recommendation 1.

From the Research

Phoslo Dosing Information

• Phoslo, also known as calcium acetate, is a phosphate binder used to treat hyperphosphatemia in patients with chronic kidney disease (CKD) 2, 3, 4.
• The dosing of Phoslo is not explicitly stated in the provided studies, but its efficacy and safety are compared to other phosphate binders such as sevelamer and lanthanum carbonate 2, 3, 4, 5.
• Phosphate binders like Phoslo are commonly prescribed to patients with CKD to limit the absorption of dietary phosphorus, as dietary restriction and dialysis are often insufficient to maintain phosphorus levels within the recommended range 2.

Comparison with Other Phosphate Binders

• Sevelamer, a non-absorbed, calcium-free, and metal-free phosphate binder, has been shown to effectively control serum phosphorus levels and may have beneficial effects on lipid metabolism and inflammation 2, 5.
• Lanthanum carbonate, another calcium-free phosphate binder, has been reported to provide similar phosphate control to calcium-based phosphate binders, but its long-term use may lead to tissue accumulation 2, 3.
• Iron-based phosphate binders, such as sucroferric oxyhydroxide, have been shown to be effective in reducing phosphatemia with a similar safety profile to sevelamer and may represent a good alternative to traditional phosphate binders 6, 4.

Safety and Efficacy

• The safety and efficacy of Phoslo and other phosphate binders have been evaluated in several studies, with varying results 3, 4, 5.
• Common adverse effects of phosphate binders include gastrointestinal symptoms, such as nausea and constipation, as well as potential interactions with other medications 3, 4.
• The choice of phosphate binder depends on various factors, including the patient's individual needs, medical history, and tolerance to the medication 3, 4.