Calcium acetate

Identification

Summary

Calcium acetate is a phosphate binder used in patients with end-stage renal disease (ESRD) to prevent elevated phosphate levels and resulting ectopic calcification and secondary hyperparathyroidism.

Brand Names

Domeboro, Eliphos, Phoslo, Phoslyra, Procalamine 3

Generic Name

Calcium acetate

DrugBank Accession Number

DB00258

Background

The chemical compound calcium acetate is the calcium salt of acetic acid. It has been commonly referred to as the acetate of lime. The anhydrous form is very hygroscopic, therefore the monohydrate is the common form.

Type

Small Molecule

Groups

Approved, Investigational

Structure

Similar Structures

Weight: Average: 158.166
Monoisotopic: 157.989199835
Chemical Formula: C₄H₆CaO₄

Synonyms

Acetate of lime
Brown acetate of lime
Calcio acetato
Calcium acetate
calcium ethanoate
calcium(II) acetate
Gray acetate of lime
Lime acetate
Lime pyrolignite

External IDs

E-263
FEMA NO. 2228
INS NO.263
INS-263

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Pharmacology

Indication

Calcium acetate is one of a number of calcium salts used to treat hyperphosphatemia (too much phosphate in the blood) in patients with kidney disease.

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Associated Conditions

Indication Type	Indication	Combined Product Details	Approval Level	Age Group	Patient Characteristics	Dose Form
Management of	Hyperphosphatemia		••••••••••••
Used in combination to treat	High phosphate levels	Combination Product in combination with: Magnesium carbonate (DB09481)	••••••••••••		•••••••• •••••••

Associated Therapies

Contraindications & Blackbox Warnings

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Pharmacodynamics

Patients with advanced renal insufficiency (creatinine clearance less than 30 ml/min) exhibit phosphate retention and some degree of hyperphosphatemia. The retention of phosphate plays a pivotal role in causing secondary hyperparathyroidism associated with osteodystrophy, and soft-tissue calcification. The mechanism by which phosphate retention leads to hyperparathyroidism is not clearly delineated. Therapeutic efforts directed toward the control of hyperphosphatemia include reduction in the dietary intake of phosphate, inhibition of absorption of phosphate in the intestine with phosphate binders, and removal of phosphate from the body by more efficient methods of dialysis. The rate of removal of phosphate by dietary manipulation or by dialysis is insufficient. Dialysis patients absorb 40% to 80% of dietary phosphorus. Therefore, the fraction of dietary phosphate absorbed from the diet needs to be reduced by using phosphate binders in most renal failure patients on maintenance dialysis. Calcium acetate when taken with meals combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the feces. Maintenance of serum phosphorus below 6.0 mg/dl is generally considered as a clinically acceptable outcome of treatment with phosphate binders. Calcium acetate is highly soluble at neutral pH, making the calcium readily available for binding to phosphate in the proximal small intestine.

Mechanism of action

Calcium acetate and other calcium salts are phosphate binders. They work by binding with the phosphate in the food you eat, so that it is eliminated from the body without being absorbed.

Target	Actions	Organism
APhosphate	binder	Humans

Absorption

40% is absorbed in the fasting state and approximately 30% is absorbed in the nonfasting state following oral administration.

Volume of distribution

Not Available

Protein binding

Not Available

Metabolism

Not Available

Route of elimination

Calcium acetate when taken with meals, combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the feces.

Half-life

Not Available

Clearance

Not Available

Adverse Effects

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Toxicity

Oral, rat: LD₅₀ = 4280 mg/kg. Symptoms of overdose include mild hypercalcemia (constipation; loss of appetite; nausea and vomiting), and severe hypercalcemia (confusion; full or partial loss of consciousness; incoherent speech).

Pathways

Not Available

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Not Available

Interactions

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This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.

Drug	Interaction
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Acebutolol	The therapeutic efficacy of Acebutolol can be decreased when used in combination with Calcium acetate.
Acetyldigitoxin	Calcium acetate may increase the arrhythmogenic and cardiotoxic activities of Acetyldigitoxin.
Alendronic acid	The serum concentration of Alendronic acid can be decreased when it is combined with Calcium acetate.
Alfacalcidol	The risk or severity of adverse effects can be increased when Alfacalcidol is combined with Calcium acetate.
Amiodarone	The therapeutic efficacy of Amiodarone can be decreased when used in combination with Calcium acetate.

Food Interactions

Take with food. When taken with food, calcium acetate forms an insoluble complex with the phosphorus from food, reducing phosphorus serum concentrations.

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Product Ingredients

Ingredient	UNII	CAS	InChI Key
Calcium acetate monohydrate	7ZA48GIM5H	5743-26-0	XQKKWWCELHKGKB-UHFFFAOYSA-L

Active Moieties

Name	Kind	UNII	CAS	InChI Key
Calcium	prodrug	SY7Q814VUP	7440-70-2	OYPRJOBELJOOCE-UHFFFAOYSA-N
Calcium cation	ionic	2M83C4R6ZB	14127-61-8	BHPQYMZQTOCNFJ-UHFFFAOYSA-N
Acetate	ionic	569DQM74SC	71-50-1	QTBSBXVTEAMEQO-UHFFFAOYSA-M

Product Images

International/Other Brands

Phoslo / Teltozan

Brand Name Prescription Products

Name	Dosage	Strength	Route	Labeller	Marketing Start	Marketing End
Phoslo	Capsule	667 mg/1	Oral	Cardinal Health	2001-04-02	2012-02-29
Phoslo	Capsule	667 mg/1	Oral	Physicians Total Care, Inc.	1997-08-27	2006-10-11
Phoslo	Capsule	667 mg/1	Oral	Nabi Biopharmaceuticals	2007-01-01	2007-06-14
Phoslo	Capsule	667 mg/1	Oral	Physicians Total Care, Inc.	2010-03-01	Not applicable
PhosLo	Capsule	667 mg/1	Oral	Fresenius Medical Care North America	2001-04-02	Not applicable

Generic Prescription Products

Name	Dosage	Strength	Route	Labeller	Marketing Start	Marketing End
Calcium Acetate	Capsule	667 mg/1	Oral	bryant ranch prepack	2016-07-26	Not applicable
Calcium Acetate	Tablet	667 mg/1	Oral	Zydus Pharmaceuticals Usa, Inc.	2012-02-23	Not applicable
Calcium Acetate	Tablet	667 mg/1	Oral	Safecor Health, LLC	2014-08-15	2019-11-11
Calcium Acetate	Capsule	667 mg/1	Oral	Mc Kesson Contract Packaging	2008-02-26	2017-09-30
Calcium Acetate	Capsule	667 mg/1	Oral	Major Pharmaceuticals	2008-02-26	Not applicable

Over the Counter Products

Name	Dosage	Strength	Route	Labeller	Marketing Start	Marketing End
Calcium Acetate Tab 667mg	Tablet	667 mg	Oral	Stanley Pharmaceuticals, A Division Of Vita Health Products Inc.	1993-12-31	2002-07-31
แคลซิเตด	Tablet, film coated	1000 mg	Oral	บริษัท โปลิฟาร์ม จำกัด จำกัด	2008-07-31	Not applicable
แคลซีเตด - เอ็ม	Tablet, film coated	667 mg	Oral	บริษัท โปลิฟาร์ม จำกัด จำกัด	2014-11-04	Not applicable
แคลสตาร์	Tablet, film coated	1000 mg	Oral	บริษัท ห้างขายยาตราเจ็ดดาว จำกัด	2018-09-07	Not applicable

Mixture Products

Name	Ingredients	Dosage	Route	Labeller	Marketing Start	Marketing End
ACETATODE ALUMINIO	Calcium acetate (36.45 g) + Aluminum sulfate (51.8 g)	Powder	Topical	SANOFI AVENTIS DE COLOMBIA S.A.	2006-11-10	Not applicable
Aluminum Acetate Astringent	Calcium acetate (839 mg/2030mg) + Aluminum sulfate hydrate (1191 mg/2030mg)	Powder, for solution	Topical	Epic Pharma, LLC	2011-02-28	2013-04-30
Aluminum Acetate Astringent	Calcium acetate (839 mg/2030mg) + Aluminum sulfate hydrate (1191 mg/2030mg)	Powder, for solution	Topical	Tagi Pharma Incorporated	2011-06-15	Not applicable
Astringent	Calcium acetate monohydrate (952 mg/2299mg) + Aluminum sulfate tetradecahydrate (1347 mg/2299mg)	Powder, for solution	Topical	TAGI Pharma Inc.	2012-06-01	2024-09-30
Astringent	Calcium acetate monohydrate (952 mg/2299mg) + Aluminum sulfate tetradecahydrate (1347 mg/2299mg)	Powder, for solution	Topical	Granulation Technology, Inc.	2023-10-05	Not applicable

Unapproved/Other Products

Name	Ingredients	Dosage	Route	Labeller	Marketing Start	Marketing End
Nutrilyte	Calcium acetate (22 mg/1mL) + Sodium gluconate (55 mg/1mL) + Magnesium acetate (43 mg/1mL) + Potassium acetate (34.5 mg/1mL) + Potassium chloride (125 mg/1mL) + Sodium acetate trihydrate (135 mg/1mL)	Injection, solution, concentrate	Intravenous	American Regent	1990-09-30	2013-05-08
OSVAREN 435 MG/235 MG 180 FILM KAPLI TABLET	Calcium acetate (435 mg) + Magnesium carbonate (235 mg)	Tablet, coated	Oral	FRESENIUS MEDİKAL HİZMETLER A.Ş.	2019-04-30	2020-12-09
PROCALAMINE SISE 1000 ML(SETLI)	Calcium acetate monohydrate (0.026 g/100ml) + Alanine (0.21 g/100ml) + Arginine (0.29 g/100ml) + Cysteine hydrochloride (0.02 g/100ml) + Glycerin (3 g/100ml) + Glycine (0.42 g/100ml) + Histidine (0.085 g/100ml) + Isoleucine (0.21 g/100ml) + Leucine (0.27 g/100ml) + Lysine (0.22 g/100ml) + Magnesium acetate tetrahydrate (0.054 g/100ml) + Methionine (0.16 g/100ml) + Phenylalanine (0.17 g/100ml) + Phosphoric acid (0.041 g/100ml) + Potassium chloride (0.149 g/100ml) + Potassium metabisulfite (0.05 g/100ml) + Proline (0.34 g/100ml) + Serine (0.18 g/100ml) + Sodium acetate trihydrate (0.204 g/100ml) + Sodium chloride (0.117 g/100ml) + Threonine (0.12 g/100ml) + Tryptophan (0.046 g/100ml) + Valine (0.2 g/100ml)	Solution	Parenteral	ECZACIBAŞI-BAXTER HASTANE ÜRÜNLERİ SAN.VE TİC. A.Ş.	2013-01-29	2024-01-23
PROCALAMINE SISE 500 ML(SETLI)	Calcium acetate monohydrate (0.026 g/100ml) + Alanine (0.21 g/100ml) + Arginine (0.29 g/100ml) + Cysteine hydrochloride (0.02 g/100ml) + Glycerin (3 g/100ml) + Glycine (0.42 g/100ml) + Histidine (0.085 g/100ml) + Isoleucine (0.21 g/100ml) + Leucine (0.27 g/100ml) + Lysine (0.22 g/100ml) + Magnesium acetate tetrahydrate (0.054 g/100ml) + Methionine (0.16 g/100ml) + Phenylalanine (0.17 g/100ml) + Phosphoric acid (0.041 g/100ml) + Potassium chloride (0.149 g/100ml) + Potassium metabisulfite (0.05 g/100ml) + Proline (0.34 g/100ml) + Serine (0.18 g/100ml) + Sodium acetate trihydrate (0.204 g/100ml) + Sodium chloride (0.117 g/100ml) + Threonine (0.12 g/100ml) + Tryptophan (0.046 g/100ml) + Valine (0.2 g/100ml)	Solution	Parenteral	ECZACIBAŞI-BAXTER HASTANE ÜRÜNLERİ SAN.VE TİC. A.Ş.	2013-01-29	2024-01-23
PROCALAMINE SISE 500 ML(SETSIZ)	Calcium acetate monohydrate (0.026 g/100ml) + Alanine (0.21 g/100ml) + Arginine (0.29 g/100ml) + Cysteine hydrochloride (0.02 g/100ml) + Glycerin (3 g/100ml) + Glycine (0.42 g/100ml) + Histidine (0.085 g/100ml) + Isoleucine (0.21 g/100ml) + Leucine (0.27 g/100ml) + Lysine (0.22 g/100ml) + Magnesium acetate tetrahydrate (0.054 g/100ml) + Methionine (0.16 g/100ml) + Phenylalanine (0.17 g/100ml) + Phosphoric acid (0.041 g/100ml) + Potassium chloride (0.149 g/100ml) + Potassium metabisulfite (0.05 g/100ml) + Proline (0.34 g/100ml) + Serine (0.18 g/100ml) + Sodium acetate trihydrate (0.204 g/100ml) + Sodium chloride (0.117 g/100ml) + Threonine (0.12 g/100ml) + Tryptophan (0.046 g/100ml) + Valine (0.2 g/100ml)	Solution	Parenteral	ECZACIBAŞI-BAXTER HASTANE ÜRÜNLERİ SAN.VE TİC. A.Ş.	2013-01-29	2024-01-23

Chemical Identifiers

UNII: Y882YXF34X
CAS number: 62-54-4
InChI Key: VSGNNIFQASZAOI-UHFFFAOYSA-L
InChI: InChI=1S/2C2H4O2.Ca/c2*1-2(3)4;/h2*1H3,(H,3,4);/q;;+2/p-2
IUPAC Name: calcium diacetate
SMILES: [Ca++].CC([O-])=O.CC([O-])=O

References

Synthesis Reference

Alan B. Gancy, "Process of making calcium acetate deicing agents and product." U.S. Patent US4444672, issued November, 1946.

US4444672

General References

Not Available

External Links

Human Metabolome Database: HMDB0303554
KEGG Drug: D00931
PubChem Compound: 6116
PubChem Substance: 46507985
ChemSpider: 5890
RxNav: 214342
ChEBI: 3310
ChEMBL: CHEMBL1200800
PharmGKB: PA164746897
Drugs.com: Drugs.com Drug Page
Wikipedia: Calcium_acetate

FDA label

Download (25.6 KB)

MSDS

Download (72.9 KB)

Clinical Trials

Clinical Trials Learn More" title="About Clinical Trials" id="clinical-trials-info" class="drug-info-popup" href="javascript:void(0);">

Phase	Status	Purpose	Conditions	Count
4	Completed	Other	Variola Major (Smallpox)	1
4	Completed	Prevention	Vascular Diseases	1
4	Completed	Prevention	We Investigated the Relationship Between Plasma FGF23 Levels and Endothelial Dysfunction in a Sizable Series of Incident Stage 3-4 CKD Patients	1
4	Completed	Treatment	Arteriosclerosis / Calcinosis / Secondary Hyperparathyroidism (SHPT)	1
4	Completed	Treatment	Cardiovascular Events / Hemodialysis Treatment / Hyperphosphataemia	1

Pharmacoeconomics

Manufacturers

Roxane laboratories inc
Fresenius medical care north america
Cypress pharmaceutical inc

Packagers

Biotest Pharmaceuticals
Braintree Laboratories Inc.
Hawthorn Pharmaceuticals
Kaiser Foundation Hospital
Murfreesboro Pharmaceutical Nursing Supply
Physicians Total Care Inc.
Roxane Labs
Stason Pharmaceuticals Inc.
Tya Pharmaceuticals
Vangard Labs Inc.

Dosage Forms

Form	Route	Strength
Lotion	Topical	0.118 g
Powder	Topical
Lotion	Topical	0.059 g
Powder, for solution	Topical
Tablet	Oral	700 mg
Tablet, film coated	Oral	475 mg/1
Capsule	Oral	667 mg/667mg
Tablet, coated	Oral	667 mg/1
Tablet, film coated	Oral	475 MG
Tablet, film coated	Oral	950 MG
Tablet, film coated	Oral	500 mg
Tablet, film coated	Oral	700 mg
Tablet, film coated	Oral	500 mg/1
Tablet, film coated	Oral	700 mg/1
Tablet, film coated	Oral	950 mg/1
Tablet	Topical
Tablet, film coated	Oral
Lotion	Topical	0.59 g
Solution	Intravenous
Liquid	Intravenous
Injection, solution, concentrate	Intravenous
Tablet, coated	Oral
Tablet, film coated	Oral
Injection, solution	Intravenous
Tablet	Oral	250 mg
Tablet	Oral	1000 mg
Tablet	Oral	667 mg
Tablet	Oral
Capsule	Oral
Capsule	Oral	667 mg/1
Tablet	Oral	667 mg/1
Solution	Oral	667 mg/5mL
Injection	Intravenous
Injection	Intravenous	0.21 g/100ml
Solution	Parenteral
Capsule, coated	Oral	500 mg
Tablet, film coated	Oral	1000 mg
Tablet, film coated	Oral	667 mg

Prices

Unit description	Cost	Unit
PhosLo 667 mg capsule	1.05USD	capsule
Phoslo 667 mg tablet	0.41USD	tablet

DrugBank does not sell nor buy drugs. Pricing information is supplied for informational purposes only.

Patents

Patent Number	Pediatric Extension	Approved	Expires (estimated)
US6576665	No	2003-06-10	2021-04-03
US6875445	No	2005-04-05	2021-07-30
US8591938	No	2013-11-26	2030-02-23
US8592480	No	2013-11-26	2027-07-20
US9089528	No	2015-07-28	2027-07-20

Properties

State

Solid

Experimental Properties

Property	Value	Source
melting point (°C)	> 160 °C	Not Available

Predicted Properties

Property	Value	Source
Water Solubility	147.0 mg/mL	ALOGPS
logP	0.24	ALOGPS
logP	-0.22	Chemaxon
logS	-0.03	ALOGPS
pKa (Strongest Acidic)	4.54	Chemaxon
Physiological Charge	-1	Chemaxon
Hydrogen Acceptor Count	2	Chemaxon
Hydrogen Donor Count	0	Chemaxon
Polar Surface Area	40.13 Å²	Chemaxon
Rotatable Bond Count	0	Chemaxon
Refractivity	23.48 m³·mol^-1	Chemaxon
Polarizability	4.96 Å³	Chemaxon
Number of Rings	0	Chemaxon
Bioavailability	1	Chemaxon
Rule of Five	Yes	Chemaxon
Ghose Filter	No	Chemaxon
Veber's Rule	No	Chemaxon
MDDR-like Rule	No	Chemaxon

Predicted ADMET Features

Property	Value	Probability
Human Intestinal Absorption	+	0.705
Blood Brain Barrier	+	0.9601
Caco-2 permeable	-	0.5258
P-glycoprotein substrate	Non-substrate	0.8366
P-glycoprotein inhibitor I	Non-inhibitor	0.9806
P-glycoprotein inhibitor II	Non-inhibitor	0.9866
Renal organic cation transporter	Non-inhibitor	0.9609
CYP450 2C9 substrate	Non-substrate	0.8335
CYP450 2D6 substrate	Non-substrate	0.9164
CYP450 3A4 substrate	Non-substrate	0.7384
CYP450 1A2 substrate	Non-inhibitor	0.9381
CYP450 2C9 inhibitor	Non-inhibitor	0.9273
CYP450 2D6 inhibitor	Non-inhibitor	0.9462
CYP450 2C19 inhibitor	Non-inhibitor	0.9608
CYP450 3A4 inhibitor	Non-inhibitor	0.9627
CYP450 inhibitory promiscuity	Low CYP Inhibitory Promiscuity	0.985
Ames test	Non AMES toxic	0.9042
Carcinogenicity	Carcinogens	0.5617
Biodegradation	Ready biodegradable	0.9734
Rat acute toxicity	1.8756 LD50, mol/kg	Not applicable
hERG inhibition (predictor I)	Weak inhibitor	0.9812
hERG inhibition (predictor II)	Non-inhibitor	0.9888

ADMET data is predicted using admetSAR, a free tool for evaluating chemical ADMET properties. (23092397)

Spectra

Mass Spec (NIST)

Not Available

Spectra

Not Available

Chromatographic Properties

Collision Cross Sections (CCS)

Adduct	CCS Value (Å²)	Source type	Source
[M-H]-	95.225822	predicted	DarkChem Lite v0.1.0
[M-H]-	116.2651	predicted	DeepCCS 1.0 (2019)
[M+H]+	119.72916	predicted	DeepCCS 1.0 (2019)
[M+Na]+	128.3014	predicted	DeepCCS 1.0 (2019)

Targets

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Details1. Phosphate

Kind

Small molecule

Organism

Humans

Pharmacological action

Yes

Actions

Binder

References

Mai ML, Emmett M, Sheikh MS, Santa Ana CA, Schiller L, Fordtran JS: Calcium acetate, an effective phosphorus binder in patients with renal failure. Kidney Int. 1989 Oct;36(4):690-5. [Article]
Nolan CR, Qunibi WY: Calcium salts in the treatment of hyperphosphatemia in hemodialysis patients. Curr Opin Nephrol Hypertens. 2003 Jul;12(4):373-9. [Article]
Nolan CR, Qunibi WY: Treatment of hyperphosphatemia in patients with chronic kidney disease on maintenance hemodialysis. Kidney Int Suppl. 2005 Jun;(95):S13-20. [Article]
Nolan CR: Phosphate binder therapy for attainment of K/DOQI bone metabolism guidelines. Kidney Int Suppl. 2005 Jul;(96):S7-14. [Article]

Drug created at June 13, 2005 13:24 / Updated at February 20, 2024 23:55

Calcium acetate

Identification

Structure for Calcium acetate (DB00258)

Pharmacology

Interactions

Products

Categories

Chemical Identifiers

References

Clinical Trials

Pharmacoeconomics

Properties

Spectra

Collision Cross Sections (CCS)

Targets

References