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Calcium acetate + Magnesium carbonate tablet is used to treat hyperphosphatemia in patients with chronic renal insufficiency who are on dialysis (haemodialysis or peritoneal dialysis). The tablet is meant for adults.
Pharmacology
Calcium acetate and magnesium carbonate both bind phosphate. Together, they combine with the phosphate in food in the gut and form calcium phosphate and magnesium phosphate salts, which dissolve poorly. These salts then leave the body with the faeces.
Calcium acetate binds phosphate best at a pH of 6-8. For this reason, the tablet also works for phosphate binding in patients whose stomach has low acid (hypoacidity) or none at all (anacidity).
Dosage Reference
Reference Information Only
Dosages shown are general references from official sources. Always consult your doctor or pharmacist for personalized dosing.
Adults:
Adults take 3 to 10 film-coated tablets of Calcium acetate + Magnesium carbonate per day, depending on the serum phosphate level. Divide the daily dose according to the number of meals in the day (usually 3). The recommended starting dose is 3 tablets daily. If necessary, the dose may be raised to a maximum of 12 film-coated tablets per day.
Pediatric population: the safety and efficacy of this tablet in children and adolescents have not been established. So it is not recommended for anyone below 18 years of age.
Method of administration: to get the maximum phosphate binding effect, take the tablet together with the meal. Do not crush or chew it. Take it with some liquid so it is easy to swallow. If a tablet is too large for the patient to swallow, break it along the score line immediately before swallowing, so that the taste of acetic acid does not develop.
The rate and/or extent of absorption of other defined medicinal products may vary when they are used together with this tablet. For that reason, no oral medicine should be taken within 2 hours before or 3 hours after this tablet. It can be used long-term.
Side Effects
Gastrointestinal disorders. Common side effects are soft stools and gastrointestinal irritation, such as nausea, anorexia, a sensation of fullness, belching, constipation and diarrhoea. Metabolism and nutrition disorders. Hypercalcaemia is common, and it may cause no symptoms or it may be symptomatic. Hypermagnesaemia without symptoms is also common. Moderate to severe hypercalcaemia with symptoms is uncommon, and so is hypermagnesaemia with symptoms. Very rare effects are hyperkalaemia and magnesium-induced osteal mineralisation disturbances.
Cautions & Contraindications
Warnings & Precautions
Use this Calcium acetate + Magnesium carbonate tablet with caution, and only with continuous monitoring of serum calcium, magnesium and phosphate. This applies to severe hyperphosphataemia with a calcium-phosphate-product of more than 5.3 mmol/L if it is refractory to therapy, to refractory hyperkalaemia, to clinically relevant bradycardia, and to AV-block II° with bradycardia. Serum phosphate, serum magnesium, serum calcium and the calcium-phosphate-product should be monitored continuously, especially if the person is also taking vitamin D preparations and thiazide diuretics. High doses and long-term use of the tablet may cause hypermagnesaemia. It is mostly without symptoms, but in some cases systemic effects may be seen. Take care when antacids and digitalis glycosides are being used as well. Patients with chronic renal insufficiency who receive the tablet may develop hypercalcaemic episodes, especially when metabolites of vitamin D are given with it. Watch for the progression or appearance of vascular and soft tissue calcifications. The risk falls when the calcium-phosphate-product is lowered to below 4.5 mmol/L. A higher intake of calcium salts may cause fatty acids and bile acid to precipitate as calcium soap, and this can lead to constipation. If diarrhoea occurs, the dose of the tablet should be reduced.
Contraindications
Calcium acetate with magnesium carbonate is contraindicated in patients with hypophosphataemia. It is also contraindicated in hypercalcaemia, with or without clinical symptoms, for example as a result of an overdose of vitamin D, a paraneoplastic syndrome (bronchial carcinoma, breast cancer, renal cell carcinoma, plasmacytoma), bone metastases, sarcoidosis or immobilisation osteoporosis. Elevated serum magnesium levels of more than 2 mmol/l, and/or symptoms of hypermagnesaemia, are contraindications too. So are AV-block III° and myasthenia gravis. The same applies to patients with hypersensitivity to the active substances or to any of the excipients.
Pregnancy & Breastfeeding
Pregnancy: There's little or no data on the use of this tablet in pregnant women, and animal studies don't tell us enough about reproductive toxicity. So the tablet should not be used during pregnancy unless the woman's clinical condition requires treatment with calcium acetate and magnesium carbonate.
Lactation: This tablet passes into human milk in amounts likely to affect breastfed newborns and infants. Breastfeeding is not recommended while a woman is being treated with it.
⚠️ Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
Overdose
In an overdose of Calcium acetate + Magnesium carbonate, acute hypermagnesaemia (with or without acute systemic toxicity) suppresses both central and peripheral nerve activity by blocking the release of acetylcholine. Systemic toxicity is to be expected from a serum concentration of 2.5 mmol/l, and severe neurotoxic side effects appear from 3 mmol/l and above. At 2.5 to 5.0 mmol/l, gastrointestinal disturbances (nausea, anorexia, constipation), cystospasm, muscle weakness, lethargy, missing deep-tendon reflexes and disturbed AV-conduction and ventricular stimulus conduction have been observed. At serum magnesium levels of 5 to 10 mmol/l, arterial hypotension caused by vasodilatation, paralytic ileus, flaccid paralysis and coma have been observed. Above 10 mmol/l, respiratory arrest and cardiac arrest occur.
Hypercalcaemia starts with muscle weakness and gastrointestinal disturbances (abdominal pain, constipation, nausea and vomiting). Severe hypercalcaemia shows as disturbances of consciousness (e.g. lethargy, disorientation, stupor, and in extreme cases coma). In patients with a serum calcium level of more than 3.5 mmol/l, a hypercalcaemic crisis is possible, with these symptoms: polyuria, polydipsia, nausea, anorexia, constipation, pancreatitis (infrequent), arrhythmia, shortening of the QT-interval, adynamia, hypertension, muscle weakness up to pseudo paralysis, and psychosis and somnolence up to coma. Long-term overdosing may lead to the development of an adynamic osteopathy.
Emergency treatment: besides symptomatic treatment, hypermagnesaemia is managed by lowering the magnesium concentration of the dialysate and reducing the dose of the Calcium acetate + Magnesium carbonate tablet. When hypercalcaemia is treated with a calcium-free dialysate, serum calcium concentration must be monitored closely to minimise the risk of hypocalcaemia and adverse cardiovascular reactions.
⚠️ In an emergency call 999 or go to the nearest hospital emergency department.
Storage
Store the medicine below 30°C, away from light and moisture. Keep it out of the reach of children.
Drug Interactions
Common questions about Renocal Plus 435 mg+ 235 mg
What is Renocal Plus 435 mg+ 235 mg Tablet?
Renocal Plus 435 mg+ 235 mg Tablet is a medicine that contains Calcium acetate + Magnesium carbonate. It is made by Everest Pharmaceuticals Ltd. It belongs to the Specific mineral preparations group of medicines.
What is Renocal Plus used for?
Calcium acetate + Magnesium carbonate tablet is used to treat hyperphosphatemia in patients with chronic renal insufficiency who are on dialysis (haemodialysis or peritoneal dialysis). The tablet is meant for adults.
What are the side effects of Renocal Plus?
Gastrointestinal disorders. Common side effects are soft stools and gastrointestinal irritation, such as nausea, anorexia, a sensation of fullness, belching, constipation and diarrhoea.
Can I take Renocal Plus during pregnancy or while breastfeeding?
Pregnancy: There's little or no data on the use of this tablet in pregnant women, and animal studies don't tell us enough about reproductive toxicity. So the tablet should not be used during pregnancy unless the woman's clinical condition requires treatment with calcium acetate and magnesium carbonate. Talk to your doctor before taking any medicine during pregnancy or while breastfeeding.
What happens if I take too much Renocal Plus?
In an overdose of Calcium acetate + Magnesium carbonate, acute hypermagnesaemia (with or without acute systemic toxicity) suppresses both central and peripheral nerve activity by blocking the release of acetylcholine. Systemic toxicity is to be expected from a serum concentration of 2.5 mmol/l, and severe neurotoxic side effects appear from 3 mmol/l and above. In an emergency call 999 or go to the nearest hospital emergency department.
How should I store Renocal Plus?
Store the medicine below 30°C, away from light and moisture. Keep it out of the reach of children.
Can I take other medicines with Renocal Plus?
Some medicines can interact with Calcium acetate + Magnesium carbonate, for example: Cefuroxime, Ciprofloxacin, Nitrofurantoin, Doxycycline, Digoxin, Cefpodoxime. Tell your doctor or pharmacist about every medicine you take.
Is there a cheaper medicine with the same ingredient?
Renocal Plus is already among the lowest-priced brands of Calcium acetate + Magnesium carbonate at this strength.
Do I need a prescription for Renocal Plus?
Renocal Plus is a prescription (Rx) medicine. Take it as your doctor advises.