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Renvela vs Calcium Acetate
Introduction
For patients with chronic kidney disease (CKD) on dialysis, certain medications that bind to dietary phosphate and prevent its absorption can help in managing hyperphosphatemia, a common complication. Renvela and Calcium Acetate are two such drugs prescribed for this purpose. They each act in the gastrointestinal tract but have different chemical compositions and mechanisms of action.
Renvela (sevelamer carbonate) is a non-calcium based binder that works by adhering to phosphate from diet within the intestinal tract, preventing its absorption into the blood. It does not contain calcium or contribute to metabolic acidosis.
On the other hand, Calcium Acetate is a calcium-based phosphate binder which also binds dietary phosphates in the gut but carries additional calcium load which could potentially lead to hypercalcemia if used excessively. Therefore, monitoring serum calcium levels becomes important during therapy with Calcium Acetate.
Renvela vs Calcium Acetate Side By Side
| Attribute | Renvela | Calcium acetate |
|---|---|---|
| Brand Name | Renvela | Calcium Acetate |
| Contraindications | Should not be taken with digitalis (digoxin) due to absorption interference. Caution advised with antibiotics like tetracycline and ciprofloxacin. | Should not be taken with digitalis (digoxin) due to absorption interference. Caution advised with antibiotics like tetracycline and ciprofloxacin. |
| Cost | $6 to $24 per day for generic | $0.80 to $4.80 per day for generic |
| Generic Name | Sevelamer Carbonate | Calcium Acetate |
| Most Serious Side Effect | Severe constipation accompanied by stomach pain, unusual tiredness or weakness, fast or irregular heartbeats | High levels of calcium in the blood (hypercalcemia), symptoms include increased thirst and urination, irregular heartbeat, stomach pain with loss of appetite and constipation, feeling tired or restless |
| Severe Drug Interactions | Digitalis (digoxin), tetracycline, ciprofloxacin | Digitalis (digoxin), tetracycline, ciprofloxacin |
| Typical Dose | 800 to 1600 mg three times a day with meals | 667 mg taken orally, three times per day with meals |
What is Renvela?
Sevelamer (the generic name for Renvela) is a phosphate binder, which represents an important advancement over the earlier class of phosphate binders known as calcium-based binders, such as Calcium Acetate. Sevelamer was first approved by the FDA in 1998. It works to control phosphorus levels in people with chronic kidney disease who are on dialysis, by binding with dietary phosphate and preventing its absorption into the body. Unlike Calcium Acetate, Sevelamer does not contain calcium or contribute to hypercalcemia (high blood calcium levels), making it preferable for patients at risk of this condition. Additionally, Sevelamer has been shown to have beneficial effects on cholesterol levels—an added benefit not seen with Calcium Acetate.
What conditions is Renvela approved to treat?
Renvela and calcium acetate are used for the treatment of hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis:
- Renvela is approved for use in CKD patients on hemodialysis or peritoneal dialysis.
- Calcium Acetate is approved to treat high levels of phosphate in people with chronic renal failure.
How does Renvela help with these illnesses?
Renvela is a medication designed to manage hyperphosphatemia (high phosphate levels in the blood) particularly in patients with chronic kidney disease on dialysis. It accomplishes this by binding dietary phosphate in the digestive tract, which prevents its absorption into the body. Phosphate is an important mineral for many bodily functions such as strengthening bones and teeth, but excessive amounts can cause serious health problems like heart disease or weakened bones.
Calcium acetate also works to control high phosphate levels but it does so using a slightly different mechanism. This drug binds with phosphorus in food within the gut, forming a compound that's not easily absorbed by your body. The surplus phosphorus then gets eliminated through your stool.
The choice between Renvela and calcium acetate often depends on individual patient factors including other medical conditions they may have, potential side effects of each drug, their diet and lifestyle habits among others.
What is Calcium Acetate?
Calcium Acetate, often marketed under the brand name Phoslo, is a phosphate binder which works by binding to dietary phosphate in the gut and reducing its absorption into the bloodstream. Its main use is for treating hyperphosphatemia (high blood phosphate levels) typically in patients with kidney disease. Calcium Acetate was first approved by FDA in 1990s. Unlike Renvela, which is a non-calcium based binder, Calcium Acetate does increase serum calcium levels as it also serves as a source of dietary calcium. The increased level of calcium can be beneficial particularly for patients with low serum calcium but caution must be taken not to cause hypercalcemia (excessively high blood calcium). Side effects may differ from that of Renvela; common ones include nausea and stomach pain but it rarely causes constipation unlike Renvela. For those who do not respond well or have adverse reactions to other types of binders like sevelamer hydrochloride (Renvela), Calcium Acetate could provide an effective alternative treatment option.
What conditions is Calcium Acetate approved to treat?
Calcium Acetate is an FDA-approved medication primarily used for the treatment of:
- Hyperphosphatemia, which involves high phosphate levels in patients undergoing dialysis due to severe kidney disease.
- It can also be used as a dietary supplement when calcium intake is insufficient.
How does Calcium Acetate help with these illnesses?
Calcium Acetate, similar to Renvela, plays a critical role in managing serum phosphorus levels in patients with chronic kidney disease (CKD). High phosphate levels can cause damage to the body, particularly bones and cardiovascular health. Calcium acetate works by binding dietary phosphates in the gastrointestinal tract which then forms insoluble calcium phosphate that is excreted from the body. This results in lower phosphate concentrations within the blood. It's often prescribed as part of a comprehensive treatment plan for those dealing with CKD or undergoing dialysis. Unlike Renvela, it provides calcium - an essential nutrient for bone health – while controlling serum phosphorus levels; this dual action makes it especially beneficial for certain patient profiles.
How effective are both Renvela and Calcium Acetate?
Both sevelamer (Renvela) and calcium acetate have established histories of success in reducing serum phosphate levels, particularly in patients with chronic kidney disease. They were approved by the FDA several years apart and function via different mechanisms. Sevelamer is a non-absorbable resin that binds phosphate within the gut, while calcium acetate combines with dietary phosphate to form an insoluble complex that is then excreted.
A 2007 study directly compared the efficacy of sevelamer and calcium acetate in managing hyperphosphatemia among dialysis patients; both medications demonstrated similar capacities to reduce serum phosphate levels while maintaining acceptable safety profiles. In this study, there was no significant difference between these two agents regarding their effectiveness or side effects profile when used for controlling elevated blood phosphorus level.
In terms of metabolic effects beyond phosphate binding, sevelamer has been shown to have beneficial impacts on lipid profiles (lowering LDL cholesterol), which could potentially translate into cardiovascular benefits for CKD patients who are at high risk of cardiovascular events. Calcium-based binders like calcium acetate may also contribute to vascular calcification due to increased calcium load.
Nonetheless, despite its potential advantages over other binders such as improved lipid profile and lack of contribution towards vascular calcification, cost considerations usually relegate sevelamer use after trying first-line treatments like calcium-based binders.
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At what dose is Renvela typically prescribed?
Oral dosages of Renvela for adults start from 800 to 1600 mg three times a day with meals. However, the dosage should be adjusted based on serum phosphorus levels. For Calcium Acetate, adult patients usually take 1334 mg per meal which can also be adjusted based on serum phosphorus levels. Neither medication is recommended for children or adolescents without specific advice from a healthcare professional. In both cases, if there's no response after several weeks of treatment, your doctor may need to reassess your dosage or consider an alternative form of treatment. The maximum daily dose for Renvela is generally capped at 14 tablets (11 g) while that for Calcium Acetate shouldn't exceed about 14 capsules (4767 mg).
At what dose is Calcium Acetate typically prescribed?
Calcium Acetate therapy often begins with a dosage of 667 mg taken orally, three times per day with meals. This can then be adjusted to maintain serum phosphorus at acceptable levels, usually not exceeding the daily limit of 14 capsules (9338 mg). The dosage may be increased gradually every two to three weeks if there is no sufficient response in lowering the phosphate level. Each dose should be divided and spaced evenly throughout the day for optimal effect. Always remember to take it along with meals as this enhances its effectiveness in binding dietary phosphate.
What are the most common side effects for Renvela?
Common side effects of Renvela (sevelamer) can include:
- Nausea, vomiting
- Upset stomach or indigestion
- Abdominal cramping
- Diarrhea or constipation
- Gas and bloating
- Unusual tiredness or weakness
On the other hand, Calcium Acetate might cause:
- Nausea, vomiting
- Decreased appetite
- Dry mouth
- Increased thirst
- High levels of calcium in your blood (hypercalcemia)
These are not all possible side effects. If you experience these symptoms persistently while on either medication, consult with a healthcare professional for advice.
Are there any potential serious side effects for Renvela?
While both Renvela and Calcium Acetate are used to control high blood phosphate levels in people with kidney disease, they may have different side effects. Here's what you should watch out for:
- Signs of allergic reaction: hives, difficulty breathing or shortness of breath, swelling in your face or throat.
- Unusual tiredness or weakness
- Fast or irregular heartbeats
- Severe constipation accompanied by stomach pain
- Abdominal cramps
- Nausea and vomiting
In rare cases, calcium acetate can cause high levels of calcium in the blood. Although it is uncommon, symptoms to look out for include loss of appetite, nausea/vomiting, unusual weight loss, mental/mood changes (such as confusion), bone/muscle pain.
In case of Renvela intake; if you notice a change in the amount of urine you produce or develop severe abdominal/stomach discomfort, these could be signs that require immediate medical attention.
Always remember: If any such symptoms appear persistently during treatment with either drug - consult your healthcare provider immediately.
What are the most common side effects for Calcium Acetate?
Calcium Acetate, commonly used as a phosphate binder for kidney disease patients, can have potential side effects that include:
- Nausea and vomiting
- Loss of appetite
- Constipation or increased urination
- Muscle weakness or twitching
- Potential confusion or feeling irritable
- Headache or dizziness While less common, some may experience symptoms like dry mouth, sore throat and stomach pain. It's also possible to notice a slow heart rate rather than fast heartbeat as seen with other drugs. A rash is rare but could indicate an allergic reaction requiring immediate medical attention. Unlike many medications, Calcium Acetate does not typically cause sleep problems such as insomnia nor lead to weight loss.
Are there any potential serious side effects for Calcium Acetate?
Calcium Acetate, like any medication, may cause some side effects. While most people tolerate the drug well and experience only mild side effects such as nausea or constipation, there are a few potentially serious reactions that could occur:
- Signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
- Symptoms indicating high levels of calcium in your blood: increased thirst and urination; irregular heartbeat; stomach pain with loss of appetite and constipation; feeling tired or restless.
- Indications of possible overdose: confusion, uneven heart rate, extreme thirst.
If you encounter any of these symptoms while taking Calcium Acetate it's very important to seek immediate medical attention.
Contraindications for Renvela and Calcium Acetate?
Both Renvela and Calcium Acetate, along with most other phosphate binders, may cause gastrointestinal issues in some individuals. If you notice symptoms such as constipation or diarrhea worsen, seek immediate medical attention.
Neither Renvela nor Calcium Acetate should be taken if you are taking, or have been taking digitalis (digoxin), a heart medication because the absorption of this drug can be affected. Always inform your physician about any medications that you are currently taking; digitalis will require careful monitoring to prevent dangerous interactions with Renvela and Calcium Acetate.
Additionally, these drugs could interact with antibiotics like tetracycline and ciprofloxacin so caution is advised when they are used together. As always make sure to keep all healthcare professionals informed of what medications you take regularly.
How much do Renvela and Calcium Acetate cost?
For the brand-name versions of these drugs:
- The price of 90 tablets of Renvela (800 mg) averages around $950, which works out to approximately $10-$20/day, depending on your dose.
- The price for 90 capsules of Calcium Acetate (667 mg) is about $70, working out to roughly $0.75-$1.50 a day.
Thus, if you're in the higher dosage range for Renvela (i.e., 2400 mg/day or higher), then brand-name Calcium Acetate is significantly less expensive on a per-day treatment basis. However, cost should not be your primary consideration when determining which drug is right for you.
Regarding generic versions:
- Sevelamer carbonate (generic name for Renvela) can vary widely in cost but typically falls within the range of $2–$4 per tablet. Considering typical dosages range from 800mg three times daily up to 1600mg three times daily this could equate to anywhere between $6 and $24 per day.
- Calcium acetate’s generic version ranges from roughly $.20 –$.40 per capsule with standard doses ranging from two capsules thrice daily up to four capsules thrice daily making it somewhere between $.80 and $4.80 a day.
Again as always costs may fluctuate based upon location and availability but generics tend towards being more affordable than their branded counterparts while offering similar effectiveness in managing conditions they are prescribed for such as controlling phosphate levels in people with chronic kidney disease who are on dialysis.
Popularity of Renvela and Calcium Acetate
Sevelamer, which is known by the brand name Renvela, was estimated to have been prescribed to about 3.9 million people in the US in 2020. Sevelamer accounted for just over 30% of phosphate binder prescriptions in the US. It appears to be a commonly used non-calcium-based phosphate binder and has been increasing in prevalence since its introduction.
Calcium Acetate, on the other hand, was prescribed to around 2.5 million people in the USA during that same year. In terms of calcium-based phosphate binders, it accounts for nearly half of all such prescriptions and just under 20% of overall phosphate binder prescriptions across classes (calcium-based and non-calcium-based). The use of Calcium Acetate has remained fairly steady over recent years with small fluctuations likely due to changes within clinical guidelines or individual patient requirements.
Conclusion
Both Renvela (sevelamer) and Calcium Acetate have a long history of use in managing hyperphosphatemia, particularly in patients with chronic kidney disease. They are phosphate binders that work by binding dietary phosphorus in the digestive tract to prevent its absorption into the body. Clinical studies suggest both medications are effective at reducing serum phosphorus levels.
Renvela is primarily used when calcium-based binders like Calcium Acetate cannot be used due to the risk of hypercalcemia (too much calcium in blood). The choice between these two drugs largely depends on individual patient needs and physician's assessment including factors such as other existing conditions and potential for drug interactions.
Both Renvela and Calcium Acetate come in generic form which can result in cost savings for patients. An adjustment period may be necessary with either medication, during which dosage might need tweaking based on lab results monitoring serum phosphorous levels.
The side effect profiles differ somewhat between the two drugs - gastrointestinal issues being common with both but hypercalcemia more associated with Calcium Acetate while metabolic acidosis is more related to sevelamer. As always, it's crucial that patients monitor their symptoms closely when starting treatment, seeking medical help immediately if adverse effects occur or if they notice an unexpected change.
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Refrences
- d'Almeida Filho, E. J., Cruz, E. de A. S. da ., Hoette, M., Ruzany, F., Keen, L. N. L., & Lugon, J. R. (2000, November 9). Calcium acetate versus calcium carbonate in the control of hyperphosphatemia in hemodialysis patients. Sao Paulo Medical Journal. FapUNIFESP (SciELO).http://doi.org/10.1590/s1516-31802000000600006
- Nguyen, H. V., Bose, S., & Finkelstein, E. (2016, April 28). Incremental cost-utility of sevelamer relative to calcium carbonate for treatment of hyperphosphatemia among pre-dialysis chronic kidney disease patients. BMC Nephrology. Springer Science and Business Media LLC.http://doi.org/10.1186/s12882-016-0256-0
- Schiller, L. R., Ana, C. A. S., Sheikh, M. S., Emmett, M., & Fordtran, J. S. (1989, April 27). Effect of the Time of Administration of Calcium Acetate on Phosphorus Binding. New England Journal of Medicine. Massachusetts Medical Society.http://doi.org/10.1056/nejm198904273201703
- Perry, C. M., & Plosker, G. L. (2014, May). Sevelamer Carbonate: A Review in Hyperphosphataemia in Adults with Chronic Kidney Disease. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-014-0215-7
- Pflanz, S., Henderson, I. S., McElduff, N., & Jones, M. C. (1994). Calcium acetate versus calcium carbonate as phosphate-binding agents in chronic haemodialysis. Nephrology Dialysis Transplantation. Oxford University Press (OUP).http://doi.org/10.1093/ndt/9.8.1121