醋酸鈣
醋酸鈣是一種口服磷結合劑，主要用於治療與慢性腎病（CKD）相關的高血磷症。與碳酸鈣相比，它結合磷的效率更高（每克元素鈣可結合約兩倍的磷），且引發醫源性高血鈣的風險較低。與檸檬酸鈣不同，它不會促進腸道對鋁的吸收。
作用機制: When administered with meals, calcium acetate dissociates in the gastrointestinal tract. The calcium ions then bind to dietary phosphorus in the stomach and proximal small intestine to form **calcium phosphate**, an insoluble complex. Dietary Phosphorus + Calcium Acetate → **Insoluble Calcium Phosphate** → Excreted in feces. This mechanism effectively reduces the gastrointestinal absorption of phosphorus, thereby lowering serum phosphorus levels. It is soluble over a wide range of pH, making it highly available for binding.
各物種劑量
- Hyperphosphatemia associated with chronic renal failure · 60-90 mg/kg/day · PO · divided with meals · In conjunction with a low-phosphorus diet. Give with food or mixed with food, or just prior to each meal. Individualize dose to achieve desired serum phosphorus concentrations. Decrease dose if serum calcium exceeds normal limits.
- Hyperphosphatemia in CKD · 60-90 mg/kg/day divided · PO · divided with meals · Long-term · Dose must be titrated based on serum phosphorus levels. Must be given with food.
- Hyperphosphatemia associated with chronic renal failure · 60-90 mg/kg/day · PO · divided with meals · In conjunction with a low-phosphorus diet. Give with food or mixed with food, or just prior to each meal. Individualize dose to achieve desired serum phosphorus concentrations. Decrease dose if serum calcium exceeds normal limits.
- Hyperphosphatemia in CKD · 60-90 mg/kg/day divided · PO · divided with meals · Long-term · Dose must be titrated based on serum phosphorus levels. Must be given with food.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新藥品仿單及個別病患確認。
給藥途徑
禁忌症
- Pre-existing hypercalcemia
不良反應
- Hypercalcemia
- Gastrointestinal intolerance (nausea)
藥物相互作用
- Calcitriol · May lead to hypercalcemia; if used concomitantly, intensified monitoring for hypercalcemia is mandatory.
- Digoxin · Not recommended; hypercalcemia induced by calcium acetate may cause serious arrhythmias in patients on digoxin.
- Fluoroquinolones · Oral calcium can reduce the absorption of fluoroquinolones. Separate dosages by at least two hours. · major
- Tetracyclines · Oral calcium can reduce the absorption of tetracyclines. Separate dosages by at least two hours. · major
- Levothyroxine · Decreased absorption of levothyroxine · moderate
監測
- Serum phosphorus (after a 12-hour fast)
- Serum ionized calcium
- Monitor initially at 10-14 day intervals; once 'stable', at 4-6 week intervals
過量
Acute overdoses could potentially cause **hypercalcemia**. - **Management:** Patients should be monitored and treated symptomatically. - If the dosage was massive and recent, consider using standard protocols to empty the gut (e.g., emesis induction or gastric lavage, followed by activated charcoal, though charcoal does not bind minerals well).
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