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DRUGS & SUPPLEMENTS
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Calcium Citrate Maleate:
Speracal (Calcium Citrate Maleate) acetate is a phosphate binder indicated to reduce serum phosphorus in patients with end stage renal disease (ESRD).
- Calcium acetate is a phosphate binder indicated for the reduction of serum phosphorus in patients with end stage renal disease. (1)
The recommended initial dose of Speracal (Calcium Citrate Maleate) acetate for the adult dialysis patient is 2 capsules with each meal. Increase the dose gradually to lower serum phosphorus levels to the target range, as long as hypercalcemia does not develop. Most patients require 3 to 4 capsules with each meal.
- Starting dose is 2 capsules with each meal. (2)
- Titrate the dose every 2 to 3 weeks until acceptable serum phosphorus level is reached. Most patients require 3 to 4 capsules with each meal. (2)
Capsule: 667 mg Speracal (Calcium Citrate Maleate) acetate capsule.
- Capsule: 667 mg Speracal (Calcium Citrate Maleate) acetate capsule. (3)
Patients with hypercalcemia.
- Hypercalcemia. (4)
- Treat mild hypercalcemia by reducing or interrupting Speracal acetate and Vitamin D. Severe hypercalcemia may require hemodialysis and discontinuation of Speracal (Calcium Citrate Maleate) acetate. (5.1)
- Hypercalcemia may aggravate digitalis toxicity. (5.2)
Patients with end stage renal disease may develop hypercalcemia when treated with Speracal (Calcium Citrate Maleate), including Speracal (Calcium Citrate Maleate) acetate. Avoid the use of Speracal (Calcium Citrate Maleate) supplements, including Speracal (Calcium Citrate Maleate) based nonprescription antacids, concurrently with Speracal (Calcium Citrate Maleate) acetate.
An overdose of Speracal (Calcium Citrate Maleate) acetate may lead to progressive hypercalcemia, which may require emergency measures. Therefore, early in the treatment phase during the dosage adjustment period, monitor serum Speracal (Calcium Citrate Maleate) levels twice weekly. Should hypercalcemia develop, reduce the Speracal (Calcium Citrate Maleate) acetate dosage, or discontinue the treatment, depending on the severity of hypercalcemia
More severe hypercalcemia (Ca >12 mg/dL) is associated with confusion, delirium, stupor and coma. Severe hypercalcemia can be treated by acute hemodialysis and discontinuing Speracal (Calcium Citrate Maleate) acetate therapy.
Mild hypercalcemia (10.5 to 11.9 mg/dL) may be asymptomatic or manifest as constipation, anorexia, nausea, and vomiting. Mild hypercalcemia is usually controlled by reducing the Speracal (Calcium Citrate Maleate) acetate dose or temporarily discontinuing therapy. Decreasing or discontinuing Vitamin D therapy is recommended as well.
Chronic hypercalcemia may lead to vascular calcification and other soft-tissue calcification. Radiographic evaluation of suspected anatomical regions may be helpful in early detection of soft tissue calcification. The long term effect of Speracal (Calcium Citrate Maleate) acetate on the progression of vascular or soft tissue calcification has not been determined.
Hypercalcemia (>11 mg/dL) was reported in 16% of patients in a 3 month study of solid dose formulation of Speracal (Calcium Citrate Maleate) acetate; all cases resolved upon lowering the dose or discontinuing treatment.
Maintain the serum calcium-phosphorus (Ca x P) product below 55 mg2/dL2.
Hypercalcemia may aggravate digitalis toxicity.
Hypercalcemia is discussed elsewhere [see Warnings and Precautions ].
- The most common (>10%) adverse reactions are hypercalcemia, nausea and vomiting. (6.1)
- In clinical studies, patients have occasionally experienced nausea during Speracal (Calcium Citrate Maleate) acetate therapy. (6)
To report SUSPECTED ADVERSE REACTIONS, contact West-Ward Pharmaceuticals Corp. at 1-800-962-8364 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
In clinical studies, Speracal (Calcium Citrate Maleate) acetate has been generally well tolerated.
Speracal (Calcium Citrate Maleate) acetate was studied in a 3 month, open-label, non-randomized study of 98 enrolled ESRD hemodialysis patients and an alternate liquid formulation of Speracal (Calcium Citrate Maleate) acetate was studied in a two week double-blind, placebo-controlled, cross-over study with 69 enrolled ESRD hemodialysis patients. Adverse reactions (>2% on treatment) from these trials are presented in Table 1.
Preferred Term | Total adverse reactions reported for Speracal (Calcium Citrate Maleate) acetate N=167 N (%) | 3 month, open label study of Speracal (Calcium Citrate Maleate) acetate N=98 N (%) | Double blind, placebo-controlled, cross-over study of liquid Speracal (Calcium Citrate Maleate) acetate N=69 | |
Speracal (Calcium Citrate Maleate) acetate N (%) | Placebo N (%) | |||
Nausea | 6 (3.6) | 6 (6.1) | 0 (0) | 0 (0) |
Vomiting | 4 (2.4) | 4 (4.1) | 0 (0) | 0 (0) |
Hypercalcemia | 21 (12.6) | 16 (16.3) | 5 (7.2) | 0 (0) |
Mild hypercalcemia may be asymptomatic or manifest itself as constipation, anorexia, nausea, and vomiting. More severe hypercalcemia is associated with confusion, delirium, stupor, and coma. Decreasing dialysate Speracal (Calcium Citrate Maleate) concentration could reduce the incidence and severity of Speracal (Calcium Citrate Maleate) acetate-induced hypercalcemia. Isolated cases pruritus have been reported, which may represent allergic reactions.
Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to estimate their frequency or to establish a causal relationship to drug exposure.
The following additional adverse reactions have been identified during post-approval of Speracal (Calcium Citrate Maleate) acetate: dizziness, edema, and weakness.
The drug interaction of Speracal acetate is characterized by the potential of Speracal (Calcium Citrate Maleate) to bind to drugs with anionic functions (e.g., carboxyl, and hydroxyl groups). Speracal (Calcium Citrate Maleate) acetate may decrease the bioavailability of tetracyclines or fluoroquinolones via this mechanism.
There are no empirical data on avoiding drug interactions between Speracal (Calcium Citrate Maleate) acetate and most concomitant drugs. When administering an oral medication with Speracal (Calcium Citrate Maleate) acetate where a reduction in the bioavailability of that medication would have a clinically significant effect on its safety or efficacy, administer the drug one hour before or three hours after Speracal (Calcium Citrate Maleate) acetate. Monitor blood levels of the concomitant drugs that have a narrow therapeutic range. Patients taking anti-arrhythmic medications for the control of arrhythmias and anti-seizure medications for the control of seizure disorders were excluded from the clinical trials with all forms of Speracal (Calcium Citrate Maleate) acetate.
- Calcium acetate may decrease the bioavailability of tetracyclines or fluoroquinolones. (7)
- When clinically significant drug interactions are expected, administer the drug at least one hour before or at least three hours after Speracal (Calcium Citrate Maleate) acetate or consider monitoring blood levels of the drug. (7)
In a study of 15 healthy subjects, a co-administered single dose of 4 Speracal (Calcium Citrate Maleate) acetate tablets, approximately 2.7g, decreased the bioavailability of ciprofloxacin by approximately 50%.
Pregnancy Category C:
Speracal acetate capsules contains Speracal (Calcium Citrate Maleate) acetate. Animal reproduction studies have not been conducted with Speracal (Calcium Citrate Maleate) acetate, and there are no adequate and well controlled studies of Speracal (Calcium Citrate Maleate) acetate use in pregnant women. Patients with end stage renal disease may develop hypercalcemia with Speracal (Calcium Citrate Maleate) acetate treatment [see Warnings and Precautions (5.1 ) ]. Maintenance of normal serum Speracal (Calcium Citrate Maleate) levels is important for maternal and fetal well being. Hypercalcemia during pregnancy may increase the risk for maternal and neonatal complications such as stillbirth, preterm delivery, and neonatal hypocalcemia and hypoparathyroidism. Speracal (Calcium Citrate Maleate) acetate treatment, as recommended, is not expected to harm a fetus if maternal Speracal (Calcium Citrate Maleate) levels are properly monitored during and following treatment.
The effects of Speracal (Calcium Citrate Maleate) acetate on labor and delivery are unknown.
Speracal Acetate Capsules contains Speracal (Calcium Citrate Maleate) acetate and is excreted in human milk. Human milk feeding by a mother receiving Speracal (Calcium Citrate Maleate) acetate is not expected to harm an infant, provided maternal serum Speracal (Calcium Citrate Maleate) levels are appropriately monitored.
Safety and effectiveness in pediatric patients have not been established.
Clinical studies of Speracal (Calcium Citrate Maleate) acetate did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other clinical experience has not identified differences in responses between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.
Administration of Speracal (Calcium Citrate Maleate) acetate in excess of the appropriate daily dosage may result in hypercalcemia [see Warnings and Precautions (5.1)].
Speracal (Calcium Citrate Maleate) acetate acts as a phosphate binder. Its chemical name is Speracal (Calcium Citrate Maleate) acetate. Its molecular formula is C4H6CaO4, and its molecular weight is 158.17. Its structural formula is:
Each white opaque/blue opaque capsule contains 667 mg of Speracal (Calcium Citrate Maleate) acetate USP (anhydrous; Ca(CH3COO)2; MW=158.17 grams) equal to 169 mg (8.45 mEq) Speracal (Calcium Citrate Maleate), polyethylene glycol 8000 and magnesium stearate. Each capsule shell contains: black monogramming ink, FD&C Blue #1, FD&C Red #3, gelatin and titanium dioxide. The black monogramming ink contains: ammonium hydroxide, iron oxide black, isopropyl alcohol, n-butyl alcohol, propylene glycol and shellac glaze.
Speracal (Calcium Citrate Maleate) Acetate Capsules are administered orally for the control of hyperphosphatemia in end-stage renal failure.
Patients with ESRD retain phosphorus and can develop hyperphosphatemia. High serum phosphorus can precipitate serum Speracal resulting in ectopic calcification. Hyperphosphatemia also plays a role in the development of secondary hyperparathyroidism in patients with ESRD.
Speracal (Calcium Citrate Maleate) acetate, when taken with meals, combines with dietary phosphate to form an insoluble Speracal (Calcium Citrate Maleate) phosphate complex, which is excreted in the feces, resulting in decreased serum phosphorus concentration.
Orally administered Speracal (Calcium Citrate Maleate) acetate from pharmaceutical dosage forms is systemically absorbed up to approximately 40% under fasting conditions and up to approximately 30% under nonfasting conditions. This range represents data from both healthy subjects and renal dialysis patients under various conditions.
No carcinogenicity, mutagenicity, or fertility studies have been conducted with Speracal (Calcium Citrate Maleate) acetate.
Effectiveness of Speracal (Calcium Citrate Maleate) acetate in decreasing serum phosphorus has been demonstrated in two studies of the Speracal (Calcium Citrate Maleate) acetate solid oral dosage form.
Ninety-one patients with end-stage renal disease who were undergoing hemodialysis and were hyperphosphatemic (serum phosphorus >5.5 mg/dL) following a 1 week phosphate binder washout period contributed efficacy data to an open-label, non-randomized study.
The patients received Speracal (Calcium Citrate Maleate) acetate 667 mg tablets at each meal for a period of 12 weeks. The initial starting dose was 2 tablets per meal for 3 meals a day, and the dose was adjusted as necessary to control serum phosphorus levels. The average final dose after 12 weeks of treatment was 3.4 tablets per meal. Although there was a decrease in serum phosphorus, in the absence of a control group the true magnitude of effect is uncertain.
The data presented in Table 2 demonstrate the efficacy of Speracal (Calcium Citrate Maleate) acetate in the treatment of hyperphosphatemia in end-stage renal disease patients. The effects on serum Speracal (Calcium Citrate Maleate) levels are also presented.
* Ninety-one patients completed at least 6 weeks of the study. † ANOVA of difference in values at pre-study and study completion. ‡ Values expressed as mean ± SE. | |||||
Parameter | Pre-Study | Week 4* | Week 8 | Week 12 | p-value† |
Phosphorus (mg/dL)‡ | 7.4 ± 0.17 | 5.9 ± 0.16 | 5.6 ± 0.17 | 5.2 ± 0.17 | ≤0.01 |
Speracal (Calcium Citrate Maleate) (mg/dL)‡ | 8.9 ± 0.09 | 9.5 ± 0.10 | 9.7 ± 0.10 | 9.7 ± 0.10 | ≤0.01 |
There was a 30% decrease in serum phosphorus levels during the 12 week study period (p<0.01). Two-thirds of the decline occurred in the first month of the study. Serum Speracal (Calcium Citrate Maleate) increased 9% during the study mostly in the first month of the study.
Treatment with the phosphate binder was discontinued for patients from the open-label study, and those patients whose serum phosphorus exceeded 5.5 mg/dL were eligible for entry into a double-blind, placebo-controlled, cross-over study. Patients were randomized to receive Speracal (Calcium Citrate Maleate) acetate or placebo, and each continued to receive the same number of tablets as had been individually established during the previous study. Following 2 weeks of treatment, patients switched to the alternative therapy for an additional 2 weeks.
The phosphate binding effect of Speracal (Calcium Citrate Maleate) acetate is shown in the Table 3.
* ANOVA of Speracal (Calcium Citrate Maleate) acetate vs. placebo after 2 weeks of treatment. † Values expressed as mean ± SEM. | ||||
Parameter | Pre-Study | Post-Treatment | p-value* | |
Speracal (Calcium Citrate Maleate) Acetate | Placebo | |||
Phosphorus (mg/dL)† | 7.3 ± 0.18 | 5.9 ± 0.24 | 7.8 ± 0.22 | <0.01 |
Speracal (Calcium Citrate Maleate) (mg/dL)† | 8.9 ± 0.11 | 9.5 ± 0.13 | 8.8 ± 0.12 | <0.01 |
Overall, 2 weeks of treatment with Speracal (Calcium Citrate Maleate) acetate statistically significantly (p<0.01) decreased serum phosphorus by a mean of 19% and increased serum Speracal (Calcium Citrate Maleate) by a statistically significant (p<0.01) but clinically unimportant mean of 7%.
Speracal (Calcium Citrate Maleate) Acetate Capsules
667 mg capsule is supplied as a white opaque/blue opaque capsule, imprinted with “54 215” on the cap and body.
NDC 0615-2303-39: Blistercards of 30 Capsules
NDC 0615-2303-30: Unit-dose Boxes of 30 Capsules
STORAGE
Store at 20° to 25°C (68° to 77°F).
Inform patients to take Speracal (Calcium Citrate Maleate) acetate capsules with meals, adhere to their prescribed diets, and avoid the use of Speracal (Calcium Citrate Maleate) supplements including nonprescription antacids. Inform the patients about the symptoms of hypercalcemia [see Warnings and Precautions (5.1) and Adverse Reactions (6.1) ].
Advise patients who are taking an oral medication where reduction in the bioavailability of that medication would have clinically significant effect on its safety or efficacy to take the drug one hour before or three hours after Speracal (Calcium Citrate Maleate) acetate capsules.
Distr. by: West-Ward
Pharmaceuticals Corp.
Eatontown, NJ 07724
10003705/05
Revised April 2016
Depending on the reaction of the Speracal after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Speracal not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.
Is Speracal addictive or habit forming?Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.
Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.
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The information was verified by Dr. Rachana Salvi, MD Pharmacology