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Phoslo
Phoslo Properties
About Phoslo
Phoslo (generic calcium acetate) is a phosphate-binding pill used to control elevated serum phosphate in adults with chronic kidney disease (CKD). By binding dietary phosphate in the gut, it reduces absorption and helps maintain mineral balance, a key component of CKD-related bone disease management. In Australia, calcium acetate is a prescription-only medication listed on the Therapeutic Goods Administration (TGA) register and is commonly prescribed for patients on dialysis or with end-stage renal failure.
What is Generic Phoslo (Calcium Acetate)?
Generic Phoslo (calcium acetate) belongs to the class of calcium-based phosphate binders. It received TGA approval in 2001 as an oral tablet (667 mg) for the treatment of hyperphosphataemia in adult patients with CKD-5 undergoing dialysis. The product is marketed as a generic equivalent to the original brand, offering the same active ingredient, dosage form, and therapeutic effect at a lower cost. Calcium acetate works by forming insoluble calcium-phosphate complexes that are excreted in the feces, thereby lowering serum phosphate levels without relying on systemic absorption.
How Phoslo Works
Phoslo releases calcium ions in the alkaline environment of the small intestine. These calcium ions rapidly bind dietary phosphate, producing calcium-phosphate salts that are poorly soluble. Because the complexes cannot be absorbed, they pass through the gastrointestinal tract and are eliminated in stool. This process reduces the net phosphate load entering the bloodstream.
Key pharmacokinetic points:
- Onset of action: Begins within minutes after ingestion as the tablet disintegrates in the stomach and releases calcium in the duodenum.
- Duration: The binding effect persists for roughly 6-8 hours, covering the typical three-times-daily dosing schedule.
- Metabolism: Calcium acetate is not systemically metabolised; the calcium component may be modestly absorbed, contributing to the patient’s total calcium intake.
- Excretion: Unbound calcium and the calcium-phosphate complexes are eliminated via the feces, with absorbed calcium excreted renally.
The direct link between phosphate binding and control of secondary hyperparathyroidism explains why Phoslo is a cornerstone of CKD-MBD (mineral and bone disorder) management.
Why Phoslo is Used for Kidney Disease Conditions
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- Hyperphosphataemia in CKD-5 (dialysis)
- By binding up to 400 mg of phosphate per 667 mg tablet, Phoslo helps achieve target serum phosphate levels (<1.78 mmol/L) recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The reduction in phosphate load also attenuates parathyroid hormone (PTH) over-production.
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- Pre-dialysis CKD stage 4-5
- Early phosphate control slows vascular calcification and improves bone turnover, aligning with proactive CKD-MBD strategies.
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- Adjunct to vitamin D analogues
- Calcium acetate provides supplemental calcium, allowing lower doses of active vitamin D while still preventing hypocalcaemia.
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- Cost-effective alternative to sevelamer
- Clinical trials demonstrate comparable phosphate-lowering efficacy, with the added benefit of a lower price point and no need for a titration based on aluminium load.
Off-Label and Investigational Uses of Phoslo
Off-label use should only be considered under the supervision of a qualified healthcare provider. Limited case series have explored calcium acetate as a calcium supplement in patients with hypocalcaemia secondary to extensive dietary restriction, but robust trial data are lacking. No formal regulatory approval exists for these indications in Australia.
Is Phoslo Right for You?
Phoslo is most appropriate for adults with CKD-5 on haemodialysis or peritoneal dialysis who exhibit persistent hyperphosphataemia despite dietary restriction. It can also be considered for patients with stage 4-5 CKD who are not yet on dialysis but have rising phosphate levels. Caution is advised in individuals with:
- Severe hypercalcaemia - excess calcium from the binder may worsen the condition.
- Active kidney stones composed of calcium phosphate - additional calcium could promote stone formation.
- Severe hepatic impairment - while metabolism is minimal, altered gastrointestinal motility may affect absorption.
Pregnant or breastfeeding patients should only use Phoslo if the potential benefit outweighs the risk, as calcium acetate crosses the placenta in small amounts.
Taking Phoslo Effectively
- Timing: Take each tablet with meals containing phosphate (breakfast, lunch, dinner) to maximise binding.
- Food interactions: The presence of fatty meals does not diminish efficacy, but very high fibre diets may reduce binding surface area; spacing the tablet 30 minutes before or after high-fiber foods can help.
- Missed dose: If a dose is missed, take it as soon as you remember provided it is still within the same meal window; otherwise skip it and resume the regular schedule-do not double-dose.
- Travel: Pack tablets in their original containers to avoid temperature extremes; calcium acetate remains stable at room temperature for up to two years.
- Adherence tip: Use a pill-organiser labelled with “Phoslo - with meals” to avoid accidental omission.
Understanding Side Effects and How to Manage Them
Common adverse events arise from the calcium component and the binder’s physical presence in the gut:
- Constipation: Calcium can reduce intestinal motility. Increase fluid intake, add bulk-forming fibre, or discuss the use of a mild osmotic laxative with your clinician.
- Nausea or abdominal discomfort: Taking the tablet with a full glass of water and ensuring it is swallowed whole reduces irritation.
- Hypercalcaemia: Routine monitoring of serum calcium every 3 months is recommended. If levels rise, dose reduction or switching to a non-calcium binder may be needed.
- Gastro-intestinal upset: Rarely, calcium-phosphate complexes can cause mild diarrhoea; dose spacing or temporary reduction often alleviates symptoms.
Serious reactions such as severe hypercalcaemia (calcium >2.75 mmol/L), hypotension, or signs of metastatic calcification require immediate medical attention.
Buying Phoslo from Our Online Pharmacy
Why Choose Our Service?
Our online pharmacy provides a secure, confidential way to obtain Phoslo when local pharmacies face stock shortages or when private prescriptions are preferred for cost reasons. We source the medication from reputable Australian wholesalers compliant with TGA standards.
Quality & Safety
We partner exclusively with licensed Australian distributors that adhere to Good Manufacturing Practice (GMP). Every batch undergoes verification against the TGA database to guarantee authenticity and potency.
Pricing & Access
Phoslo is offered at a competitive price point, typically 30 % lower than retail pharmacy rates. Bulk-order discounts and a lifetime 10 % discount on all reorders further enhance affordability. Alternative calcium-based binders (e.g., calcium carbonate) are listed for comparison.
Discreet Delivery
Orders are packed in unbranded, tamper-evident boxes. Express shipping arrives within 7 days, while standard delivery is completed in up to 3 weeks, all with full tracking.
Frequently Asked Questions
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Is Phoslo safe to use with other phosphate binders? Combining calcium acetate with another binder is sometimes practiced to achieve tighter phosphate control, but the total calcium load must be monitored closely to avoid hypercalcaemia.
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Can I take Phoslo on an empty stomach? The tablet is designed to work with dietary phosphate; taking it without food markedly reduces its binding efficiency.
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How often should my blood work be checked while on Phoslo? Serum phosphate, calcium, and PTH are typically evaluated every 3 months, or more frequently during dose adjustments.
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Does Phoslo affect the absorption of other oral medications? Calcium can chelate certain drugs (e.g., tetracyclines, fluoroquinolones). Stagger those medications by at least 2 hours before or after Phoslo.
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What should I do if I experience persistent constipation? Increase daily fluid intake, incorporate soluble fibre, and discuss a gentle laxative regimen with your renal dietitian.
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Is there a maximum daily dose of Phoslo? The usual ceiling is 3 tablets per day (≈2 g of calcium acetate), but clinicians may individualise dosing based on serum calcium trends.
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Can Phoslo be used in pediatric CKD patients? Evidence is limited; paediatric use is considered off-label and requires specialist oversight.
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Will Phoslo interfere with vitamin D supplementation? Calcium acetate can raise serum calcium, potentially reducing the need for high-dose vitamin D. Monitoring is essential to avoid excess calcium.
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Is Phoslo available in a liquid formulation? Currently only the 667 mg tablet is marketed in Australia; no oral suspension exists.
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How does Phoslo compare to sevelamer in terms of cardiovascular risk? Calcium-based binders carry a theoretical risk of vascular calcification, whereas sevelamer is non-calcium; however, large meta-analyses have not shown a definitive difference in mortality, making cost-effectiveness a key consideration.
Glossary
- Phosphate binder
- A medication that attaches to dietary phosphate in the gastrointestinal tract, forming an insoluble complex that is excreted in stool.
- Hyperphosphataemia
- Elevated levels of phosphate in the blood, commonly seen in advanced kidney disease and associated with bone and cardiovascular complications.
- KDIGO
- Kidney Disease: Improving Global Outcomes, an international organization that issues evidence-based clinical practice guidelines for kidney diseases.
- Calciphylaxis
- A rare but serious condition where calcium deposits in small blood vessels cause tissue necrosis, often linked to uncontrolled calcium-phosphate balance.
- GMP
- Good Manufacturing Practice, a set of regulations ensuring that pharmaceutical products are consistently produced and controlled according to quality standards.
Disclaimer
The information provided about Phoslo is for general knowledge only and does not replace professional medical consultation. All treatment decisions, including those regarding off-label use, should be made under the supervision of a qualified healthcare provider. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to Phoslo for individuals who may have limited availability through traditional pharmacies, prescription-based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication.
