Phosphate binders calcium-based

Hyperphosphatemia is generally benign and rarely needs aggressive therapy. Dietary restriction of phosphate and protein is effective for most minor elevations. Phosphate binders such as aluminum-based antacids, calcium carbonate, calcium acetate (PhosLo , Nabi), sevelamer (Renagel , Genzyme), and lanthanum carbonate (Fosrenol , Shire) may be necessary for some patients.43 If patients exhibit findings of hypocalcemia (tetany), IV calcium should be administered empirically. 

PTH levels observed but also a decrease in serum calcium and phosphorous levels. This represents a significant therapeutic advantage over vitamin D-based treatments for secondary hyperparathyroidism (19). Cinacalcet hydrochloride is a second-generation calcimimetic approved for the treatment of secondary hyperparathyroidism in patients with chronic kidney disease on dialysis and for the treatment of hypercalcemia in patients with parathyroid cancer. It can be used alone, with vitamin D, and/or with a phosphate binder (51). 

Although agents that contain aluminium are highly efficient as phosphate binders, they are no longer widely used because of proven neurotoxicity and osteotoxicity. They are gradually being replaced by safer calcium-based salts, or calcium-free compounds, such as sevelamer hydrochloride and lanthanum carbonate [1 ]. 

The term chronic kidney disease-mineral and bone disorder (CKD-MBD) was introduced in a position statement by the Kidney Disease Foundation. According to the guidelines, CKD-MBD is a systemic disorder and patients with vascular or valvular calcification should be included in the group with the greatest cardiovascular risk. Therefore, the presence or absence of calcification is a key factor in strategy decisions for such patients. In particular, it is recommended that the use of calcium-based phosphate binders should be restricted in patients with hypercalcaemia, vascular calcification, low levels of parathyroid hormone or adynamic bone disease. 

Hutchison and Laville 2008 Mehrotra, Martin et al. 2008). Another advantage of lanthanum carbonate over calcium-based drugs is that rather than increasing the risk of hypercalcaemia and cardiovascular calcification, lanthanum carbonate actually prevents arterial calcification (in animal experiments) (Neven, Dams et al. 2009). Nevertheless, a recent meta-analysis of published clinical trials (Navaneethan, Palmer et al. 2009) concluded that there are as yet there are insufficient data to establish the comparative superiority of non-calcium-binding agents, such as lanthanum carbonate, over calcium-containing phosphate binders for such important patient-level outcomes as all-cause mortality and cardiovascular end points. 

Besides the API, excipients such as a filler or fillers, a disintegrant (not applicable to controlled release), and a binder are also included in the powder mixture of a tablet formulation. The fillers used in tablet formulations can be classified into two categories, based on their water solubility soluble fillers such as lactose, sucrose, mannitol, etc., and insoluble fillers such as MCC, starch, calcium carbonate, calcium phosphate, etc. The binders used in the wet granulation process are water-soluble... 

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