Renocal Plus435 mg+ 235 mg

Renocal Plus is a combination phosphate-binding agent indicated for:

• Control of hyperphosphatemia (elevated blood phosphate) in patients with chronic kidney disease (CKD), particularly those on maintenance dialysis (haemodialysis or peritoneal dialysis). This is the established, guideline-supported use of Renocal Plus, based on its ability to bind dietary phosphate in the gut and reduce its absorption.

Renocal Plus is used as part of a broader chronic kidney disease/dialysis management plan and does not treat the underlying kidney disease itself; it must be used together with dietary phosphate restriction and regular monitoring by the treating nephrology team.

Each tablet of Calcium acetate + Magnesium carbonate typically contains calcium acetate and magnesium carbonate (heavy), providing elemental calcium and magnesium ions that combine with dietary phosphate in the gastrointestinal tract. Exact strengths vary by manufacturer/brand; refer to the product packaging for the specific composition.

Renocal Plus is a fixed-dose combination phosphate binder that combines two calcium- and magnesium-based salts to control elevated serum phosphorus (hyperphosphataemia) in people with chronic kidney disease, particularly those on dialysis. Combining calcium acetate with magnesium carbonate allows a lower overall calcium exposure compared with calcium-only phosphate binders, while still effectively binding dietary phosphate, which may help reduce the risk of calcium-related complications such as vascular calcification when used appropriately and monitored.

Renocal Plus belongs to the therapeutic class of phosphate-binding agents (antihyperphosphataemic agents) used in the management of chronic kidney disease-related mineral and bone disorder.

Calcium acetate + Magnesium carbonate works locally within the gastrointestinal tract. When taken with meals, the calcium and magnesium ions released from Calcium acetate + Magnesium carbonate combine with dietary phosphate to form insoluble calcium phosphate and magnesium phosphate complexes, which are not absorbed and are eliminated in the faeces. This reduces the amount of phosphate absorbed into the bloodstream, helping to lower serum phosphate levels in patients whose kidneys can no longer excrete phosphate efficiently. Calcium acetate + Magnesium carbonate has no significant systemic pharmacological action of its own beyond the small fraction of calcium and magnesium that is absorbed.

Renocal Plus must be taken by mouth with or immediately after meals (with each main meal), swallowed whole with a sufficient amount of liquid. Renocal Plus is not effective if taken apart from food, since its phosphate-binding action depends on being present in the gut at the same time as dietary phosphate. Other oral medicines should be taken at least 1–2 hours before or after Renocal Plus where interaction is a concern (see Interactions).

Renocal Plus can reduce the absorption of a number of oral medicines by binding to them in the gastrointestinal tract or by altering gut pH, which may reduce their clinical effectiveness. Clinically significant interactions include:

• Tetracycline and fluoroquinolone antibiotics – absorption may be significantly reduced; separate dosing by at least 2–3 hours.
• Oral iron, levothyroxine, and bisphosphonates – absorption may be reduced; separate dosing and monitor therapeutic response (e.g., thyroid function on levothyroxine).
• Vitamin D analogues and calcium- or magnesium-containing supplements/antacids – concurrent use increases the risk of hypercalcaemia and/or hypermagnesaemia; requires closer monitoring if co-administered with Renocal Plus.
• Digoxin – hypercalcaemia arising from Renocal Plus may increase the risk of digoxin toxicity/arrhythmia; monitor calcium and cardiac status.

As a general precaution, other oral medicines with a narrow therapeutic index or where reduced absorption would be clinically significant should be taken well apart from Renocal Plus, on the advice of a physician or pharmacist.

The most commonly reported side effects of Renocal Plus are gastrointestinal and generally mild:

• Diarrhoea (related to the magnesium component)
• Constipation (related to the calcium component)
• Nausea, vomiting, dyspepsia, flatulence, abdominal discomfort

Less commonly, Renocal Plus can cause hypercalcaemia or hypermagnesaemia, particularly with excessive dosing or concurrent use of calcium/magnesium supplements or vitamin D analogues (see Precautions and Warnings). Report persistent or severe symptoms such as muscle weakness, confusion, irregular heartbeat, or severe constipation/diarrhoea to your physician promptly.

Data on the use of Renocal Plus in pregnancy are limited. Renocal Plus should be used during pregnancy only if clearly needed and if the potential benefit justifies the potential risk to the fetus; consult a physician before use. Small amounts of calcium and magnesium may pass into breast milk; caution is advised and a physician should be consulted before using Renocal Plus while breastfeeding, weighing the benefits of treatment against any potential risk to the infant.

Renocal Plus must be taken with meals; it is not effective if taken apart from food, because its phosphate-binding mechanism relies on being present in the gut together with dietary phosphate.

Risk of hypercalcaemia and hypermagnesaemia: Regular monitoring of serum calcium, magnesium, and phosphate is required during treatment with Renocal Plus, particularly during dose titration. This risk is increased with concurrent use of calcium or magnesium supplements, or vitamin D analogues.

Renal impairment: In patients with kidney disease, magnesium excretion is reduced, which increases the risk of hypermagnesaemia with Renocal Plus specifically — a notable consideration distinguishing it from calcium-only phosphate binders. Serum magnesium should be monitored closely.

Not a treatment for kidney disease: Renocal Plus controls serum phosphate but does not treat the underlying chronic kidney disease; it must be used as part of a broader management plan under the supervision of the treating nephrology team, including dietary phosphate restriction and regular laboratory monitoring.

Gastrointestinal effects: GI side effects such as constipation, diarrhoea, and nausea are common with Renocal Plus (see Side Effects).

Drug spacing: Renocal Plus can reduce absorption of certain oral medications if taken at the same time; separate dosing from other oral medicines, especially those with a narrow therapeutic index (see Interactions).

Overdose of Renocal Plus may cause hypercalcaemia and/or hypermagnesaemia, with symptoms such as nausea, vomiting, muscle weakness, confusion, lethargy, low blood pressure, and cardiac arrhythmias. If overdose of Renocal Plus is suspected, seek immediate medical attention or contact emergency services/poison control; do not attempt specific home treatment. Management in a medical facility may include stopping the medicine, intravenous fluids, and dialysis with a low-calcium/low-magnesium dialysate if the patient is on dialysis, under close monitoring of serum electrolytes and cardiac status.

Store Renocal Plus at room temperature (below 30°C), away from light and moisture. Keep out of reach of children.

Renal impairment: Renocal Plus is specifically used in patients with chronic kidney disease, particularly those on dialysis; magnesium excretion is reduced in these patients, increasing the risk of hypermagnesaemia (see Precautions and Warnings).

Hepatic impairment: No specific dose adjustment of Renocal Plus is established for hepatic impairment; use with usual caution.

Elderly: Elderly patients may be more susceptible to hypermagnesaemia and hypercalcaemia; monitor serum electrolytes closely.

Children: Safety and efficacy of Renocal Plus in children have not been established; use in paediatric patients only under specialist supervision.

Renocal Plus is generally used long-term, for as long as the patient has hyperphosphataemia related to chronic kidney disease/dialysis, under ongoing monitoring and dose adjustment by the treating physician. Do not stop Renocal Plus without medical advice, as phosphate levels may rise again.

Calcium acetate + Magnesium carbonate belongs to the phosphate binder / antihyperphosphataemic drug class, combining a calcium salt (calcium acetate) with a magnesium salt (magnesium carbonate).

Calcium acetate + Magnesium carbonate acts locally in the gastrointestinal tract, where calcium and magnesium ions bind dietary phosphate to form insoluble, non-absorbable calcium and magnesium phosphate complexes that are excreted in the stool, thereby lowering serum phosphate levels.

The safety and efficacy of Renocal Plus in children and adolescents have not been established. Renocal Plus should only be used in paediatric patients under the direct supervision of a paediatric nephrology specialist, with close monitoring of growth, serum calcium, magnesium, and phosphate.