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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD). It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 1-2 tablets (667 mg - 1334 mg elemental calcium) with each meal.
* **Titration:** Dose should be titrated based on serum phosphate levels. Target serum phosphate is generally below 5.5 mg/dL.
* **Maximum Dose:** Individualize based on patient response and tolerance. Some sources suggest a maximum of 12 tablets per day, but this can vary.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized based on serum phosphate levels and clinical response. Consult specialized pediatric nephrology resources.
## Dose Adjustments
* **Renal Impairment:** Dose reduction is typically guided by serum phosphate and calcium levels. In patients with CKD, careful monitoring is essential.
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Patients with urolithiasis (kidney stones) or a history thereof.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, dry mouth, hypermagnesemia (if magnesium-containing antacids are also used).
* **Serious:** Severe hypercalcemia can lead to cardiac arrhythmias, confusion, stupor, coma, and acute kidney injury.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Calcium may reduce the absorption of bisphosphonates. Administer at least 30 minutes before calcium.
* **Digoxin:** Hypercalcemia associated with calcium acetate can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor regularly to detect and prevent hypercalcemia. Target serum calcium is generally below 10.5 mg/dL.
* **Alkaline Phosphatase:** Monitor periodically.
* **Renal Function:** Monitor as clinically indicated.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Ensure adequate fluid intake to minimize constipation.
* Educate patients on signs and symptoms of hypercalcemia.
* Consider the elemental calcium content when dosing and monitoring. Each 667 mg tablet of calcium acetate contains approximately 169 mg of elemental calcium.
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*Disclaimer: This information is intended for clinical use and does not replace professional judgment. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
