Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD). It binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* Dosing is individualized based on serum phosphate levels and patient tolerance.
* Typically initiated at 667 mg (13.3 mEq elemental calcium) per 250 mg of phosphate to be bound, often given as 1-2 tablets (667-1334 mg) with each meal.
* Dose can be increased incrementally up to a maximum of 4000 mg (80 mEq elemental calcium) daily, divided into doses taken with meals.
* Target serum phosphate is typically < 5.5 mg/dL.
## Pediatric Dosing
* Dosing is not well-established in pediatric populations. Extrapolation from adult data or use of specialized pediatric guidelines is necessary.
* A common starting dose is 10-20 mg/kg/day of elemental calcium, divided into doses with meals, not to exceed adult maximums.
## Dose Adjustments
* No specific dose adjustments are listed for hepatic impairment.
* Dose should be adjusted based on serum phosphate and calcium levels. Avoid doses that lead to hypercalcemia.
## Contraindications
* Hypercalcemia.
* Conditions that may predispose to hypercalcemia, such as metastatic calcification or certain granulomatous diseases.
## Adverse Effects
* Hypercalcemia (most common serious side effect). Symptoms include constipation, nausea, vomiting, abdominal pain, lethargy, confusion, thirst, and polyuria.
* Constipation.
* Hypophosphatemia.
* Potential for aluminum toxicity if used concurrently with aluminum-containing antacids.
## Key Drug Interactions
* **Tetracyclines and fluoroquinolones:** Calcium acetate can decrease absorption of these antibiotics. Separate administration by at least 2 hours.
* **Thyroid hormones:** Calcium acetate may decrease absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium may reduce the absorption of bisphosphonates. Separate administration by at least 2 hours.
* **Calcium channel blockers:** Concurrent use may potentiate hypercalcemia.
## Monitoring
* Serum calcium levels: Monitor frequently, especially during initiation and dose titration. Target serum calcium is generally up to 10 mg/dL.
* Serum phosphate levels: Monitor regularly to assess efficacy.
* Serum magnesium levels.
* Alkaline phosphatase.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Monitor calcium levels closely to avoid hypercalcemia, which can lead to serious sequelae.
* Patients with CKD are at increased risk of vascular and soft tissue calcification; maintaining serum calcium within the target range is crucial.
* Ensure patients are not taking other calcium supplements or vitamin D analogs unless specifically advised by their physician.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
