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
* **Hyperphosphatemia in End-Stage Renal Disease (ESRD):** To reduce serum phosphate levels in patients undergoing dialysis.
## Adult Dosing
* **Initial Dose:** Typically 2 tablets (667 mg elemental calcium per tablet) taken orally with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. The goal is to maintain serum phosphate below 6 mg/dL.
* **Maximum Dose:** Doses can be increased gradually. The exact maximum dose is not strictly defined but should be guided by clinical response and prevention of hypercalcemia. Generally, doses up to 12 tablets per day (2 tablets with each meal) have been studied.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized by a clinician experienced in pediatric nephrology. General recommendations suggest starting with a lower dose and titrating cautiously.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, the dose of calcium acetate should be reduced or discontinued. If hypercalcemia persists, other calcium-containing phosphate binders may need to be avoided, and phosphate-binding may need to be managed with non-calcium-based binders.
* **Concomitant Medications:** Avoid concurrent administration with certain medications that can interact (see Key Drug Interactions).
## Contraindications
* Hypercalcemia
* Hypersensitivity to calcium acetate
* Conditions causing hypercalcemia (e.g., certain malignancies, primary hyperparathyroidism)
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, fatigue, muscle weakness, confusion, frequent urination).
* **Less Common:** Hypersensitivity reactions.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after these agents.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids containing calcium or magnesium:** May increase the risk of hypercalcemia and hypermagnesemia.
* **Digoxin:** Hypercalcemia can potentiate cardiac glycoside toxicity.
* **Thiazide Diuretics:** Can increase serum calcium levels, increasing the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Regularly monitor serum phosphate levels to guide dosage adjustments and assess efficacy.
* **Serum Calcium:** Monitor serum calcium levels regularly to detect and manage hypercalcemia. Aim for serum calcium within the normal range or slightly above, but avoid sustained elevations.
* **Alkaline Phosphatase:** May be monitored as an indicator of bone turnover.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphate.
* Patient education on recognizing symptoms of hypercalcemia is crucial.
* For patients on dialysis, it is important to consider the calcium load from other sources, including dialysate.
***
*This information is intended for healthcare professionals and is not a substitute for the complete prescribing information. Always verify the current prescribing information and consult with a qualified healthcare provider for any medical advice.*
