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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 binds to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 667 mg (equivalent to 13.3 mEq calcium) orally three times daily with meals.
* **Titration:** Doses should be individualized based on serum phosphate levels. Dosage may be increased up to 4000 mg (equivalent to 80 mEq calcium) per day, divided into doses with meals.
* **Maximum dose:** 4000 mg per day.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be determined by a specialist. Dosing is typically based on age and weight, with initial doses often starting lower than adult doses and titrated carefully.
## Dose Adjustments
* No specific dose adjustments are recommended for hepatic impairment.
* Dose should be adjusted based on serum phosphate levels and serum calcium levels. If serum calcium exceeds the upper limit of normal (typically 10 mg/dL or 2.5 mmol/L), the dose should be reduced.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Patients with renal calculi (kidney stones).
* History of calcification of soft tissues.
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern), nausea, vomiting, constipation, diarrhea, abdominal pain, headache, dizziness.
* **Serious:** Calcification of soft tissues (vascular and visceral), cardiac arrhythmias, renal insufficiency.
## 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 calcium acetate.
* **Thyroid hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium acetate can decrease the absorption of bisphosphonates. Administer at least 60 minutes before calcium acetate.
* **Cation-donating medications:** Concurrent use with other calcium-containing products or antacids can increase the risk of hypercalcemia.
* **Digitalis glycosides:** Hypercalcemia associated with calcium acetate can increase the risk of digitalis toxicity.
## Monitoring
* **Serum phosphate levels:** Monitor regularly to guide dosage adjustments.
* **Serum calcium levels:** Monitor closely, especially with dose increases, to prevent hypercalcemia. Target serum calcium is typically below 10 mg/dL (2.5 mmol/L).
* **Alkaline phosphatase:** Monitor as an indicator of bone turnover.
* **Renal function:** Monitor serum creatinine and BUN.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Patients should be educated on signs and symptoms of hypercalcemia (e.g., constipation, nausea, vomiting, polyuria, polydipsia, bone pain, lethargy, confusion) and instructed to report them immediately.
* The total daily elemental calcium intake from all sources (diet, supplements, medications) should be considered to avoid exceeding the recommended upper limits.
* Monitor for evidence of vascular or visceral calcification, especially in patients with prolonged use or risk factors.
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*Disclaimer: This information is intended for clinical use and does not replace professional medical advice. Always verify current prescribing information with the official drug manufacturer's labeling or a trusted drug information resource.*
