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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, often associated with chronic kidney disease. It works by binding to dietary phosphorus in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in patients with chronic kidney disease.
## Adult Dosing
* **Dosage is highly individualized and titrated based on serum phosphorus levels and dietary phosphorus intake.**
* **Typical starting dose:** 667 mg (13.3 mEq elemental calcium) orally with each meal.
* **Titration:** Dose may be increased in increments of 667 mg per meal.
* **Maximum dose:** Generally not to exceed 4000 mg (80 mEq elemental calcium) per day, divided among meals.
* **Note:** Dosing is often expressed in terms of elemental calcium (mEq or mg). Each 667 mg tablet of calcium acetate contains approximately 13.3 mEq or 169 mg of elemental calcium.
## Pediatric Dosing
* The safety and efficacy in pediatric patients are not well-established. Dosing, if used, should be determined by a specialist and based on serum phosphorus levels.
## Dose Adjustments
* **Renal Impairment:** While used in chronic kidney disease, caution is advised. Monitor calcium and phosphorus levels closely. Dose adjustments are based on laboratory parameters.
* **Hepatic Impairment:** No specific dose adjustments are generally required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions leading to hypercalcemia (e.g., sarcoidosis, certain malignancies).
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern), constipation, nausea, vomiting, anorexia, abdominal pain, dry mouth.
* **Serious:** Severe hypercalcemia, vascular calcification, renal osteodystrophy (with prolonged excessive calcium intake).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours before or 6 hours after.
* **Thyroid Hormones:** Calcium can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** Thiazides can increase serum calcium levels, potentially leading to hypercalcemia when used with calcium acetate.
* **Vitamin D Analogs:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Calcium:** Monitor frequently, especially during initiation and dose titration. Target corrected calcium levels are generally within the normal range.
* **Serum Phosphorus:** Monitor regularly to assess efficacy.
* **Alkaline Phosphatase:** Monitor periodically.
* **Renal Function (BUN, Creatinine):** Monitor periodically.
* **Parathyroid Hormone (PTH):** May be monitored depending on the clinical context.
## Clinical Pearls
* Administer with meals to effectively bind dietary phosphorus.
* Crushing or chewing tablets may be necessary for some patients; check product specifics and local guidelines.
* Recognize that hypercalcemia is the most common and serious adverse effect. Dose adjustments are crucial.
* Patient education on signs and symptoms of hypercalcemia is essential.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Verify drug information with official sources and institutional protocols.*
