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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with chronic kidney disease (CKD) on dialysis. It binds to dietary phosphorus in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) requiring dialysis.
## Adult Dosing
* **Initial Dose:** 1-2 tablets (169-338 mg elemental calcium) with each meal.
* **Titration:** Dose should be individualized based on serum phosphorus levels. Titrate by 1-2 tablets per meal.
* **Maximum Dose:** Typically not to exceed 12 tablets (2028 mg elemental calcium) per day.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be determined by a physician with expertise in pediatric nephrology.
## Dose Adjustments
* **Renal Impairment:** Dose should be adjusted based on serum phosphorus levels and calcium levels. Monitor closely for hypercalcemia.
* **Hepatic Impairment:** No specific adjustments are typically required, but monitor calcium and phosphorus levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions associated with hypercalcemia (e.g., certain types of cancer, vitamin D intoxication).
## Adverse Effects
* **Common:** Hypercalcemia (signs include constipation, nausea, vomiting, abdominal pain, dry mouth, increased urination, thirst, weakness, headache), hypophosphatemia.
* **Less Common:** Arrhythmias, hypocalcemia (rare, especially with adequate intake).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer these drugs at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Calcium may decrease the absorption of biphosphonates. Separate administration.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Vitamin D Analogs:** Concurrent use can increase the risk of hypercalcemia.
## Monitoring
* Serum phosphorus levels (target generally < 5.5 mg/dL).
* Serum calcium levels (should generally not exceed 10.5 mg/dL).
* Alkaline phosphatase.
* Signs and symptoms of hypercalcemia and hypophosphatemia.
## Clinical Pearls
* Administer with meals to maximize phosphorus binding.
* Monitor calcium and phosphorus levels frequently, especially during dose titration.
* Patients should be educated on signs and symptoms of hypercalcemia.
* Consider the total daily elemental calcium intake from all sources.
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*Disclaimer: This information is intended for clinical pharmacy professionals and should not replace a thorough review of the most current prescribing information and relevant literature. Always verify drug information with the latest official product labeling and institutional protocols.*
