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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 works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease on dialysis.
## Adult Dosing
Dosing is individualized based on serum phosphate levels and dietary phosphate intake.
* **Starting Dose:** 2 tablets (approximately 1333 mg elemental calcium) orally with meals.
* **Titration:** Dosage should be adjusted to lower serum phosphate to target levels (e.g., < 5.5 mg/dL). Doses can range from 2 to 16 tablets per day, divided with meals.
* **Maximum Dose:** Typically limited by calcium intake and risk of hypercalcemia. A common maximum daily dose is 16 tablets (approximately 10,664 mg elemental calcium), but this can vary.
## Pediatric Dosing
Dosing in pediatric patients should be based on individual clinical response and serum phosphate levels, and is less well-established than in adults. Consultation with a pediatric nephrologist is recommended.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in CKD patients. Dosing is titrated to serum phosphate and calcium levels.
* **Hepatic Impairment:** No specific adjustments are typically needed.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions that may lead to hypercalcemia (e.g., hyperparathyroidism, metastatic bone disease, certain vitamin D therapies).
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, anorexia, abdominal pain, polyuria, polydipsia, confusion, lethargy), hypophosphatemia, hypermagnesemia (if magnesium-containing antacids are used concurrently), metallic taste.
* **Serious:** Calciphylaxis, vascular calcification.
## 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; administer at least 4 hours apart.
* **Biphosphonates:** Calcium may interfere with the absorption of biphosphonates; administer at least 30 minutes apart.
* **Calcium Channel Blockers:** Potential for additive hypercalcemia effects.
* **Vitamin D and its analogs:** Increased risk of hypercalcemia.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dosing and assess efficacy.
* **Serum Calcium:** Monitor regularly to prevent and manage hypercalcemia.
* **Serum Magnesium:** Monitor, especially if concurrent magnesium-containing products are used.
* **Alkaline Phosphatase:** May be monitored as an indicator of bone turnover.
## Clinical Pearls
* Administer calcium acetate with each meal to effectively bind dietary phosphate.
* Encourage patients to follow a low-phosphate diet.
* Patients should be educated on signs and symptoms of hypercalcemia.
* The amount of elemental calcium per tablet can vary by product. Always check the product labeling for the exact elemental calcium content.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to verify this information before making clinical decisions.*
