Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, typically associated with chronic kidney disease (CKD). It works by binding to dietary phosphate in the gastrointestinal tract, forming an insoluble calcium phosphate precipitate that is then excreted in the feces.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 1 to 2 tablets (667 mg to 1334 mg calcium acetate) orally with each meal.
* **Titration:** Dosage should be titrated based on serum phosphorus levels. The goal is to maintain serum phosphorus below 6 mg/dL.
* **Maximum dose:** Generally, no more than 12 tablets (8004 mg calcium acetate) per day. However, individual patient response and tolerance should guide the maximum dose. Doses higher than 12 tablets per day are not typically recommended due to the risk of hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under the guidance of a pediatric nephrologist. A common starting point is 1-2 tablets (667 mg - 1334 mg) per meal, adjusted based on phosphorus levels.
## Dose Adjustments
* **Renal Impairment:** This medication is primarily used in patients with renal impairment. However, caution is advised, and close monitoring of calcium and phosphorus levels is crucial.
* **Hypercalcemia:** If hypercalcemia occurs, the dose of calcium acetate should be reduced or discontinued.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Potential contraindications include patients with active kidney stones (nephrolithiasis) or a history of them, and patients with certain metabolic bone diseases.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, dry mouth.
* **Serious:** Severe hypercalcemia (symptoms include confusion, lethargy, arrhythmias, constipation, polyuria, polydipsia, bone pain, kidney stones), 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 (levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Concurrent use may decrease the absorption of biphosphonates. Separate administration by at least 2 hours.
* **Cardiac glycosides (digoxin):** Hypercalcemia associated with calcium acetate can potentiate the effects of digoxin, increasing the risk of arrhythmias.
## Monitoring
* **Serum calcium levels:** Regularly monitor for hypercalcemia, especially when initiating therapy or increasing the dose.
* **Serum phosphorus levels:** Monitor to assess efficacy and guide dose titration.
* **Albumin levels:** Used in conjunction with calcium levels to calculate corrected calcium.
* **Renal function:** Monitor periodically.
## Clinical Pearls
* Calcium acetate is most effective when taken with meals to bind dietary phosphate.
* Monitor corrected calcium levels closely, as hypercalcemia is a significant risk.
* Educate patients about signs and symptoms of hypercalcemia.
* For patients on hemodialysis, calcium acetate can be an effective choice, but calcium levels should be managed carefully to avoid extraskeletal calcification.
***
*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.*
