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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD) requiring dialysis.
## Adult Dosing
* **Initial dose:** Typically 667 mg to 1000 mg (equivalent to 133 mg to 200 mg elemental calcium per tablet, depending on formulation) administered orally with each meal.
* **Titration:** Dosing should be individualized based on serum phosphate levels. The goal is to achieve and maintain serum phosphate levels below 6 mg/dL.
* **Maximum dose:** There is no absolute maximum dose, but doses should be carefully titrated to avoid hypercalcemia. Typical total daily doses range from 2000 mg to 4000 mg divided with meals.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be individualized under the guidance of a pediatric nephrologist.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium levels are elevated.
* **Hypocalcemia:** May require calcium supplementation or dose adjustment.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Patients with a history of nephrolithiasis (calcium oxalate stones).
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Metastatic calcification, cardiac arrhythmias (associated with severe hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics by forming insoluble complexes. Separate administration by at least 2 hours.
* **Bisphosphonates:** Concomitant use may reduce the absorption of bisphosphonates. Separate administration by at least 2 hours.
* **Thyroid Hormones:** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Certain Antacids:** Avoid concurrent use with other calcium-containing antacids to prevent excessive calcium intake.
* **Vitamin D Analogs:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., before dialysis, weekly, or as clinically indicated) to assess efficacy and guide dose adjustments.
* **Serum Calcium:** Monitor regularly, especially at the initiation of therapy and with dose changes, to detect and manage hypercalcemia. Target serum calcium levels are generally in the normal to slightly elevated range (e.g., 8.5-10.5 mg/dL).
* **Alkaline Phosphatase:** Monitor periodically.
* **Electrolytes:** Monitor other electrolytes as clinically indicated.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Educate patients on the importance of taking medication with food and potential side effects, particularly constipation and signs of hypercalcemia (e.g., confusion, nausea, increased urination).
* Consider the total elemental calcium content when calculating total daily intake, especially in patients receiving other calcium-containing medications or supplements.
* If hypercalcemia develops, treatment often involves reducing the dose of calcium acetate, decreasing calcium and vitamin D intake, and possibly withholding the medication.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive guidance. This response does not substitute for professional medical advice.*
