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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, particularly those with chronic kidney disease (CKD) on dialysis. It works by binding to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate which is then eliminated in the feces.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 2 tablets (668 mg elemental calcium) orally with meals.
* **Titration:** Dose should be titrated based on serum phosphorus levels. Typical doses range from 2 to 4 tablets with each meal.
* **Maximum Dose:** Clinical trials have used up to 16 tablets (5344 mg elemental calcium) per day. Monitor calcium levels closely.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized based on serum phosphorus levels and clinical response. Close monitoring of calcium levels is crucial.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is primarily used in patients with ESRD.
* **Hepatic Impairment:** No specific adjustment recommended.
* **Hypercalcemia:** Discontinue or reduce dose if hypercalcemia occurs.
## Contraindications
* Hypercalcemia.
* Known hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea.
* **Serious:** Vascular calcification, cardiac valvular calcification, arrhythmias (associated with severe hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** 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 can impair the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may decrease the absorption of bisphosphonates. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia associated with calcium acetate can increase the risk of digoxin toxicity.
## Monitoring
* **Serum Phosphorus:** Monitor regularly to assess efficacy and guide dose titration. Target levels are generally < 5.5 mg/dL.
* **Serum Calcium:** Monitor frequently, especially with higher doses, to detect and manage hypercalcemia. Target levels are generally 8.5-10 mg/dL (or as per local protocol).
* **Alkaline Phosphatase:** Monitor periodically.
* **Intact Parathyroid Hormone (iPTH):** Monitor periodically.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Each tablet of calcium acetate contains approximately 169 mg of elemental calcium.
* Be vigilant for signs and symptoms of hypercalcemia, including nausea, vomiting, constipation, polyuria, polydipsia, weakness, and confusion.
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*This information is intended for healthcare professionals. Please consult the official prescribing information for the most current and complete details. It is essential to verify the accuracy and applicability of this information with current local protocols and individual patient circumstances.*
