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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD).
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 2 tablets (667 mg calcium acetate per tablet) by mouth with meals.
* **Titration:** Titrate dose based on serum phosphate levels, typically aiming for serum phosphate < 5.5 mg/dL.
* **Maximum Dose:** Generally not to exceed 12 tablets (4002 mg elemental calcium) per day. Doses higher than this have been associated with hypercalcemia.
## Pediatric Dosing
* Dosing for pediatric patients is not well-established and should be individualized based on clinical response and serum phosphate levels.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue if hypercalcemia occurs.
* **Renal Impairment:** Dose adjustments are not typically required for renal impairment beyond the established use in ESRD patients, but careful monitoring is essential.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Vascular calcification, soft tissue calcification, arrhythmias (associated with hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia associated with calcium acetate can potentiate digoxin toxicity.
* **Antacids (Magnesium or Aluminum):** Concomitant use may increase the risk of hypermagnesemia or aluminum toxicity, respectively.
## Monitoring
* **Serum Phosphate:** Regularly monitor serum phosphate levels to guide dosing.
* **Serum Calcium:** Regularly monitor serum calcium levels, especially when initiating or titrating therapy, and periodically thereafter. Aim for serum calcium levels within the normal range.
* **Renal function:** Monitor as clinically indicated.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* The goal of therapy is to lower serum phosphate levels and prevent complications of hyperphosphatemia, not to provide calcium supplementation.
* Patients should be educated on signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, fatigue, polyuria, polydipsia).
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the official prescribing information and relevant clinical guidelines for the most up-to-date and complete information before making any treatment decisions.*
