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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, typically those with end-stage renal disease (ESRD). It works by binding dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted in the feces.
## Primary Indications
* Management of hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
* **Starting Dose:** 2 tablets (667 mg elemental calcium per 1000 mg calcium acetate) by mouth with meals.
* **Titration:** Dosage should be titrated based on serum phosphate levels. Typical doses range from 2 to 4 tablets with each meal.
* **Maximum Dose:** Typically not to exceed 12 tablets (4002 mg elemental calcium) per day.
## Pediatric Dosing
* Dosing is not well-established in pediatric patients. Use should be individualized and guided by serum phosphate levels and clinical response under the guidance of a physician experienced in pediatric nephrology.
## Dose Adjustments
* **Renal Impairment:** Not applicable, as it is primarily used in patients with ESRD.
* **Hepatic Impairment:** No specific dose adjustment.
* **Hypercalcemia:** Dose must be reduced or discontinued if serum calcium levels are elevated.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Concurrent use with other calcium-containing phosphate binders or antacids is generally avoided.
## Adverse Effects
* **Most Common:** Hypercalcemia (signs include constipation, nausea, vomiting, abdominal pain, anorexia, dry mouth, thirst, polyuria, fatigue, weakness, dizziness, headache, confusion, hallucinations, lethargy, stupor, coma, cardiac arrhythmias).
* **Gastrointestinal:** Constipation, diarrhea, nausea, vomiting.
* **Other:** Hypersensitivity reactions (rare).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of oral tetracyclines and fluoroquinolones. Separate administration by at least 2 hours.
* **Thyroid Hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Other Calcium Salts/Antacids:** Concurrent use can increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Vitamin D and its analogs:** Can increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly (frequency determined by clinical status and treatment response) to guide dosage adjustments.
* **Serum Calcium:** Monitor regularly to prevent and manage hypercalcemia.
* **Alkaline Phosphatase:** May be monitored in patients with CKD.
* **Signs and Symptoms of Hypercalcemia:** Educate patients and monitor for these symptoms.
## Clinical Pearls
* Administer **with meals** to effectively bind dietary phosphate.
* Individualize dosage based on serum phosphate and calcium levels.
* Closely monitor for signs and symptoms of hypercalcemia.
* Patients should be educated on potential drug interactions, especially with antibiotics and thyroid medications.
* Ensure adequate hydration to help prevent constipation.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols. Dosing and recommendations may vary.*
