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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD). It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* **Hyperphosphatemia** in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* The typical starting dose is 2 tablets (approximately 1332 mg of elemental calcium) with meals.
* Dosing should be individualized based on serum phosphate levels.
* Maximum recommended dose is 16 tablets per day.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under specialist guidance.
## Dose Adjustments
* Dose adjustments are based on serum phosphate levels and calcium levels.
* If serum phosphate is < 6 mg/dL, reduce the dose.
* If serum phosphate is > 6 mg/dL, increase the dose.
* Monitor calcium levels closely; if hypercalcemia occurs, the dose should be reduced or discontinued.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* History of kidney stones (calcium-containing).
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern), constipation, nausea, vomiting, abdominal pain, dry mouth.
* **Serious:** Calciphylaxis (rare but serious), cardiac arrhythmias (due to hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Thyroid hormones (levothyroxine):** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium acetate can 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.
* **Thiazide diuretics:** May increase the risk of hypercalcemia.
* **Vitamin D and its analogs:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum phosphate levels:** Monitor regularly, typically before starting therapy and periodically thereafter, to guide dosing.
* **Serum calcium levels:** Monitor regularly, especially when initiating or adjusting therapy, and periodically thereafter.
* **Alkaline phosphatase:** May be monitored in patients with CKD.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* It is crucial to monitor both serum phosphate and calcium levels. Treatment goals are to lower phosphate to < 6 mg/dL while avoiding hypercalcemia.
* Hypercalcemia is a significant risk and can manifest as confusion, lethargy, nausea, vomiting, constipation, polyuria, polydipsia, and cardiac arrhythmias.
* Patients should be advised to report any symptoms of hypercalcemia immediately.
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for definitive patient care decisions. Dosing may vary based on individual patient factors and local protocols.*
