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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 binds to dietary phosphate in the gastrointestinal tract, forming an insoluble calcium phosphate precipitate that is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 2 tablets (668 mg elemental calcium) orally with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Doses can be increased by 1-2 tablets per meal as needed.
* **Maximum dose:** Typically not to exceed 12 tablets per day. Monitor serum calcium levels closely.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized by a clinician experienced in pediatric nephrology.
## Dose Adjustments
* **Hypercalcemia:** Reduce or discontinue dose if serum calcium levels are elevated.
* **Hypocalcemia:** May require calcium supplementation.
* **Renal Impairment:** Use with caution. Monitor calcium and phosphate levels closely.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions that may predispose to hypercalcemia, such as multiple myeloma, sarcoidosis, or primary hyperparathyroidism.
## Adverse Effects
* **Common:** Hypercalcemia (headache, nausea, vomiting, constipation, abdominal pain, dry mouth, increased urination, thirst).
* **Less common:** Hypotension, arrhythmias, dehydration, hypermagnesemia, metabolic alkalosis.
## 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.
* **Digoxin:** Hypercalcemia may potentiate digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Vitamin D and its analogues:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dosing.
* **Serum Calcium:** Monitor regularly, especially at initiation and dose increases, to prevent hypercalcemia. Target serum calcium levels are typically within the normal range.
* **Alkaline Phosphatase:** Monitor as an indicator of bone turnover.
* **Electrolytes:** Monitor sodium, potassium, and magnesium.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Close monitoring of serum calcium is crucial to avoid hypercalcemia, which can lead to serious complications.
* Patient education regarding symptoms of hypercalcemia is important.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.*
