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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD) receiving dialysis.
## Adult Dosing
* **Initiation:** Typically initiated at 1000 mg to 2000 mg (containing 250 mg to 500 mg elemental calcium) orally with meals.
* **Titration:** Dosage should be titrated gradually based on serum phosphate levels and calcium levels. Doses are usually given with each meal, and sometimes between meals if needed.
* **Maximum Recommended Dose:** Up to 8000 mg (2000 mg elemental calcium) per day, divided with meals. Higher doses may increase the risk of hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized by a physician. Some sources suggest starting doses of 10-13 mg/kg/day of elemental calcium, divided into multiple doses with meals.
## Dose Adjustments
* **Renal Impairment:** Not applicable for patients with ESRD on dialysis, as this is the primary indication. For patients with CKD not on dialysis, close monitoring of calcium and phosphate is required, and dose adjustments may be necessary.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions leading to metastatic calcification.
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, dry mouth, increased urination, thirst, fatigue, muscle weakness, bone pain, headache, confusion, irregular heartbeat).
* **Less Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation).
* **Rare:** Metastatic calcification.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer calcium acetate at least 2 hours before or 6 hours after these antibiotics.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concurrent use may increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dosing.
* **Serum Calcium:** Monitor frequently to prevent and manage hypercalcemia. Target serum calcium levels should be individualized but generally aim to avoid levels above 10.5 mg/dL.
* **Alkaline Phosphatase:** May be monitored.
* **Electrolytes:** Monitor other electrolytes as clinically indicated.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* The amount of elemental calcium varies by product (e.g., 250 mg elemental calcium per 1000 mg of calcium acetate). Always verify the elemental calcium content for accurate dosing.
* Patients should be advised to report symptoms of hypercalcemia promptly.
* Consider the total calcium load from all sources, including dietary intake and other supplements.
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*Disclaimer: This information is intended for healthcare professionals and does not replace a thorough review of the full prescribing information and clinical judgment. Dosing and management decisions should be made based on individual patient factors and current clinical guidelines. Always verify the most current prescribing information for any medication.*
