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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 in the feces.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 2 tablets (1332 mg calcium acetate) administered orally with meals.
* **Titration:** Dose should be individualized based on serum phosphate levels. Dosage may be increased by 1-2 tablets per meal as needed.
* **Maximum Dose:** Typically 16 tablets per day (8576 mg calcium acetate). Serum phosphate should be monitored and the dose adjusted to maintain serum phosphate below 6 mg/dL.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized by a physician. Refer to specific pediatric guidelines or consult a pediatric nephrologist.
## Dose Adjustments
* **Renal Impairment:** Patients with CKD require careful monitoring of serum calcium and phosphate levels. Dose adjustments are based on these levels.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions leading to hypercalcemia (e.g., metastatic bone disease, certain granulomatous diseases).
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, diarrhea.
* **Serious:** Severe hypercalcemia (symptoms include confusion, lethargy, muscle weakness, cardiac arrhythmias, polyuria, polydipsia), soft tissue calcification.
## 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 calcium acetate.
* **Thyroid Hormones:** Calcium acetate can decrease the absorption of levothyroxine. Administer levothyroxine at least 4 hours before calcium acetate.
* **Certain Antacids:** Concurrent use of other calcium-containing antacids may increase the risk of hypercalcemia.
* **Vitamin D Analogs:** May potentiate the effects of calcium, increasing the risk of hypercalcemia.
## Monitoring
* **Serum Calcium and Phosphate:** Monitor regularly, especially during dose titration. Target serum phosphate is generally < 6 mg/dL.
* **Serum Magnesium and Alkaline Phosphatase:** Monitor periodically.
* **Signs and Symptoms of Hypercalcemia:** Assess for confusion, lethargy, nausea, vomiting, constipation, muscle weakness, polyuria, polydipsia.
## Clinical Pearls
* Calcium acetate is most effective when taken with meals to bind dietary phosphate.
* Patients should be educated about the signs and symptoms of hypercalcemia.
* Fluid intake should be adequate to prevent constipation.
* The total daily elemental calcium intake from all sources (diet, supplements, medications) should be considered to avoid exceeding recommended limits and risking hypercalcemia.
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*Disclaimer: This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines for complete details before making any treatment decisions.*
