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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, forming insoluble calcium phosphate, which is then excreted in the feces.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
The usual starting dose is 667 mg (equivalent to 169 mg of elemental calcium) per 250 mg of phosphorus ingested, given with each meal. Doses should be titrated based on serum phosphate levels.
* Typical range: 1334 mg to 2668 mg per day, divided among meals.
* Maximum recommended dose: Generally not to exceed 1334 mg per meal (7.5 mEq or 169 mg elemental calcium per meal). However, some sources suggest higher total daily doses may be used under close monitoring. Consult local protocols for specific maximums.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized under the guidance of a pediatric nephrologist.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in patients with severe renal impairment.
* **Hepatic Impairment:** No specific adjustments are typically needed.
* **Monitoring:** Serum calcium and phosphate levels should be monitored regularly. Dose adjustments are made based on these levels and patient tolerance.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions that may predispose to hypercalcemia, such as certain cancers or granulomatous diseases.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, arrhythmias (associated with severe hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer them at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Concurrent use may decrease the absorption of biphosphonates. Separate administration by at least 2 hours.
* **Calcium Channel Blockers:** Monitor for potential additive effects on hypercalcemia.
* **Digitalis Glycosides:** Hypercalcemia can increase the risk of digitalis toxicity.
## Monitoring
* Serum phosphate levels: Target < 5.5 mg/dL.
* Serum calcium levels: Monitor closely for hypercalcemia. The goal is to maintain serum calcium within the normal range, typically up to 10.5 mg/dL, but this can vary based on individual patient factors and local protocols.
* Serum intact parathyroid hormone (iPTH) levels.
* Alkaline phosphatase.
* Lactate levels (if indicated).
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphorus.
* Crush tablets and mix with a small amount of food or liquid if difficulty swallowing.
* When switching from other phosphate binders, carefully monitor and adjust calcium acetate dosage to avoid both hyperphosphatemia and hypercalcemia.
* Educate patients on the importance of taking medication with meals and reporting symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, fatigue).
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**Disclaimer:** This information is intended for healthcare professionals and should not be considered a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines, and exercise your professional judgment when making clinical decisions. Dosing and recommendations may vary based on individual patient factors, specific product labeling, and local institutional protocols.
