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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with end-stage renal disease (ESRD). It works by binding to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate that is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
The initial dose is typically 2 tablets (668 mg elemental calcium) taken with each meal. The dose should be titrated based on serum phosphate levels. The goal is to maintain serum phosphate levels below 6 mg/dL.
* Maximum dose: Generally not to exceed 12 tablets (4008 mg elemental calcium) per day, but may be guided by patient response and tolerance.
## Pediatric Dosing
Dosing in children is not well established and should be individualized based on the child's age, weight, and serum phosphate levels. Consult pediatric nephrology guidelines.
## Dose Adjustments
* **Renal Impairment:** Not applicable for patients with ESRD; dose is titrated based on serum phosphate and calcium levels.
* **Hepatic Impairment:** No specific adjustments needed.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Patients with a history of calcium nephrolithiasis or calcinosis.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting.
* **Serious:** Calcification of soft tissues, cardiac arrhythmias (secondary to hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after these agents.
* **Thyroid Hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids containing magnesium or aluminum:** Increased risk of hypermagnesemia or aluminum toxicity.
* **Digoxin:** Hypercalcemia can potentiate digoxin toxicity.
## Monitoring
* **Serum Phosphate:** Monitor frequently, especially during dose titration, to achieve target levels.
* **Serum Calcium:** Monitor regularly to prevent or detect hypercalcemia. Aim for serum calcium levels within the normal range or slightly elevated as per local protocol.
* **Alkaline Phosphatase:** May be monitored as an indicator of bone turnover.
## Clinical Pearls
* Administer with meals to ensure optimal binding of dietary phosphate.
* Monitor both serum phosphate and serum calcium levels closely. The therapeutic goal is to lower phosphate without causing significant hypercalcemia.
* If hypercalcemia occurs, reduce the dose or temporarily discontinue the medication.
* Educate patients about signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, polyuria, polydipsia).
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*This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information with the official drug label or a reliable drug information resource.*
