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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 dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* Dosage is individualized based on serum phosphate levels and patient tolerance.
* Typically initiated at **667 mg (15 mmol elemental calcium) orally with each meal**.
* Dosage may be increased incrementally up to a maximum of **1334 mg to 2668 mg (30 to 60 mmol elemental calcium) orally with meals** as needed to control serum phosphate levels.
* The goal is to reduce serum phosphate to a target level typically below 5.5 mg/dL (1.78 mmol/L).
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under specialist guidance.
* Some sources suggest starting doses based on age and weight, but these are often extrapolated. For example, a starting dose of **10-15 mg elemental calcium/kg/day divided into 3 doses with meals** has been used, with titration based on response and tolerability.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in ESRD patients. Careful monitoring of calcium and phosphate is crucial.
* **Hepatic Impairment:** No specific adjustments are typically required, but monitoring of calcium levels is important.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Patients with a history of nephrocalcinosis or calcium-containing kidney stones.
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern), constipation, nausea, vomiting, abdominal pain.
* **Serious:** Calcification of soft tissues, cardiac valvular and vascular calcification, hypersensitivity reactions.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics; administer them at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones (e.g., Levothyroxine):** Calcium acetate can reduce the absorption of thyroid hormones; separate administration by at least 4 hours.
* **Bisphosphonates and Sodium Fluoride:** Calcium acetate can reduce the absorption of these agents; separate administration by at least 2 hours.
* **Antacids containing calcium or magnesium:** Avoid concurrent use due to risk of additive hypercalcemia or hypermagnesemia.
* **Vitamin D analogs:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Calcium:** Monitor frequently, especially during initiation and dose titration. Target corrected calcium levels typically within the normal range or slightly above.
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing.
* **Serum Magnesium and Albumin:** To accurately interpret serum calcium levels.
* **BUN and Creatinine:** To assess renal function.
## Clinical Pearls
* Administer calcium acetate **with meals** to maximize phosphate binding.
* Monitor for signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, polydipsia, confusion, cardiac arrhythmias).
* Concurrent use of calcium supplements or vitamin D should be carefully evaluated due to the increased risk of hypercalcemia.
* The elemental calcium content of calcium acetate is approximately 25%. Each 667 mg tablet contains approximately 169 mg of elemental calcium.
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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 your healthcare provider for any questions regarding a medication.
