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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 insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 2 tablets (668 mg elemental calcium) orally with each meal.
* **Titration:** Dose should be adjusted based on serum phosphate levels. Target serum phosphate is typically less than 5.5 mg/dL.
* **Maximum dose:** Generally, no more than 12 tablets (4008 mg elemental calcium) per day. However, higher doses may be used under close medical supervision. Doses should be individualized to achieve phosphate control while minimizing hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well established. It is generally recommended to use with caution and individualized dosing based on serum phosphate levels and calcium concentrations.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, the dose of calcium acetate should be reduced or discontinued. Monitor calcium levels closely.
* **Renal Impairment:** Dose adjustments are often guided by serum phosphate and calcium levels. Patients with CKD require careful monitoring.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Ventricular fibrillation.
## Adverse Effects
* **Common:** Hypercalcemia (signs include constipation, nausea, vomiting, abdominal pain, dry mouth, polyuria, polydipsia, weakness, fatigue, confusion, headache, anorexia), hypophosphatemia.
* **Less Common:** Gastrointestinal upset, acid rebound.
## 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.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity. Monitor closely if used concurrently.
* **Thiazide Diuretics:** Can increase the absorption of calcium. Concomitant use may lead to hypercalcemia.
* **Vitamin D analogues:** Increased risk of hypercalcemia.
## Monitoring
* Serum phosphate levels (target < 5.5 mg/dL).
* Serum calcium levels (caution with levels > 10.5 mg/dL).
* Serum magnesium and potassium levels may be monitored.
* Alkaline phosphatase.
## Clinical Pearls
* Calcium acetate should be taken with meals to maximize phosphate binding.
* Pill burden can be high; consider alternative phosphate binders if adherence is an issue.
* Monitor for signs and symptoms of hypercalcemia, especially in patients with underlying conditions that predispose them to it.
* Ensure adequate hydration to help prevent constipation.
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and institutional protocols before making any clinical decisions.*
