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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
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Starting Dose:** 667 mg (10 mEq elemental calcium) orally with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Doses are typically increased incrementally.
* **Maximum Dose:** Doses as high as 3335 mg (50 mEq elemental calcium) per meal have been used, but higher doses increase the risk of hypercalcemia. The total daily dose should not exceed 100 mEq of elemental calcium.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be individualized under specialist guidance.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue if hypercalcemia occurs.
* **Renal Impairment:** Use with caution in patients with impaired renal function due to the risk of calcium accumulation.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Use in patients with metastatic calcification.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, dry mouth, abdominal pain, diarrhea.
* **Serious:** Cardiovascular events (especially in the presence of hypercalcemia), milk-alkali syndrome.
## 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 calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Administer levothyroxine at least 4 hours before or 4 hours after calcium acetate.
* **Bisphosphonates:** Calcium may decrease the absorption of bisphosphonates. Separate administration by at least 30 minutes, preferably longer.
* **Digoxin:** Hypercalcemia secondary to calcium acetate can increase the risk of digoxin toxicity.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dose titration.
* **Serum Calcium:** Monitor regularly to prevent and detect hypercalcemia. Target serum calcium levels are typically within the normal range.
* **Electrolytes:** Monitor other electrolytes as clinically indicated.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Individualize dosing based on patient response and tolerance, aiming for the lowest effective dose.
* Be vigilant for signs and symptoms of hypercalcemia (e.g., polyuria, polydipsia, anorexia, nausea, vomiting, constipation, weakness, confusion).
* Consider alternative phosphate binders if hypercalcemia is persistent or difficult to manage.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and your institution's protocols before making any treatment decisions.*
