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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, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
The initial dose is typically 667 mg (elemental calcium 169 mg) orally with each meal. Doses should be adjusted to control serum phosphorus levels. The target serum phosphorus level is generally less than 5.5 mg/dL. Titration is based on serum phosphorus levels.
Maximum dose: There is no strict maximum dose established, but doses are titrated to achieve therapeutic phosphorus control. Doses exceeding 4000 mg (elemental calcium 1013 mg) per day have been used.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized by a physician experienced in pediatric nephrology. The goal is to control serum phosphorus levels.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is necessary as the drug is intended for patients with renal impairment.
* **Hepatic Impairment:** No dose adjustment is necessary.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions that may predispose to hypercalcemia, such as sarcoidosis, multiple myeloma, or metastatic bone disease.
## Adverse Effects
* **Common:** Nausea, vomiting, constipation, hypercalcemia (e.g., confusion, somnolence, lethargy, cardiac arrhythmias, polyuria, polydipsia).
* **Serious:** Severe hypercalcemia, vascular calcification.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may reduce the efficacy of bisphosphonates. Separate administration by at least 2 hours.
* **Calcium Channel Blockers:** Hypercalcemia can potentiate the effects of calcium channel blockers.
## Monitoring
* **Serum Phosphorus:** Regularly monitor serum phosphorus levels to guide dosing.
* **Serum Calcium:** Regularly monitor serum calcium levels to prevent and manage hypercalcemia.
* **BUN and Creatinine:** Monitor as clinically indicated.
* **Signs and Symptoms of Hypercalcemia:** Educate patients and monitor for symptoms.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Tablets should be swallowed whole, not crushed or chewed, to ensure proper dissolution and phosphate binding in the gastrointestinal tract.
* Monitor for signs and symptoms of hypercalcemia, especially in patients taking other calcium-containing supplements or vitamin D.
* The amount of elemental calcium per dose varies by product; always confirm the elemental calcium content for accurate monitoring and dosing.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for clinical judgment. Always consult the most current prescribing information and relevant clinical guidelines for complete details and to ensure patient safety.*
