Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted in the feces.
## Primary Indications
* **Hyperphosphatemia:** Management of elevated serum phosphate levels in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* **Initial Dose:** 667 mg (13.4 mEq elemental calcium) orally three times daily with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Typical doses range from 1334 mg to 2668 mg (26.8 to 53.6 mEq elemental calcium) per day, divided into multiple doses with meals.
* **Maximum Dose:** No specific maximum dose is established, but it is guided by serum phosphate and calcium levels.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be managed by a clinician experienced in pediatric nephrology.
## Dose Adjustments
* **Hypercalcemia:** Dose should be reduced or temporarily discontinued if serum calcium levels exceed the upper limit of normal.
* **Concurrent Medications:** Patients should be monitored for interactions with other calcium-containing products or medications that affect calcium absorption.
## Contraindications
* Hypercalcemia
* Hypersensitivity to calcium acetate or any component of the formulation
* Conditions that may predispose to hypercalcemia, such as certain malignancies or granulomatous diseases.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), nausea, vomiting, constipation, diarrhea.
* **Serious:** Severe hypercalcemia (symptoms include confusion, lethargy, bradycardia, arrhythmias, coma), vascular calcification.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate may decrease the absorption of these antibiotics by forming chelates. Administer these antibiotics at least 1 hour before or 2-3 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may reduce the absorption of bisphosphonates. Administer bisphosphonates at least 30 minutes before calcium.
* **Calcium Channel Blockers:** Use with caution, as hypercalcemia can potentiate the effects of calcium channel blockers.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Regularly monitor to guide dosing.
* **Serum Calcium:** Regularly monitor to prevent or manage hypercalcemia. Target serum calcium levels are typically within the normal range.
* **Alkaline Phosphatase:** May be monitored in patients with significant bone disease.
## Clinical Pearls
* Calcium acetate must be taken with meals to effectively bind dietary phosphate.
* It is crucial to monitor both serum calcium and phosphate levels closely. Avoid exceeding the target calcium level.
* Ensure patients are not taking other calcium supplements or antacids containing calcium to prevent additive effects and hypercalcemia.
* The amount of elemental calcium per tablet varies by manufacturer; always confirm the elemental calcium content when calculating doses.
***
**Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.
