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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 to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate which is then excreted in the feces.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* **Initial Dose:** Typically 2 tablets (667 mg elemental calcium and 334 mg acetate per tablet) taken with each meal.
* **Titration:** Dose should be titrated based on serum phosphate levels. Doses can range from 2 to 4 tablets with each meal.
* **Maximum Dose:** Not explicitly defined, but titration should aim for target phosphate levels while avoiding hypercalcemia. Monitor calcium-phosphorus product (Ca x P) and aim to keep it below 55 mg²/dL².
## Pediatric Dosing
* There is no established pediatric dosing for calcium acetate. Use is generally not recommended in pediatric patients.
## Dose Adjustments
* **Renal Impairment:** Not applicable, as this drug is used in patients with ESRD.
* **Hepatic Impairment:** No dose adjustment necessary.
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or temporarily discontinue the medication.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions leading to hypercalcemia such as metastatic bone disease or primary hyperparathyroidism.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting.
* **Serious:** Severe hypercalcemia (symptoms include lethargy, confusion, coma, decreased reflexes, hypotension, cardiac arrhythmias, constipation, nausea, vomiting, polyuria, polydipsia, anorexia, abdominal pain), hyperphosphatemia (paradoxical), 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 (e.g., Levothyroxine):** Calcium acetate can reduce the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia associated with calcium acetate may increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Antacids:** Concurrent use may increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Regularly monitor to guide dosing and assess efficacy. Target levels are typically < 5.5 mg/dL.
* **Serum Calcium:** Monitor regularly, especially during initial titration and dose changes, to detect and manage hypercalcemia.
* **Calcium-Phosphorus Product (Ca x P):** Monitor regularly. Aim to keep below 55 mg²/dL².
* **Alkaline Phosphatase:** May be monitored in patients with bone disease.
* **Signs and Symptoms of Hypercalcemia:** Educate patients and monitor for these.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphate.
* Pill burden can be significant; consider patient adherence.
* Crushing or chewing tablets may be preferred by some patients for easier administration, but confirm product specifics.
* Adequate fluid intake is important to prevent constipation.
* Education on dietary phosphate restriction is also crucial for managing hyperphosphatemia.
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**Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always verify the most current prescribing information with the official drug product labeling or a reliable drug information resource before making clinical decisions.
