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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, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
Dosing is highly individualized and titrated to achieve target serum phosphate levels.
* **Starting Dose:** Typically 2 tablets (667 mg elemental calcium per tablet, 1334 mg total elemental calcium) orally with meals.
* **Titration:** Increase by 1-2 tablets per meal as needed, up to a maximum of 12 tablets per day, divided among meals.
* **Target:** Serum phosphate < 5.5 mg/dL.
## Pediatric Dosing
* **Children:** Limited data available. Dosing should be individualized based on serum phosphate levels and clinical response. A common starting point may be 1-2 tablets per meal, but caution and close monitoring are essential.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically needed as it is used in patients with CKD. However, monitor calcium and phosphate levels closely.
* **Hepatic Impairment:** No specific adjustments are generally recommended.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions causing calcium accumulation (e.g., sarcoidosis, certain malignancies).
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Calciphylaxis (rare but severe), cardiovascular events associated with hypercalcemia.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium may reduce the absorption of bisphosphonates. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia can potentiate digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Calcium:** Monitor frequently, especially during initiation and dose adjustments, to prevent hypercalcemia. Target serum calcium levels are generally between 8.0-9.5 mg/dL.
* **Serum Phosphate:** Monitor regularly to assess efficacy.
* **Serum Bicarbonate:** Monitor for potential metabolic alkalosis.
* **Signs and Symptoms of Hypercalcemia:** Confusion, fatigue, nausea, constipation, polyuria, polydipsia.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Calcium acetate contains elemental calcium; dose calculations should consider the amount of elemental calcium per tablet (667 mg elemental calcium per tablet).
* Patients with underlying cardiovascular disease or those taking digoxin require particularly close monitoring for hypercalcemia.
* If hypercalcemia occurs, reduce the dose or discontinue the medication and consider alternatives.
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*This information is intended for educational purposes only and does not constitute medical advice. Always verify current prescribing information with the official product labeling or a trusted drug reference before making clinical decisions.*
