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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, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Dosage:** Start with 2 tablets (667 mg elemental calcium per tablet) by mouth with each meal.
* **Titration:** Adjust dose gradually based on serum phosphate levels.
* **Maximum Dose:** Typically not to exceed 12 tablets (4002 mg elemental calcium) per day. Doses may vary based on individual patient response and laboratory values.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be determined by a nephrologist.
## Dose Adjustments
* **Renal Impairment:** Dose should be adjusted based on serum phosphate and calcium levels. Caution is advised to avoid hypercalcemia.
* **Hepatic Impairment:** No specific dose adjustments are typically required, but monitoring is still necessary.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions that predispose to hypercalcemia, such as severe hyperparathyroidism.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, dry mouth, abdominal pain.
* **Serious:** Ectopic calcifications, cardiovascular events (associated with hypercalcemia).
## 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 absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates and Sodium Fluoride:** Concurrent use may reduce the absorption of bisphosphonates and fluoride. Separate administration by at least 2 hours.
* **Digitalis Glycosides:** Hypercalcemia in patients taking digitalis may potentiate cardiac toxicity.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dosing.
* **Serum Calcium:** Monitor regularly to prevent hypercalcemia. Aim for serum calcium levels within the normal or low-normal range.
* **BUN and Creatinine:** Monitor renal function.
* **Electrolytes:** Monitor other electrolytes as indicated.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Monitor for signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, polydipsia, weakness, confusion).
* The target serum phosphate level is generally less than 5.5 mg/dL, but may vary based on local protocols and individual patient factors.
* Adjust dose gradually to avoid both hyperphosphatemia and hypercalcemia.
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_This information is intended for clinical pharmacy professionals and should not be considered a substitute for complete prescribing information or professional medical advice. Always consult the most current drug information resources and institutional protocols before making any clinical decisions._
