Calcium%252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252525252520acetate

# 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 and promoting its excretion. ## Primary Indications * **Hyperphosphatemia:** Management of elevated serum phosphate levels in patients with end-stage renal disease (ESRD). ## Adult Dosing * **Initial Dose:** 667 mg (approximately 13.3 mEq calcium) orally three times daily with meals. * **Titration:** Dose should be adjusted based on serum phosphate levels. Titration should occur gradually, increasing by one 667 mg tablet per meal, up to a maximum of 4 tablets per meal (total daily dose of 8000 mg or 160 mEq calcium). * **Target Serum Phosphate:** Typically aims for levels below 5.5 mg/dL. ## Pediatric Dosing * Dosing in pediatric patients is not well-established. Use with caution and consult specialized pediatric nephrology resources. ## Dose Adjustments * **Renal Impairment:** Dose should be guided by serum phosphate and calcium levels. Hypercalcemia is a risk. * **Hepatic Impairment:** No specific dose adjustments are typically recommended, but monitor calcium and phosphate levels. ## Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate. * Patients with concurrent use of intravenous calcium. ## Adverse Effects * **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, abdominal pain. * **Serious:** Severe hypercalcemia leading to cardiac arrhythmias, vascular calcification, kidney stones, and neurological symptoms. ## Key Drug Interactions * **Tetracyclines and Quinolones:** Calcium acetate can decrease absorption of these antibiotics. Administer at least 2 hours before or 6 hours after. * **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease absorption of levothyroxine. Administer at least 4 hours apart. * **Certain Antacids:** May increase the risk of hypercalcemia. * **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity. * **Vitamin D Analogs:** Concurrent use can increase the risk of hypercalcemia. ## Monitoring * **Serum Phosphate:** Monitor regularly (frequency dependent on patient's clinical status and response to therapy). * **Serum Calcium:** Monitor regularly to prevent and detect hypercalcemia. If calcium levels are consistently above 10.5 mg/dL, consider reducing the dose or temporarily discontinuing. * **Alkaline Phosphatase:** May be monitored in patients with CKD. * **Signs and Symptoms of Hypercalcemia:** Monitor for nausea, vomiting, constipation, abdominal pain, polyuria, polydipsia, muscle weakness, confusion, and cardiac arrhythmias. ## Clinical Pearls * Administer calcium acetate with meals to maximize phosphate binding. * Adequate dietary phosphate restriction is crucial. * Monitor corrected calcium levels, especially in patients with hypoalbuminemia. * Consider alternative phosphate binders if hypercalcemia or constipation is problematic. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication. Dosages and recommendations may vary.