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. Each 667 mg tablet contains 169 mg (13 mEq) of elemental calcium.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 2 tablets (1334 mg) orally with each meal.
* **Titration:** Dose should be adjusted based on serum phosphorus levels. Typical doses range from 2 to 4 tablets (1334 mg to 2668 mg) with each meal.
* **Maximum Dose:** Not explicitly defined, but titration aims for serum phosphorus levels of 3.5-5.5 mg/dL. Doses exceeding 12 tablets (8004 mg) daily are uncommon.
## Pediatric Dosing
* Data is limited. Generally, the dose is individualized based on age, weight, and serum phosphorus levels. Doses of 1-2 tablets (667-1334 mg) orally with meals have been used in adolescents.
## Dose Adjustments
* No specific dose adjustments are typically needed for hepatic impairment.
* Dose should be adjusted based on serum phosphorus and calcium levels.
## Contraindications
* Hypercalcemia.
* Conditions causing increased risk of hypercalcemia, such as multiple myeloma, sarcoidosis, or primary hyperparathyroidism.
* Hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, dry mouth, increased urination, thirst), hypophosphatemia.
* **Serious:** Vascular calcification, arrhythmias, severe hypercalcemia.
## 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 (Levothyroxine):** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Concurrent use may decrease the absorption of biphosphonates. Separate administration.
* **Calcium Channel Blockers:** Hypercalcemia may potentiate the effects of calcium channel blockers.
## Monitoring
* **Serum Phosphorus:** Monitor regularly (e.g., every 2-4 weeks initially, then every 1-3 months once stable).
* **Serum Calcium:** Monitor regularly. Target serum calcium levels are generally 8.4-10.0 mg/dL. Adjust dose if serum calcium exceeds 10.0 mg/dL.
* **Alkaline Phosphatase:** Monitor periodically.
* **BUN and Creatinine:** Monitor as clinically indicated.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphorus.
* Accurate pill counts are important to avoid under- or overdosing.
* Vigilance for signs and symptoms of hypercalcemia is crucial.
* Consider alternative phosphate binders if hypercalcemia is persistent.
***
*Disclaimer: This information is intended for clinical professionals. Always consult the most current prescribing information and relevant literature for complete details before making clinical decisions.*
