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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
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Dosage:** Doses are individualized based on serum phosphate levels. A common starting dose is 667 mg (approximately 169 mg elemental calcium) orally three times daily with meals.
* **Titration:** Doses can be increased gradually based on serum phosphate levels.
* **Maximum Dose:** The maximum recommended daily dose is typically 4000 mg (approximately 1000 mg elemental calcium) orally divided into doses with meals.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be based on clinical judgment and local protocol. Some sources suggest starting doses of 10-20 mg/kg/day of elemental calcium divided into doses with meals, but this is highly variable.
## Dose Adjustments
* **Renal Impairment:** While used in CKD, careful monitoring of serum calcium and phosphate is essential. Patients not on dialysis may require closer monitoring due to risk of accumulation.
## Contraindications
* Hypercalcemia.
* Conditions that predispose to hypercalcemia, such as multiple myeloma, sarcoidosis, or metastatic bone lesions.
* Ventricular fibrillation.
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern), constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Less Common:** Hypophosphatemia, headache, dizziness, dry mouth.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 4-6 hours after these agents.
* **Thyroid Hormones (e.g., Levothyroxine):** Calcium can reduce the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may reduce bisphosphonate absorption. Separate administration by at least 2 hours.
* **Calcium Channel Blockers:** May potentiate hypercalcemic effects.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Calcium:** Regularly monitor serum calcium levels, especially at initiation and with dose changes, to prevent and manage hypercalcemia. Target corrected calcium is typically within the normal range or slightly elevated per guidelines (e.g., <11 mg/dL or <2.75 mmol/L).
* **Serum Phosphate:** Monitor to assess efficacy.
* **Serum Magnesium and Alkaline Phosphatase:** May be monitored periodically.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* The elemental calcium content is approximately 25% of the total weight of calcium acetate.
* Hypercalcemia is the most common and serious adverse effect. Educate patients on signs and symptoms (e.g., nausea, vomiting, constipation, confusion, bone pain).
* If hypercalcemia occurs, discontinue calcium acetate and consider reducing calcium and vitamin D intake.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and clinical guidelines before making therapeutic decisions. Local protocols may influence dosing and management.*
