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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 dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* Dosing is individualized based on serum phosphate levels.
* Start with 667 mg (equivalent to 169 mg elemental calcium) orally with meals.
* Titrate dose as needed to lower serum phosphate to target levels (typically < 5.5 mg/dL).
* Maximum dose: Generally not to exceed 4000 mg per day (equivalent to 1000 mg elemental calcium).
## Pediatric Dosing
* Dosing in pediatric patients (under 18 years) is not well-established and should be based on clinical judgment and institutional protocols. Refer to specialized pediatric guidelines if available.
## Dose Adjustments
* **Renal Impairment:** Primarily used in ESRD patients. Use with caution in other stages of CKD due to risk of hypercalcemia.
* **Hepatic Impairment:** No specific dose adjustment needed.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Ventricular fibrillation.
## Adverse Effects
* **Common:** Hypercalcemia (signs include constipation, nausea, vomiting, abdominal pain, dry mouth, thirst, increased urination, muscle weakness, bone pain, lethargy, headache, confusion, arrhythmias).
* **Less Common:** Hypersensitivity reactions.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease absorption. Separate administration by at least 2 hours.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease absorption. Separate administration by at least 4 hours.
* **Certain Antacids:** May increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** Can increase serum calcium levels.
## Monitoring
* Serum calcium and phosphate levels regularly, especially during dose initiation or adjustment.
* Monitor for signs and symptoms of hypercalcemia.
* Magnesium and alkaline phosphatase levels may also be monitored.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Doses should be individualized and titrated carefully to avoid hypercalcemia.
* Patients should be educated on dietary phosphate restriction in conjunction with this medication.
* The elemental calcium content is approximately 25.3% of the total calcium acetate weight. Each 667 mg tablet contains approximately 169 mg of elemental calcium.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the official prescribing information and institutional protocols for the most up-to-date and comprehensive guidance. Verify current prescribing information before making clinical decisions.*
