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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, typically associated with chronic kidney disease (CKD). It binds to dietary phosphate in the gastrointestinal tract, forming an insoluble calcium phosphate precipitate that is then excreted.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 667 mg (equivalent to 13.3 mEq elemental calcium and 169 mg acetate) orally with each meal.
* **Titration:** Doses can be increased incrementally up to 2000 mg (40 mEq elemental calcium) orally with each meal, divided into 3-4 doses per day, based on serum phosphorus levels.
* **Maximum Dose:** The total daily dose should not exceed 4000 mg (80 mEq elemental calcium).
## Pediatric Dosing
* Data for pediatric dosing is limited. Consult specific pediatric nephrology guidelines.
* Some sources suggest starting doses around 1-2 mEq/kg/day of elemental calcium, divided with meals, not to exceed adult doses.
## Dose Adjustments
* **Renal Impairment:** Dose should be carefully adjusted based on serum phosphorus and calcium levels. Patients with CKD are prone to hypercalcemia.
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue. If severe, interrupt treatment and administer IV fluids, consider a loop diuretic, and monitor calcium and phosphate levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Tromboembolism (rare, but associated with calcium-based binders).
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Vascular calcification, cardiac valvular calcification, hypotension, abdominal pain.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concurrent use may increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Calcium Channel Blockers:** Monitor blood pressure and heart rate.
## Monitoring
* **Serum Phosphorus:** Monitor regularly to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor regularly, especially in patients with a history of hypercalcemia or those taking other calcium-containing supplements. Target a serum calcium level within the normal range.
* **Alkaline Phosphatase:** Monitor as an indicator of bone turnover.
* **Renal Function:** Monitor electrolytes and creatinine.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Crush tablets or open capsules for patients who have difficulty swallowing, ensuring complete administration with meals.
* Be vigilant for signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, fatigue, confusion, polyuria, polydipsia).
* Consider other calcium-containing medications and supplements to avoid additive calcium load.
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*This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions. Dosing may vary based on individual patient factors and local protocols.*
