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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 to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted in the feces.
### Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
### Adult Dosing
* **Initial dose:** 667 mg (13.3 mEq elemental calcium) orally with each meal.
* **Titration:** Dose should be individualized based on serum phosphate levels. Monitor serum phosphate levels regularly and adjust the dose to maintain serum phosphate below 6 mg/dL.
* **Maximum dose:** Generally not to exceed 4000 mg (80 mEq elemental calcium) per day. Some sources suggest a maximum of 3000 mg (60 mEq elemental calcium) per day.
### Pediatric Dosing
* Dosing in pediatric patients is not well established. Close monitoring of calcium and phosphate levels is crucial. Recommendations often start at 10-15 mg/kg/day of elemental calcium, divided with meals.
### Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in ESRD.
* **Hepatic Impairment:** No specific adjustments are typically needed.
* **Hypercalcemia:** If hypercalcemia occurs, the dose should be reduced or discontinued.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* In patients with metastatic calcification.
### Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Less Common:** Hypersensitivity reactions.
### 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:** Calcium acetate may decrease absorption of levothyroxine. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Bisphosphonates, Sodium Fluoride:** Calcium acetate may decrease the absorption of these agents.
### Monitoring
* Serum calcium levels (especially for hypercalcemia).
* Serum phosphate levels.
* Alkaline phosphatase.
* Urine calcium excretion (in patients not on dialysis).
### Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Titrate dose based on serum phosphate levels, aiming to keep them below 6 mg/dL.
* Monitor for signs and symptoms of hypercalcemia (e.g., nausea, vomiting, abdominal pain, increased urination, thirst, confusion, fatigue).
* Correct hypophosphatemia before initiating therapy if necessary, as calcium acetate can also bind dietary phosphate.
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**Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult current prescribing information and institutional protocols for the most up-to-date and complete drug information.
