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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, preventing its absorption and leading to a decrease in serum phosphate levels.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Starting Dose:** 667 mg to 1333 mg (equivalent to 169 mg to 339 mg elemental calcium) orally with meals.
* **Titration:** Doses should be individualized based on serum phosphate levels, with the goal of achieving serum phosphate levels below 6 mg/dL. Doses can be increased by 667 mg (169 mg elemental calcium) per meal, as needed.
* **Maximum Dose:** Generally not to exceed 1333 mg (339 mg elemental calcium) per meal, but total daily elemental calcium intake should be monitored to avoid hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under the guidance of a pediatric nephrologist.
## Dose Adjustments
* **Renal Impairment:** Calcium acetate is primarily used in patients with ESRD. Dose adjustments are based on serum phosphate and calcium levels.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Patients with increased risk of metastatic calcification.
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern), constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Ectopic calcification, cardiac arrhythmias (secondary to hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Concomitant use may decrease the absorption of biphosphonates. Separate administration by at least 2 hours.
* **Calcium Channel Blockers:** Potential for additive hypercalcemic effects.
* **Vitamin D and its Analogs:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dose titration.
* **Serum Calcium:** Monitor regularly, especially at initiation and dose changes, to prevent hypercalcemia. Aim for serum calcium levels within the normal range.
* **Alkaline Phosphatase:** Monitor as an indicator of bone disease.
* **Renal Function:** Monitor serum creatinine and BUN.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Monitor for signs and symptoms of hypercalcemia, including nausea, vomiting, constipation, polyuria, polydipsia, weakness, and confusion.
* Individualize dosing based on patient-specific phosphate and calcium levels and dietary intake.
* Ensure adequate patient education regarding the importance of taking medication with meals and recognizing hypercalcemia symptoms.
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**Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant literature, and consider individual patient factors before making any treatment decisions.
