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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Initial dose:** 2 capsules (1330 mg calcium acetate, providing 338 mg elemental calcium and 266 mg acetate) with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Monitor phosphate levels closely and adjust the dose as needed.
* **Typical maintenance dose:** Ranges from 2 to 16 capsules per day, divided with meals.
* **Maximum dose:** While not strictly defined, doses exceeding 16 capsules per day are generally not recommended due to risk of hypercalcemia.
## Pediatric Dosing
* Safety and efficacy in pediatric patients have not been established. Dosing should be individualized by a clinician experienced in pediatric nephrology if used.
## Dose Adjustments
* **Renal Impairment:** While used in CKD patients, caution is advised. Close monitoring of serum calcium and phosphate levels is essential.
* **Hepatic Impairment:** No specific adjustments are typically needed, but monitor calcium levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Use in patients with hyperparathyroidism who are prone to hypercalcemia.
## Adverse Effects
* **Common:** Hypercalcemia (signs include constipation, nausea, vomiting, anorexia, abdominal pain, fatigue, weakness, confusion, polyuria, polydipsia, dehydration, cardiac arrhythmias), hypophosphatemia.
* **Less Common:** Gastrointestinal upset (nausea, vomiting, diarrhea).
## 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 (Levothyroxine):** Calcium can decrease absorption. Separate administration by at least 4 hours.
* **Antacids containing magnesium or aluminum:** May increase the risk of hypermagnesemia or aluminum toxicity, respectively.
* **Vitamin D:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy.
* **Serum Calcium:** Monitor regularly, especially during dose titration and in patients with risk factors for hypercalcemia. A calcium-phosphate product greater than 55 mg²/dL² is associated with metastatic calcification.
* **Alkaline Phosphatase:** May be monitored in patients with bone disease.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Frequent monitoring of serum calcium and phosphate is crucial for safe and effective use.
* Educate patients on signs and symptoms of hypercalcemia.
* The goal is to achieve a serum phosphate level less than 6 mg/dL.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for definitive guidance, as drug information can change. Local protocols may dictate specific dosing strategies.
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