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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 binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Hyperphosphatemia:** Start with 2 tablets (667 mg elemental calcium per tablet) orally with each meal. Titrate dose based on serum phosphate levels.
* **Maximum Dose:** Generally not to exceed 12 tablets (4002 mg elemental calcium) per day. However, the actual maximum dose should be guided by serum calcium levels and tolerability, often capped around 8-10 tablets per day to avoid hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under specialist guidance. Recommended starting doses vary but are typically based on elemental calcium needs and phosphate levels.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Monitor serum calcium and phosphate levels closely. Dose should be adjusted to maintain serum phosphate within target range and avoid hypercalcemia.
* **Hepatic Impairment:** No specific dose adjustments are recommended.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Tidation.
## Adverse Effects
* **Common:** Hypercalcemia (may present as nausea, vomiting, constipation, abdominal pain, dry mouth, increased urination, weakness, headache, confusion, metallic taste), hypophosphatemia.
* **Less Common:** Diarrhea, flatulence, anorexia.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer these antibiotics at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium salts can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Calcium can reduce the absorption of bisphosphonates. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dose titration. Target levels are typically <5.5 mg/dL.
* **Serum Calcium:** Monitor regularly to prevent and detect hypercalcemia. Target levels are typically 8.5-10 mg/dL.
* **Alkaline Phosphatase:** Monitor periodically.
* **Electrolytes:** Monitor periodically.
## Clinical Pearls
* Administer calcium acetate **with meals** to effectively bind dietary phosphate.
* Educate patients on signs and symptoms of hypercalcemia and hypophosphatemia.
* The amount of *elemental calcium* per dose is crucial for calculation and monitoring. Each tablet of calcium acetate typically contains 169 mg of elemental calcium.
* Total daily elemental calcium intake from all sources (diet, supplements, binders) should be considered to avoid cumulative hypercalcemia.
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**Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information with the manufacturer's labeling and consult relevant clinical guidelines before making therapeutic decisions. Dosing and recommendations may vary based on patient-specific factors and local protocols.
