Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD). It works by binding dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
* **Dosage is individualized based on serum phosphate levels.**
* Initiate with 667 mg (equivalent to 169 mg elemental calcium) orally with each meal.
* Dose may be increased incrementally.
* **Typical target dose:** 1332 mg to 2664 mg (338 mg to 676 mg elemental calcium) per day, divided among meals.
* **Maximum recommended daily dose:** Generally up to 4000 mg (1018 mg elemental calcium) per day, divided among meals. However, doses up to 5000 mg (1273 mg elemental calcium) have been used in some clinical scenarios under close monitoring. **Refer to local protocol for specific maximums.**
## Pediatric Dosing
* Dosing in pediatric patients is not well established. Consult pediatric nephrology guidelines or specialist recommendations.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically needed as the drug is used in CKD patients. However, monitor serum calcium and phosphate levels closely.
* **Hepatic Impairment:** No specific adjustments are usually necessary.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Urolithiasis (history of calcium-containing kidney stones).
## Adverse Effects
* **Common:** Hypercalcemia (especially with excessive intake or in patients with reduced GFR), constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Less Common:** Hypercalciuria, hypophosphatemia, milk-alkali syndrome.
## 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 (Levothyroxine):** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use can decrease bisphosphonate absorption. Separate administration by at least 2 hours.
* **Certain Antacids:** May increase calcium absorption and risk of hypercalcemia.
## Monitoring
* **Serum Calcium:** Monitor frequently, especially during initiation and dose adjustments. Target serum calcium levels should be determined by the prescriber, but generally aim for the upper end of the normal range.
* **Serum Phosphate:** Monitor to assess efficacy and guide dosing.
* **Serum Magnesium and Bicarbonate:** May be monitored periodically.
* **Signs and Symptoms of Hypercalcemia:** Include confusion, lethargy, nausea, vomiting, constipation, polyuria, polydipsia.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Ensure adequate dietary phosphate intake as recommended by a dietitian.
* Patients taking calcium supplements or vitamin D should be closely monitored for hypercalcemia.
* Compliance is crucial for effective phosphate control.
***
*This information is intended for healthcare professionals. Always verify current prescribing information and consult relevant guidelines before making clinical decisions.*
