Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, particularly those with chronic kidney disease (CKD). It works by binding to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* **Hyperphosphatemia** in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
* **Initial dose:** 2 tablets (667 mg elemental calcium per 1000 mg calcium acetate) orally with each meal.
* **Titration:** Dosage should be individualized based on serum phosphorus levels. Doses can be increased or decreased in increments of 1-2 tablets per meal.
* **Maximum dose:** Typically not to exceed 12 tablets per day.
* **Dosing frequency:** Administer with meals.
## Pediatric Dosing
* Dosing for pediatric patients is not well-established and should be determined by a specialist based on individual patient factors.
## Dose Adjustments
* **Renal Impairment:** Calcium acetate is primarily indicated for CKD patients. Careful monitoring of calcium and phosphorus levels is essential.
* **Hepatic Impairment:** No specific dose adjustment is typically required, but monitor calcium levels.
## Contraindications
* Hypercalcemia
* Hypersensitivity to calcium acetate or any component of the formulation
* Concurrent use with intravenous calcium
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, anorexia.
* **Serious:** Severe hypercalcemia leading to cardiac arrhythmias, vascular calcification, kidney stones, adynamic bone disease (with long-term excessive use).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Concurrent use can decrease absorption of biphosphonates. Separate administration.
* **Digoxin:** Hypercalcemia induced by calcium acetate can increase the risk of digoxin toxicity.
## Monitoring
* **Serum Phosphorus:** Monitor regularly to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor regularly. Target serum calcium levels should be individualized, but generally aim for the upper end of the normal range or slightly above, as tolerated. Avoid significant hypercalcemia.
* **Serum Magnesium and Alkaline Phosphatase:** May be monitored periodically.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Ensure tablets are chewed or crushed for optimal efficacy, especially in patients with difficulty swallowing.
* Patients should be educated on signs and symptoms of hypercalcemia and instructed to report them promptly.
* Dosing is highly individualized and requires frequent monitoring of serum phosphorus and calcium.
***
*This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the current prescribing information and your healthcare provider for definitive guidance.*
