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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
* **Initiation:** Typically 667 mg (equivalent to 133 mg elemental calcium and 169 mg acetate) given orally with each meal.
* **Titration:** Dose should be adjusted based on serum phosphate levels. Target serum phosphate is generally between 3.5-5.5 mg/dL.
* **Maximum:** While specific maximums can vary, doses up to 3000 mg per day (1500 mg per meal) have been used. Careful monitoring for hypercalcemia is essential.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be determined by a nephrologist. Usual starting doses may range from 10-20 mg/kg/day of elemental calcium, divided with meals, with titration based on phosphate levels and tolerance.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is primarily used in patients with ESRD.
* **Hepatic Impairment:** No specific dose adjustments are typically recommended.
* **Hypercalcemia:** If hypercalcemia occurs, the dose of calcium acetate should be reduced or discontinued. In severe cases, other measures to lower calcium may be necessary.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions that may predispose to hypercalcemia, such as metastatic calcification.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea, abdominal pain, anorexia.
* **Serious:** Hypercalcemia (symptoms include confusion, lethargy, weakness, constipation, nausea, vomiting, bone pain, frequent urination, kidney stones, cardiac arrhythmias), hypophosphatemia.
## 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 can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** May reduce the absorption of bisphosphonates. Administer bisphosphonates at least 2 hours before or 6 hours after calcium acetate.
* **Cation-containing antacids:** Increased risk of hypercalcemia.
* **Digitalis glycosides:** Hypercalcemia may increase the risk of digitalis toxicity.
## Monitoring
* Serum phosphate levels (at baseline and regularly after dose adjustments).
* Serum calcium levels (at baseline and regularly, especially with dose increases).
* Serum magnesium and alkaline phosphatase levels may also be monitored.
* Signs and symptoms of hypercalcemia.
## Clinical Pearls
* Calcium acetate is most effective when taken with meals to bind dietary phosphate.
* The dose should be individualized based on serum phosphate levels and patient tolerance.
* Close monitoring for hypercalcemia is crucial, as it can lead to serious complications. The goal is to achieve target phosphate levels without causing significant hypercalcemia.
* Consider other phosphate binders (e.g., sevelamer, lanthanum carbonate) if hypercalcemia is a persistent issue.
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*Disclaimer: This information is intended for healthcare professionals and does not substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.*
