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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 works by binding dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
Dosing is individualized based on serum phosphate levels. A common starting dose is 667 mg (13.3 mEq elemental calcium) orally three times daily with meals. Doses can be increased incrementally. The goal is to maintain serum phosphate < 5.5 mg/dL.
* **Maximum dose:** Typically no specific maximum is stated, but doses should be titrated to achieve target phosphate levels while minimizing hypercalcemia and acid rebound.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized under specialist care.
## Dose Adjustments
* **Renal Impairment:** Patients with CKD already have impaired calcium and phosphate regulation. Dosing requires careful titration and monitoring.
* **Hepatic Impairment:** No specific dose adjustment is typically needed, but monitoring for hypercalcemia is crucial.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Use with caution in patients with active kidney stones.
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, confusion, lethargy, arrhythmias), acid rebound (if used with antacids containing bicarbonate).
* **Less Common:** Dry mouth, nausea, vomiting, diarrhea.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer antibiotics at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bicarbonate-containing products:** Increased risk of acid rebound and hypercalcemia.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor closely to prevent and manage hypercalcemia. Target serum calcium levels are typically < 10.5 mg/dL.
* **Serum Albumin:** To correct calcium levels if needed (adjusted calcium = measured calcium + 0.8 * (4 - albumin)).
* **Electrolytes:** Monitor for other electrolyte imbalances.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Patients should be educated on the signs and symptoms of hypercalcemia.
* Consider the total elemental calcium intake from all sources (diet, supplements, antacids) when dosing.
* If hypercalcemia occurs, the dose of calcium acetate should be reduced or discontinued.
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_This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before initiating therapy._
