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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
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* **Initiation:** Start with 667 mg (10 mEq elemental calcium) orally with meals.
* **Titration:** Gradually increase dose based on serum phosphate levels, aiming for levels less than 6 mg/dL. Doses range from 667 mg to 2000 mg (30 mEq elemental calcium) per meal.
* **Maximum:** Do not exceed 2000 mg (30 mEq elemental calcium) per meal.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized based on serum phosphate levels and calcium concentrations. Consult specialized pediatric nephrology resources for guidance.
## Dose Adjustments
* **Hypocalcemia:** Reduce dose or temporarily discontinue if hypocalcemia occurs.
* **Hypercalcemia:** Reduce dose or temporarily discontinue if hypercalcemia occurs. Monitor serum calcium closely.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions leading to calcification (e.g., metastatic calcification).
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, hypocalcemia.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours before and 6 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concurrent use can increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dosing.
* **Serum Calcium:** Monitor closely, especially during initiation and dose adjustments, to prevent hypercalcemia. Aim for serum calcium levels within the normal range.
* **Electrolytes:** Monitor other electrolytes as clinically indicated.
* **Alkaline Phosphatase:** Monitor as clinically indicated.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Monitor for signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, fatigue, bone pain, kidney stones).
* The amount of elemental calcium per tablet can vary; check product labeling. Each 667 mg tablet typically contains 169 mg of elemental calcium.
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*This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details and to ensure patient-specific management.*
