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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 binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
Dose is individualized based on serum phosphate levels.
* **Initial dose:** 667 mg (13.3 mEq calcium) orally three times daily with meals.
* **Titration:** Dose may be increased up to 2001 mg (40 mEq calcium) orally three times daily with meals.
* **Maximum:** No explicit maximum dose is established, but titrate to achieve target serum phosphate levels.
## Pediatric Dosing
* Dosing for pediatric patients is not well established and should be determined by a specialist.
## Dose Adjustments
* **Renal Impairment:** Dose adjustments are not typically required for renal impairment as the drug is used in patients with CKD. However, careful monitoring of calcium and phosphate levels is crucial.
* **Hepatic Impairment:** No specific dose adjustments are recommended.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
Common: Hypercalcemia, constipation, nausea, vomiting, abdominal pain, diarrhea.
Serious: Cardiovascular calcification, hypophosphatemia, acid-base imbalance.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease absorption of these antibiotics. Administer at least 2 hours before or 6 hours after.
* **Thyroid Hormones:** Calcium acetate can reduce absorption of levothyroxine. Separate administration by at least 4 hours.
* **Calcium Channel Blockers:** Concurrent use may increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia associated with calcium acetate can increase the risk of digoxin toxicity.
* **Vitamin D Analogs:** Increased risk of hypercalcemia.
## Monitoring
* Serum calcium levels (target usually 8.0-9.5 mg/dL, but consult local protocol).
* Serum phosphate levels (target usually < 5.5 mg/dL, but consult local protocol).
* Serum magnesium and aluminum levels if other binders are used concurrently.
* BUN and creatinine.
* Signs and symptoms of hypercalcemia (e.g., constipation, nausea, fatigue, bone pain, confusion).
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Monitor calcium levels closely to avoid hypercalcemia, especially in patients also receiving vitamin D or its analogs.
* Consider the total elemental calcium content when calculating daily intake from all sources. Each 667 mg tablet contains approximately 13.3 mEq or 166.7 mg of elemental calcium.
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*This information is intended for clinical decision-making and does not replace professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before initiating or modifying therapy.*
