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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 in the feces.
## Primary Indications
* Treatment of hyperphosphatemia in end-stage renal disease (ESRD).
## Adult Dosing
* Dosing is individualized based on serum phosphate levels.
* **Initial dose:** 1 to 2 tablets (667 mg to 1334 mg of calcium acetate) taken with each meal.
* **Titration:** Dose should be titrated to achieve target serum phosphate levels.
* **Maximum dose:** Generally, do not exceed 12 tablets (8004 mg of calcium acetate) per day. Some sources suggest a maximum of 8-10 tablets per day. Consult local protocol for specific maximums.
* Doses should be administered with meals.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized by a clinician experienced in pediatric nephrology. Some sources suggest a starting dose of 1-2 tablets (667-1334 mg) per day divided into 3 doses with meals, titrating based on phosphate levels.
## Dose Adjustments
* **Renal Impairment:** Dose should be carefully adjusted to avoid hypercalcemia and should not be used in patients with hypercalcemia.
* **Hepatic Impairment:** No specific adjustments recommended; however, monitor calcium levels closely.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions leading to metastatic calcification.
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, dry mouth, increased urination, thirst, loss of appetite, fatigue, headache, confusion, muscle weakness, bone pain, kidney stones), hypophosphatemia.
* **Less Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation), dry mouth.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 1 hour before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity. Monitor closely.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Antacids:** Concurrent use may increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Regularly monitor to assess efficacy and guide dosing.
* **Serum Calcium:** Regularly monitor to detect and prevent hypercalcemia. Target range is typically 8.4-9.5 mg/dL (2.1-2.4 mmol/L), but may be higher in ESRD patients (e.g., up to 10.5 mg/dL or 2.6 mmol/L). Consult local guidelines.
* **Other Electrolytes:** Monitor magnesium and potassium as needed.
* **Alkaline Phosphatase:** Monitor for bone disease.
## Clinical Pearls
* Administer tablets with meals to maximize phosphate binding.
* Chewable tablets are available and may be preferred for some patients.
* Monitor for signs and symptoms of hypercalcemia, especially in patients taking other calcium-containing products or vitamin D.
* If hypercalcemia develops, reduce the dose or discontinue the medication.
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*Please verify the current prescribing information for complete details and specific indications before use.*
