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# Calcium Acetate
## Overview
Calcium acetate is a calcium salt used to bind phosphate in the gastrointestinal tract, thereby reducing phosphate absorption. It is also a source of calcium.
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
* Management of hypocalcemia.
## Adult Dosing
**Hyperphosphatemia:**
* **Initial:** 2 tablets (667 mg elemental calcium per 1 gram calcium acetate) orally with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Doses can be increased by 1-2 tablets per meal.
* **Maximum:** Typically up to 12-16 tablets per day, divided with meals. It is crucial to monitor serum phosphate and calcium levels for titration.
**Hypocalcemia:**
* Dosing varies widely depending on the degree of hypocalcemia and patient status. It is typically guided by serum calcium levels and may require titration based on therapeutic response.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized under specialist guidance.
## Dose Adjustments
* **Renal Impairment:** Patients with CKD require careful monitoring due to the risk of hypercalcemia.
* **Hepatic Impairment:** No specific adjustments are typically needed.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Renal calculi (historical contraindication, caution advised).
## Adverse Effects
* **Common:** Hypercalcemia (especially with excessive intake or impaired renal function), nausea, vomiting, constipation, diarrhea.
* **Serious:** Arrhythmias, vascular calcification, milk-alkali syndrome (rare).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics; administer at least 2 hours before or 6 hours after.
* **Thyroid Hormones (Levothyroxine):** Calcium can reduce the absorption of levothyroxine; separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may decrease bisphosphonate absorption; separate administration.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase serum calcium levels, increasing the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly, especially during titration, to guide dosing for hyperphosphatemia.
* **Serum Calcium:** Monitor regularly (e.g., weekly for patients on dialysis, monthly thereafter) to prevent or detect hypercalcemia. Target serum calcium levels should be considered within the laboratory's normal range or per institutional protocol.
* **Alkaline Phosphatase:** Monitor in patients with CKD.
* **BUN/Creatinine:** Monitor renal function.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphate.
* Compliance with taking medication with all meals is crucial for efficacy.
* Dose adjustments should be made cautiously based on both phosphate and calcium levels. A common goal for phosphate is < 5.5 mg/dL.
* Patients should be advised to report symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, abdominal pain, increased thirst, confusion).
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*Disclaimer: This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and institutional protocols for definitive guidance. The prescriber is responsible for determining the appropriate course of treatment.*
