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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 to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in adult and pediatric patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Initial dose:** 1 to 2 tablets (approximately 169 mg to 338 mg of elemental calcium per tablet) with each meal.
* **Titration:** Adjust dose gradually based on serum phosphate levels. The goal is to maintain serum phosphate below 6 mg/dL.
* **Maximum dose:** Doses up to 4 grams (approximately 12 tablets) per day have been used, but higher doses increase the risk of hypercalcemia. Doses are typically guided by patient response and tolerance, with frequent monitoring of serum calcium and phosphate.
## Pediatric Dosing
* **Initial dose:** 10 to 13 mg/kg/day divided into 3 or 4 doses with meals. Doses should be calculated based on the elemental calcium content of the formulation being used.
* **Titration:** Adjust dose based on serum phosphate levels. The goal is to maintain serum phosphate below 6 mg/dL.
* **Maximum dose:** Typically not to exceed 4 grams/day.
## Dose Adjustments
* Dose adjustments are primarily based on serum phosphate and calcium levels. Increase dose if phosphate control is inadequate. Decrease dose or withhold if hypercalcemia occurs.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Use with caution in patients with a history of kidney stones.
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern), nausea, vomiting, constipation, diarrhea, abdominal pain, anorexia.
* **Serious:** Vascular calcification, cardiac arrhythmias (associated with hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Thyroid hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids containing calcium or magnesium:** May lead to additive hypercalcemia or magnesium toxicity.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Vitamin D and its analogs:** Can increase the risk of hypercalcemia.
## Monitoring
* **Frequent monitoring of serum calcium and phosphate levels is crucial.** Target serum phosphate levels are generally below 6 mg/dL.
* Monitor serum calcium levels closely to avoid hypercalcemia. Therapeutic range for calcium is typically 8.5-10.5 mg/dL; however, target levels for CKD patients may vary based on institutional protocol.
* Monitor for signs and symptoms of hypercalcemia (e.g., constipation, nausea, fatigue, confusion, bone pain).
* Monitor for signs of vascular or soft tissue calcification.
## Clinical Pearls
* Calcium acetate should be administered with meals to effectively bind dietary phosphate.
* It is important to distinguish between calcium acetate tablets (which contain a significant amount of elemental calcium) and other calcium salts when calculating doses.
* Hypercalcemia is a common and serious adverse effect. Careful dose titration and regular monitoring are essential.
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*This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant clinical guidelines for complete details before making any treatment decisions.*
