Please check your internet connection and try again.
# 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
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 2 tablets (667 mg elemental calcium per tablet) orally with each meal.
* **Titration:** Dose should be titrated based on serum phosphate levels. The target serum phosphate is typically less than 6 mg/dL.
* **Maximum dose:** Generally, no more than 12 tablets per day (8004 mg calcium acetate, providing 2001 mg elemental calcium).
## Pediatric Dosing
* There is no established standard pediatric dosing for calcium acetate. Dosing should be individualized based on patient factors and serum phosphate levels, under the guidance of a nephrologist.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in patients with CKD. Dose is adjusted based on serum phosphate and calcium levels.
* **Hepatic Impairment:** No dose adjustment necessary.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions causing hypercalcemia, such as sarcoidosis, primary hyperparathyroidism, and certain malignancies.
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern), constipation, nausea, vomiting, abdominal pain.
* **Serious:** Cardiovascular events (due to hypercalcemia), milk-alkali syndrome.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of oral tetracyclines and quinolone antibiotics. Separate administration by at least 2 hours.
* **Thyroid Hormones:** Calcium acetate may reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may reduce bisphosphonate absorption. Separate administration.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
## Monitoring
* **Serum Phosphate:** Monitor regularly (frequency determined by clinical status and dose).
* **Serum Calcium:** Monitor regularly. Target serum calcium is typically between 8.4 to 9.5 mg/dL. Avoid hypercalcemia.
* **BUN and Creatinine:** Monitor periodically.
* **Electrolytes:** Monitor periodically.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Be vigilant for signs and symptoms of hypercalcemia (e.g., confusion, fatigue, nausea, constipation, polyuria, polydipsia).
* If hypercalcemia occurs, reduce the dose or discontinue the medication.
* Consider alternative phosphate binders if GI side effects are poorly tolerated.
***
*Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the best course of treatment for your patients and to ensure you have the most up-to-date information. Review the official prescribing information for complete details.*
