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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, preventing its absorption.
### Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
### Adult Dosing
* **Initial Dose:** 2 tablets (133 mg elemental calcium per tablet, 665 mg calcium acetate per tablet) orally with meals.
* **Titration:** Dosage should be adjusted based on serum phosphate levels. Doses typically range from 2 to 4 tablets with each meal.
* **Maximum Dose:** While not definitively established, doses up to 12 tablets per day have been used. Higher doses increase the risk of hypercalcemia.
### Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized. Consultation with a pediatric nephrologist is recommended.
### Dose Adjustments
* **Renal Impairment:** Dosage adjustment is based on serum phosphate levels, but the risk of hypercalcemia is a significant concern.
* **Hepatic Impairment:** No specific adjustments are typically required, but monitor for hypercalcemia.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* A history of kidney stones (calcium-containing).
### Adverse Effects
* **Common:** Hypercalcemia (may manifest as nausea, vomiting, constipation, abdominal pain, confusion, polyuria, polydipsia), hypophosphatemia.
* **Less Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation).
### Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concurrent use with other calcium-containing antacids may increase the risk of hypercalcemia.
* **Vitamin D:** Increased risk of hypercalcemia when used concurrently with vitamin D or its analogs.
### Monitoring
* Serum calcium levels (monitor closely for hypercalcemia).
* Serum phosphate levels (to assess efficacy).
* Alkaline phosphatase levels.
* BUN and creatinine.
### Clinical Pearls
* Calcium acetate should be taken with meals to maximize phosphate binding.
* The amount of elemental calcium per tablet is approximately 133 mg.
* Patients should be instructed to report symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, fatigue, confusion) to their healthcare provider.
* Dietary phosphate intake should be considered when adjusting the dose.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider to ensure the appropriateness of any medication for a specific patient. Verify current prescribing information before making any treatment decisions.
