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) on dialysis. 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) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* **Initial dose:** 667 mg (1 gram of calcium acetate) orally with meals.
* **Titration:** Dose should be individualized based on serum phosphate levels. Increase the dose gradually as needed.
* **Typical dose range:** 1332 mg to 2664 mg (2 to 4 grams of calcium acetate) per day, divided and administered with meals.
* **Maximum dose:** Some sources suggest a maximum of 4 grams (approximately 2664 mg of calcium acetate) per day.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established. Consultation with a pediatric nephrologist or pharmacologist is recommended.
## Dose Adjustments
* **Renal Impairment:** Dose must be adjusted based on serum phosphate and calcium levels. Patients with CKD require close monitoring.
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue the medication.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions leading to hypercalcemia (e.g., metastatic bone disease, certain endocrine disorders).
## Adverse Effects
* **Most Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, diarrhea.
* **Serious:** Arrhythmias (due to hypercalcemia), vascular calcification.
## 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 calcium acetate.
* **Thyroid Hormones:** Calcium acetate may reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Calcium Channel Blockers:** Potential for increased risk of hypercalcemia.
* **Digitalis Glycosides:** Hypercalcemia may increase the risk of digitalis toxicity.
* **Fatty acid and amino acid solutions:** May precipitate calcium salts.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dosing.
* **Serum Calcium:** Monitor frequently, especially during initiation and dose adjustments. Aim for a serum calcium level within the normal range or as per institutional guidelines.
* **Alkaline Phosphatase:** May be monitored periodically.
* **Electrolytes:** Including magnesium and potassium, may be monitored.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Monitor serum calcium levels closely to avoid hypercalcemia, which can be asymptomatic or cause significant toxicity.
* Patients should be educated on signs and symptoms of hypercalcemia (e.g., constipation, nausea, vomiting, bone pain, mental status changes).
* For patients on hemodialysis, serum calcium and phosphate levels are often checked post-dialysis.
***
*This information is intended for healthcare professionals and should not be a substitute for clinical judgment. Always verify current prescribing information and consult with a qualified healthcare provider for any health concerns or before making any decisions related to patient care.*
