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, preventing its absorption and lowering serum phosphate levels.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Dosage:** 2 tablets (1334 mg calcium acetate) orally with meals.
* **Titration:** Dosage should be titrated based on serum phosphate levels. Target serum phosphate is typically < 5.5 mg/dL.
* **Maximum:** The maximum effective dose is typically 16 tablets per day, but should be guided by serum phosphate and calcium levels.
## Pediatric Dosing
* Dosing for pediatric patients is not well-established and should be individualized based on patient weight, serum phosphate levels, and clinical response. Consultation with a pediatric nephrologist is recommended.
## Dose Adjustments
* **Renal Impairment:** Not applicable for patients with ESRD. For other degrees of renal impairment, caution is advised due to potential for hypercalcemia.
* **Hepatic Impairment:** No specific dose adjustment is generally required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Esophageal obstruction or dysphagia.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Adynamic bone disease (with long-term use, especially with vitamin D therapy), hypophosphatemia, calcification of soft tissues.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Vitamin D and analogs:** Increased risk of hypercalcemia.
* **Levothyroxine:** Calcium acetate can reduce the absorption of levothyroxine. Administer at least 4 hours apart.
## Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., at least every 2 weeks initially, then monthly) to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor regularly (e.g., at least monthly) to prevent or manage hypercalcemia.
* **Electrolytes:** Monitor as clinically indicated.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Monitor calcium levels closely, as hypercalcemia is a significant risk, especially in patients taking vitamin D.
* Consider alternative phosphate binders if constipation is severe or unmanageable.
* Educate patients on the importance of taking medication with meals and reporting symptoms of hypercalcemia (e.g., nausea, vomiting, confusion, constipation, bone pain).
***
*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and clinical guidelines, and use your professional judgment when making treatment decisions. Dosing and recommendations may vary based on individual patient factors and local protocols.*
