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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
* **Hyperphosphatemia** in patients with end-stage renal disease (ESRD).
## Adult Dosing
The goal is to lower serum phosphate levels. Dosing is individualized based on serum phosphate levels and patient tolerance.
* **Initial Dose:** Typically 2 tablets (667 mg calcium acetate per tablet) by mouth with each meal.
* **Titration:** Doses can be increased gradually to achieve target phosphate levels, generally below 5.5 mg/dL. The maximum dose is generally 8 tablets (approximately 2000 mg calcium acetate) per day, divided among meals.
* **Formulations:** Available as oral tablets and capsules. The amount of elemental calcium per dose varies by formulation. Each tablet contains 250 mg of elemental calcium.
## Pediatric Dosing
Dosing in pediatric patients is not well established and should be individualized and managed by a physician experienced in pediatric nephrology.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in patients with ESRD.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
* **Concurrent Medications:** Separate administration from other oral medications by at least 1 hour before or 3 hours after calcium acetate to prevent absorption interference.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Anuria or oliguria.
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern, symptoms include nausea, vomiting, constipation, abdominal pain, confusion, lethargy, cardiac arrhythmias), hypophosphatemia.
* **Less Common:** Dry mouth, anorexia, metallic taste.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease absorption. Separate administration by at least 1 hour before or 3 hours after.
* **Digoxin:** Hypercalcemia can potentiate digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Vitamin D and its analogs:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly (frequency determined by clinical status and dialysis schedule) to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor regularly, especially when initiating or titrating therapy, to prevent and manage hypercalcemia.
* **Alkaline Phosphatase:** May be monitored to assess bone turnover.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Encourage patients to adhere to dietary phosphate restrictions.
* Educate patients on the signs and symptoms of hypercalcemia and the importance of reporting them promptly.
* Patients with CKD may have altered calcium and phosphate metabolism, requiring careful monitoring.
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*This information is intended for healthcare professionals. Always verify current prescribing information and consult with a pharmacist or physician for specific patient management.*
