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# 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 phosphorus in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* Dosing is highly individualized based on serum phosphorus levels and dietary phosphorus intake.
* **Starting dose:** Typically 2 tablets (667 mg elemental calcium per tablet) with each meal.
* **Titration:** Increase dose gradually as needed to lower serum phosphorus to target levels (often < 5.5 mg/dL or < 6 mg/dL, per institutional guidelines).
* **Maximum dose:** Generally, no more than 12 tablets (4002 mg elemental calcium) per day. Higher doses increase the risk of hypercalcemia.
* **Administration:** Must be taken with meals.
## Pediatric Dosing
* Information on pediatric dosing is limited. Dosing should be individualized under specialist guidance.
* Some sources suggest starting doses based on age and weight, but specific recommendations are not well-established and require careful monitoring.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in patients with ESRD.
* **Hepatic Impairment:** No specific adjustments are typically needed.
* **Hypercalcemia:** Dose should be reduced or temporarily discontinued.
* **Hypocalcemia:** Dose may need adjustment, but this is uncommon in the context of its use.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Use with caution in patients with a history of kidney stones.
## Adverse Effects
* **Most Common:** Hypercalcemia, constipation, nausea, vomiting.
* **Serious:** Vascular calcification, cardiac valvular calcification, metabolic alkalosis.
* Symptoms of hypercalcemia include: anorexia, nausea, vomiting, constipation, abdominal pain, polyuria, polydipsia, weakness, lethargy, confusion, arrhythmias, and coma.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones (e.g., Levothyroxine):** Calcium acetate can decrease the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Biphosphonates:** Calcium may decrease the absorption of bisphosphonates. Separate administration by at least 2 hours.
* **Calcium Channel Blockers:** Monitor for potential additive effects on serum calcium.
* **Digoxin:** Hypercalcemia can potentiate digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphorus:** Monitor frequently (e.g., weekly to monthly, depending on clinical status and dosing adjustments) to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor regularly (e.g., monthly or more frequently if hypercalcemia is suspected) to prevent and detect hypercalcemia.
* **Alkaline Phosphatase:** May be monitored.
* **Renal Function:** Baseline and periodic monitoring.
## Clinical Pearls
* Dosing must be individualized and closely titrated to achieve target phosphorus levels while avoiding hypercalcemia.
* Patient adherence to taking the medication with meals is crucial for efficacy.
* Educate patients on signs and symptoms of hypercalcemia and constipation.
* Consider alternative phosphate binders or dose adjustments if hypercalcemia is persistent.
* The elemental calcium content per tablet is approximately 333.5 mg. This is important when calculating total calcium intake.
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*This information is intended for healthcare professionals and does not substitute for current prescribing information. Always verify current drug information with the official product monograph or other reliable sources.*
