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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, forming insoluble calcium phosphate that is then excreted in the feces.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 667 mg (2 tablets) orally with each meal.
* **Titration:** Dose should be adjusted based on serum phosphate levels. The goal is to lower serum phosphate to less than 6 mg/dL.
* **Maximum Dose:** Generally, do not exceed 1332 mg (8 tablets) per day, given with meals. Higher doses may be used under close medical supervision, but hypercalcemia risk increases.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under specialist guidance.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue calcium acetate. Monitor serum calcium levels closely.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions leading to hypercalcemia (e.g., metastatic bone disease, certain malignancies).
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, dry mouth, thirst, increased urination, fatigue, muscle weakness, headache, bone pain, kidney stones).
* **Less Common:** Hypotension, cardiac arrhythmias, gastrointestinal upset.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer antibiotics at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Calcium Channel Blockers:** Use with caution due to potential for additive hypercalcemic effects.
* **Vitamin D:** Concurrent use with vitamin D or its analogs can increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., weekly to monthly) and adjust dose to maintain levels below 6 mg/dL.
* **Serum Calcium:** Monitor regularly (e.g., weekly to monthly) to detect and manage hypercalcemia.
* **Serum Magnesium and Albumin:** May be monitored to assess nutritional status and interpret calcium levels.
## Clinical Pearls
* Calcium acetate is most effective when taken with meals to bind dietary phosphate.
* The acetate component is metabolized to bicarbonate, which can contribute to metabolic alkalosis in some patients.
* Patients with a history of kidney stones should be monitored closely.
* The calcium content per tablet is approximately 169 mg of elemental calcium.
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*Disclaimer: This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and professional resources for complete details before making any treatment decisions.*
