Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is an oral phosphate binder used to reduce serum phosphate levels in patients with chronic kidney disease (CKD) on dialysis. 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) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* **Dosage Range:** 667 mg to 2000 mg (1 to 3 tablets) orally with each meal.
* **Titration:** Dosing should be individualized based on serum phosphate levels. The goal is to achieve and maintain serum phosphate below 5.5 mg/dL.
* **Maximum Dose:** Generally considered to be 3000 mg (4 tablets) per day, though higher doses may be used under strict monitoring if necessary to control hyperphosphatemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized and carefully monitored. Some sources suggest starting doses around 10-12 mg/kg/day of elemental calcium divided with meals, titrating to control phosphate.
## Dose Adjustments
* No dose adjustment is typically needed for hepatic impairment.
* Dosing adjustments are based on serum phosphate and calcium levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Worsening hypercalcemia, particularly in patients taking other calcium-containing supplements or vitamin D analogs.
## 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.
* **Levothyroxine:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Oral bisphosphonates:** Calcium acetate can reduce the absorption of bisphosphonates. Separate administration by at least 30 minutes (before) to 2 hours (after).
* **Calcium channel blockers:** Monitor for potential additive effects on serum calcium.
* **Vitamin D analogs and other calcium supplements:** Increased risk of hypercalcemia. Use with caution and monitor serum calcium closely.
## Monitoring
* **Serum Phosphate:** Monitor frequently, especially during initial treatment and dose adjustments, to guide therapy.
* **Serum Calcium:** Monitor regularly (e.g., weekly initially, then monthly) to prevent and manage hypercalcemia. Target serum calcium levels should be individualized, but typically aim for the lower end of the normal range.
* **Dialysate Calcium:** Consider the calcium concentration in dialysis fluid when managing serum calcium levels.
## Clinical Pearls
* Administer calcium acetate **with meals** to effectively bind dietary phosphate.
* When titrating doses, make changes gradually and monitor both serum phosphate and calcium.
* Be aware of the significant risk of hypercalcemia, especially in patients concomitantly receiving vitamin D or other calcium-containing products.
* Consider the elemental calcium content when calculating total daily calcium intake. Each 667 mg tablet of calcium acetate contains approximately 169 mg (8.45 mEq) of elemental calcium.
***
*Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.*
