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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with chronic kidney disease (CKD) on dialysis. It binds to dietary phosphorus 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:** Doses vary based on serum phosphorus levels. A common starting dose is 667 mg (equivalent to 169 mg elemental calcium) orally with meals.
* **Titration:** Doses are typically adjusted to maintain serum phosphorus levels below 6 mg/dL. The maximum recommended dose is 4000 mg per day (2000 mg per meal).
* **Administration:** Must be taken with meals or immediately after.
## Pediatric Dosing
* Dosing in pediatric patients has not been established and should be determined by a physician based on individual patient needs.
## Dose Adjustments
* No specific dose adjustments are typically required for hepatic impairment.
* Dosing should be guided by serum phosphorus and calcium levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Patients with a history of calcium oxalate nephrolithiasis.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), nausea, vomiting, constipation, diarrhea.
* **Serious:** Cardiac arrhythmias (due to hypercalcemia), vascular calcification.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thyroid Hormones (Levothyroxine):** Calcium can decrease the absorption of levothyroxine. Administer levothyroxine at least 4 hours before or 4 hours after calcium acetate.
* **Antacids:** Concurrent use may increase the risk of hypercalcemia.
## Monitoring
* **Serum Calcium:** Monitor regularly, especially when initiating therapy or increasing the dose, to prevent hypercalcemia. Target serum calcium levels should be individualized but generally maintained within the normal range.
* **Serum Phosphorus:** Monitor regularly to assess efficacy.
* **Alkaline Phosphatase:** Monitor periodically.
## Clinical Pearls
* Calcium acetate is an effective phosphate binder, but close monitoring of serum calcium is crucial.
* Ensure administration with meals to maximize phosphate binding.
* Consider alternative phosphate binders if hypercalcemia is difficult to manage.
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**Disclaimer:** This information is intended for healthcare professionals. Please consult the official prescribing information and current clinical guidelines for definitive guidance. Dosing and management may vary based on individual patient factors and local protocols.
