Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, typically associated with chronic kidney disease (CKD). It works by binding dietary phosphate in the gastrointestinal tract, forming an insoluble calcium phosphate precipitate that is then excreted.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Dosing is individualized based on serum phosphate levels and dietary phosphate intake.**
* **Initial dose:** Typically 667 mg to 1332 mg (equivalent to 169-339 mg elemental calcium) administered orally with meals.
* **Titration:** Doses may be increased, usually by 667 mg per meal, up to a maximum of 4000 mg per day (or 1001 mg elemental calcium per day).
* **Dose should be adjusted to achieve and maintain serum phosphate levels below 6 mg/dL.**
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be determined by a specialist.
## Dose Adjustments
* **Renal Impairment:** Patients with CKD require careful monitoring due to impaired phosphate and calcium excretion. Dose should be adjusted based on serum calcium and phosphate levels.
* **Hypercalcemia:** If hypercalcemia occurs, the dose should be reduced or temporarily discontinued.
## Contraindications
* Hypercalcemia.
* History of hypersensitivity to calcium acetate.
## Adverse Effects
* **Most common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, fatigue, muscle weakness, confusion, and cardiac arrhythmias).
* Gastrointestinal upset (constipation, diarrhea, dyspepsia).
* Hypotension (especially with intravenous administration, which is not typical for this indication).
## 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.
* **Thyroid Hormones:** Calcium acetate can reduce the absorption of levothyroxine. Administer levothyroxine at least 4 hours apart from calcium acetate.
* **Digoxin:** Hypercalcemia can potentiate digoxin toxicity.
* **Vitamin D and its analogs:** Can increase the risk of hypercalcemia.
## Monitoring
* **Serum phosphate levels:** Frequently monitor to guide dosing.
* **Serum calcium levels:** Monitor regularly, as hypercalcemia is a common adverse effect. Aim for serum calcium levels within the normal range, or as per local protocol.
* **Alkaline phosphatase levels:** May also be monitored.
## Clinical Pearls
* Calcium acetate should be administered with meals to maximize its phosphate-binding capacity.
* Ensure adequate dietary phosphate restriction in conjunction with calcium acetate therapy.
* Be aware of the potential for aluminum toxicity if given concurrently with aluminum-containing antacids.
---
***Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and institutional protocols for the most current and complete guidance. Drug dosing and management can vary based on individual patient factors and local guidelines.*
