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## Calcium Acetate
### Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, commonly associated with chronic kidney disease.
### Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
### Adult Dosing
* **Initial Dose:** 667 mg (equivalent to 169 mg elemental calcium) orally three times daily with meals.
* **Titration:** Dosage should be adjusted based on serum phosphorus levels. The goal is to lower serum phosphorus to < 6 mg/dL.
* **Maximum Dose:** Generally, up to 1332 mg (equivalent to 338 mg elemental calcium) orally three times daily with meals. Some sources suggest higher doses may be used under close monitoring. Consult local protocol for specific maximums.
### Pediatric Dosing
* **Limited Data:** Dosing in pediatric patients is not well-established. Consult pediatric nephrology guidelines or a pediatric specialist for appropriate dosing.
### Dose Adjustments
* **Renal Impairment:** Dose is guided by serum phosphorus levels. Patients with ESRD typically require the highest doses.
* **Hepatic Impairment:** No specific dose adjustments are typically required, but liver function should be monitored.
### Contraindications
* Hypercalcemia.
* Known hypersensitivity to calcium acetate.
* Conditions causing hypercalcemia (e.g., metastatic bone disease, certain malignancies).
### Adverse Effects
* **Most Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, diarrhea.
* **Serious:** Cardiovascular events, metastatic calcification, hypokalemia, hypophosphatemia.
### 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 these drugs.
* **Thyroid Hormones:** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Calcium Channel Blockers:** Potential for increased hypercalcemic effects. Monitor calcium levels closely.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Aluminum-containing antacids:** Avoid concurrent use due to risk of aluminum accumulation.
### Monitoring
* **Serum Phosphorus:** Regularly monitor to guide dose titration.
* **Serum Calcium:** Monitor closely, especially at the initiation of therapy or dose changes, to prevent or manage hypercalcemia. Target serum calcium levels are typically between 8.5 and 10 mg/dL.
* **Alkaline Phosphatase:** May be monitored.
* **BUN and Creatinine:** Monitor kidney function.
* **Electrolytes:** Monitor potassium, magnesium, and chloride.
### Clinical Pearls
* Administer calcium acetate with meals to maximize its phosphate-binding capacity.
* Ensure adequate hydration to help prevent constipation and reduce the risk of hypercalcemia.
* Concurrent administration of vitamin D or its analogues may increase the risk of hypercalcemia. Monitor calcium and phosphorus levels closely if used together.
* Recognize that calcium acetate is a source of elemental calcium; consider total daily calcium intake from all sources.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
