Please check your internet connection and try again.
# 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, which is then excreted.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Starting Dose:** Typically 667 mg (13.3 mEq calcium) orally three times daily with meals.
* **Titration:** Dosage should be titrated based on serum phosphate levels. The goal is to reduce serum phosphate to a target level, generally less than 6 mg/dL.
* **Maximum Dose:** Doses up to 4000 mg (80 mEq calcium) per day have been used, but doses should be individualized and serum calcium monitored closely.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be individualized based on clinical response and monitoring of serum phosphate and calcium levels. Consult specialized pediatric nephrology resources for guidance.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue the medication. Correct underlying causes of hypercalcemia (e.g., vitamin D therapy).
* **Renal Impairment:** While used in CKD patients, caution is advised as calcium can accumulate. Monitor serum calcium closely.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Use with caution in patients with history of kidney stones.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Severe hypercalcemia (symptoms include confusion, lethargy, muscle weakness, cardiac arrhythmias, coma). 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.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Certain Antihypertensives (e.g., Diltiazem):** Hypercalcemia can potentiate the effects of calcium channel blockers.
* **Vitamin D and its analogs:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor regularly to prevent and manage hypercalcemia. Target serum calcium levels vary by institution but aim to keep within the normal range or a specific target range provided by the prescriber.
* **Serum Magnesium and Alkaline Phosphatase:** May be monitored periodically.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* The total daily calcium load should be considered, especially in patients taking other calcium-containing medications or supplements.
* Patient education on symptoms of hypercalcemia is crucial.
***
*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making any treatment decisions. Dosing and recommendations may vary.*
