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## Calcium Acetate
### Overview
Calcium acetate is a phosphate binder used to manage 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:** 667 mg orally three times daily with meals.
* **Titration:** Dose should be titrated based on serum phosphate levels. Target serum phosphate is generally < 5.5 mg/dL.
* **Maximum Dose:** Typically 2001 mg orally three times daily with meals (total daily dose of 6003 mg). Doses higher than this are generally not recommended due to risk of hypercalcemia.
### Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized based on serum phosphate levels, age, and weight.
* Some sources suggest a starting dose of 20-40 mg/kg/day of elemental calcium, divided into 3 doses with meals.
* Careful monitoring is essential.
### Dose Adjustments
* No specific dose adjustments are routinely recommended for hepatic impairment.
* Dose should be adjusted based on serum phosphate and calcium levels. If hypercalcemia occurs, the dose should be reduced or discontinued.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Patients with a history of nephrolithiasis (kidney stones) may require careful consideration.
### Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting.
* **Serious:** Ectopic calcification, vascular calcification, adynamic bone disease (with chronic excessive use).
### 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 may increase the risk of digoxin toxicity.
* **Levothyroxine:** Calcium acetate may decrease the absorption of levothyroxine. Administer at least 4 hours apart.
* **Other Calcium-Containing Products:** Concurrent use can increase the risk of hypercalcemia.
### Monitoring
* **Serum Phosphate:** Monitor regularly, aiming for target levels (< 5.5 mg/dL).
* **Serum Calcium:** Monitor regularly, especially with dose adjustments. Target serum calcium is generally within the normal range (usually 8.5-10 mg/dL), but some dialysis protocols may aim for slightly higher levels. Avoid hypercalcemia.
* **Serum Bicarbonate:** Monitor for acid-base status if used in patients with metabolic acidosis.
### Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Educate patients on signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, bone pain).
* Be aware of the total elemental calcium content when calculating doses and monitoring serum calcium. Each 667 mg tablet of calcium acetate contains approximately 169 mg of elemental calcium.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions. Dosing and recommendations may vary based on individual patient factors and evolving clinical guidelines.*
