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## Calcium Acetate
### Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It works by binding to dietary phosphorus in the gastrointestinal tract, preventing its absorption and promoting its excretion.
### Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
### Adult Dosing
* **Starting Dose:** 1332 mg (250 mg elemental calcium) with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Typical doses range from 1332 mg to 2666 mg (250 mg to 500 mg elemental calcium) administered with each meal.
* **Maximum Dose:** Not explicitly defined, but clinical trials have used up to 6660 mg per day (divided among meals). It is important to monitor serum calcium and phosphate levels closely.
### Pediatric Dosing
* Dosing in pediatric patients is not well established. Consult specific pediatric nephrology guidelines or literature.
### Dose Adjustments
* **Renal Impairment:** This drug is used in CKD patients. Dose adjustments are based on serum phosphate and calcium levels.
* **Hypercalcemia:** If hypercalcemia occurs, the dose should be reduced or interrupted.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Concurrent use with intravenous digitalis glycosides (risk of severe hypercalcemia).
### Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, diarrhea, dyspepsia.
* **Serious:** Severe hypercalcemia (symptoms include confusion, lethargy, cardiac arrhythmias, hypotension, anorexia, polyuria, polydipsia), hypophosphatemia, adynamic bone disease (with long-term excessive calcium absorption).
### Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** May decrease the absorption of bisphosphonates. Administer bisphosphonates at least 2 hours before calcium acetate.
* **Calcium Channel Blockers:** Concurrent use may increase the risk of hypercalcemia.
### Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy. Target levels are typically <5.5 mg/dL (or as per local protocol).
* **Serum Calcium:** Monitor regularly, especially at the initiation of therapy or dose adjustments. Target levels are typically 8.5-10.0 mg/dL (or as per local protocol).
* **Serum magnesium and alkaline phosphatase:** May be monitored periodically.
### Clinical Pearls
* Administer with meals to effectively bind dietary phosphorus.
* Crush tablets and mix with a small amount of water or applesauce for patients who have difficulty swallowing.
* Long-term use of phosphate binders can lead to adynamic bone disease; monitor bone metabolism parameters.
* Ensure adequate dietary phosphorus restriction concurrently with calcium acetate therapy.
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*Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information and consult local protocols or a drug information specialist for patient-specific recommendations.*
