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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD). It binds to dietary phosphorus 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 (elemental calcium 169 mg) orally with each meal.
* **Titration:** Dose should be titrated based on serum phosphorus levels.
* **Maximum dose:** Typically up to 2000 mg (4 tablets of 500 mg each) administered with meals, but clinical guidance often suggests titration to achieve target phosphorus levels, which may exceed this. The total daily elemental calcium intake from calcium acetate should not exceed 4000 mg.
## Pediatric Dosing
Dosing in pediatric patients is not well established and should be individualized under specialist care.
## Dose Adjustments
* **Renal Impairment:** Dose adjustments are typically based on serum phosphorus and calcium levels.
* **Hypercalcemia:** Discontinue or reduce dose if hypercalcemia occurs. Monitor calcium levels closely.
## Contraindications
* Hypercalcemia.
* Known hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, hyperphosphatemia (if not taken with meals).
* **Serious:** Severe hypercalcemia (symptoms include confusion, lethargy, muscle weakness, constipation, nausea, vomiting, polyuria, polydipsia, cardiac arrhythmias).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 4-6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate can reduce the absorption of thyroid hormones. Administer thyroid hormones at least 4 hours before or 4 hours after calcium acetate.
* **Calcium Channel Blockers:** Potential for additive hypercalcemic effects.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphorus:** Monitor regularly, especially after dose initiation or adjustment. Target levels are typically < 5.5 mg/dL.
* **Serum Calcium:** Monitor regularly. Target corrected calcium levels are typically within the normal range or slightly above (e.g., up to 10.5 mg/dL).
* **Alkaline Phosphatase:** Monitor periodically.
* **BUN and Creatinine:** Monitor periodically.
* **Signs and symptoms of hypercalcemia.**
## Clinical Pearls
* Must be taken with meals to effectively bind dietary phosphorus.
* The amount of elemental calcium per tablet varies by manufacturer and formulation; always check the product label. Calcium acetate 667 mg contains approximately 169 mg of elemental calcium. Calcium acetate 500 mg tablets contain approximately 125 mg of elemental calcium.
* Monitor for constipation and encourage adequate fluid and fiber intake.
* Consider the total daily intake of elemental calcium from all sources (diet, supplements, medications) to avoid hypercalcemia.
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*This information is for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment. Prescribing information can change, and it is essential to verify current prescribing information from the manufacturer or other reliable sources before administering any medication.*
