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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 works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* **Hyperphosphatemia:** Treatment of elevated serum phosphate levels in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initiation:** Typically started at 667 mg (equivalent to 169 mg elemental calcium) orally with each meal.
* **Titration:** Dose should be adjusted based on serum phosphate levels. The goal is to achieve serum phosphate levels below 6 mg/dL. Doses can range from 667 mg to 3335 mg per meal.
* **Maximum Dose:** While specific maximum doses are not well-defined, a common guideline is to avoid exceeding 3335 mg per meal. Individualization is key.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized by a physician.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustment is typically needed for renal impairment, as the drug is intended for patients with CKD. However, careful monitoring of calcium and phosphate levels is crucial.
* **Hepatic Impairment:** No specific dose adjustment is typically needed.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Patients with anuria or oliguria (risk of severe hypercalcemia).
## Adverse Effects
* **Hypercalcemia:** The most significant adverse effect. Symptoms include nausea, vomiting, constipation, abdominal pain, dry mouth, increased urination, thirst, anorexia, headache, fatigue, and confusion.
* **Gastrointestinal:** Nausea, vomiting, constipation, diarrhea, abdominal pain.
* **Other:** Acidosis (rare).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer these antibiotics at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may decrease bisphosphonate absorption. Separate administration by at least 1 hour.
* **Antacids:** Concomitant use can lead to increased serum calcium levels.
## Monitoring
* **Serum Calcium:** Monitor frequently, especially during initiation and dose adjustments, and periodically thereafter. Target corrected calcium levels are typically between 8.4 to 9.5 mg/dL.
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing.
* **Alkaline Phosphatase:** Monitor periodically.
* **Renal Function:** Monitor as clinically indicated.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Crush tablets and mix with a small amount of food or liquid if difficulty swallowing.
* Consider the elemental calcium content when calculating total daily calcium intake to avoid hypercalcemia. Each 667 mg tablet of calcium acetate contains approximately 169 mg of elemental calcium.
* Patient education on signs and symptoms of hypercalcemia is essential.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and clinical guidelines before making therapeutic decisions. Dosing and recommendations may vary based on patient-specific factors and local protocols.*
