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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to manage hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption and thus lowering serum phosphate levels.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* **Typical starting dose:** 667 mg (equivalent to 13.3 mEq elemental calcium and 667 mg acetate) orally with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Doses can be increased gradually.
* **Maximum dose:** Generally considered to be 4000 mg to 5000 mg per day (or up to 8-10 tablets of 500 mg strength, which is approximately 1250 mg elemental calcium). However, individual patient response and tolerability should guide the maximum dose. Doses above 5000 mg/day are not generally recommended due to risk of hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under specialist guidance. Some sources suggest starting doses around 10-20 mg/kg/day of elemental calcium, divided with meals.
## Dose Adjustments
* **Renal Impairment:** This medication is primarily used in patients with severe renal impairment (ESRD). Dose adjustments are based on serum phosphate and calcium levels.
* **Hepatic Impairment:** No specific dose adjustments are generally recommended.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Patients with metastatic calcification.
## Adverse Effects
* **Common:** Hypercalcemia (most serious), constipation, nausea, vomiting, dry mouth, abdominal pain.
* **Serious:** Vascular calcification, cardiac arrhythmias, hypotension.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer oral antibiotics at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may reduce bisphosphonate absorption. Separate administration.
* **Digoxin:** Hypercalcemia from calcium acetate can increase the risk of digoxin toxicity.
* **Vitamin D Analogs:** Increased risk of hypercalcemia. Monitor calcium levels closely.
## Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., weekly or bi-weekly initially, then monthly) to assess efficacy.
* **Serum Calcium:** Monitor regularly (e.g., weekly or bi-weekly initially, then monthly) to prevent and detect hypercalcemia. Goal serum calcium is generally < 11 mg/dL (2.75 mmol/L).
* **Albumin:** Correct calcium levels for serum albumin if indicated.
## Clinical Pearls
* Administer with meals to effectively bind dietary phosphate.
* If a dose is missed, take it with the next meal. Do not double the dose.
* Educate patients on signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, increased urination, thirst, confusion).
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*This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the appropriate treatment for your specific condition and to ensure the information provided is accurate and complete. Verify current prescribing information before making any decisions.*
