Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control 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
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD) or advanced CKD.
## Adult Dosing
* **Initial dose:** 667 mg to 1.333 g (equivalent to 133 mg to 267 mg elemental calcium) orally with meals.
* **Titration:** Dose should be adjusted based on serum phosphate levels. The goal is to reduce serum phosphate to <6 mg/dL.
* **Maximum dose:** No strict maximum dose is established, but doses exceeding 12 g per day have been used. However, higher doses increase the risk of hypercalcemia. Dosing should be individualized.
## Pediatric Dosing
* **Dosing is not well-established in pediatric patients.** Consultation with a pediatric nephrologist is recommended. Some sources suggest a starting dose of 20 mg/kg/day of elemental calcium, divided with meals, titrated based on serum phosphate and calcium levels.
## Dose Adjustments
* **Renal impairment:** Dose adjustment is based on serum phosphate and calcium levels. Patients with CKD already have impaired calcium and phosphate homeostasis, requiring careful monitoring.
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue the medication.
## Contraindications
* Hypercalcemia
* Hypersensitivity to calcium acetate or any component of the formulation
* Concurrent use with intravenous digitalis glycosides (due to risk of digitalis toxicity from hypercalcemia)
## Adverse Effects
* **Common:** Hypercalcemia (signs include constipation, nausea, vomiting, abdominal pain, dry mouth, increased urination, fatigue, headache, thirst), hypophosphatemia.
* **Less Common:** Gastrointestinal upset, bone pain.
## 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 these agents.
* **Thyroid hormones (levothyroxine):** Calcium acetate can decrease absorption. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may decrease bisphosphonate absorption. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia secondary to calcium acetate can potentiate digitalis toxicity.
## Monitoring
* **Serum phosphate:** Monitor regularly to assess efficacy and guide dosing.
* **Serum calcium:** Monitor regularly, especially with higher doses, to prevent hypercalcemia.
* **Serum magnesium and alkaline phosphatase:** May be monitored periodically.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Consider the total calcium load from all sources (diet, supplements, other medications).
* Be aware of the signs and symptoms of hypercalcemia.
***
*Please verify this information with the most current prescribing information and relevant clinical guidelines before use.*
