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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, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Initial Dose:** 500 mg to 1000 mg (equivalent to 250-500 mg elemental calcium) administered orally with meals.
* **Titration:** Dose should be adjusted based on serum phosphorus levels. The goal is to achieve and maintain serum phosphorus below 6 mg/dL.
* **Maximum Dose:** Typically not to exceed 4000 mg per day (equivalent to 2000 mg elemental calcium). Doses higher than this may increase the risk of hypercalcemia.
## Pediatric Dosing
* **Dosing in pediatric patients has not been definitively established and should be individualized based on serum phosphorus levels and tolerance.** Some sources suggest starting doses of 2.5-5 mg/kg/day in divided doses with meals, but caution is advised due to potential for hypercalcemia. Consult specific pediatric guidelines or literature.
## Dose Adjustments
* **Hypercalcemia:** If serum calcium levels exceed the therapeutic goal (e.g., > 10.5 mg/dL or as per local protocol), reduce the dose or temporarily discontinue the medication.
* **Hypophosphatemia:** If serum phosphorus falls too low, reduce the dose.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Severe hypercalcemia and/or hyperphosphatemia.
## Adverse Effects
* **Common:** Hypercalcemia (signs include constipation, nausea, vomiting, abdominal pain, confusion, fatigue, thirst, polyuria).
* **Less Common:** Hypophosphatemia, gastrointestinal upset.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours before or 6 hours after the antibiotic.
* **Thyroid Hormones:** Calcium salts can interfere with the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Concurrent use may decrease biphosphonate absorption. Separate administration.
* **Digitalis Glycosides:** Hypercalcemia can increase the risk of digitalis toxicity. Monitor closely.
* **Calcium Channel Blockers:** Hypercalcemia may potentiate the effects of calcium channel blockers.
## Monitoring
* **Serum Phosphorus:** Monitor regularly (frequency determined by clinical status and local protocol) to guide dosing and assess efficacy.
* **Serum Calcium:** Monitor regularly to detect and prevent hypercalcemia.
* **Dialysate Calcium:** Monitor if patient is on dialysis, as this can affect calcium balance.
* **Alkaline Phosphatase:** May be monitored in patients with CKD.
## Clinical Pearls
* Administer calcium acetate **with meals** to maximize phosphate binding.
* Patients may require the same total daily dose of elemental calcium, regardless of the specific calcium salt used.
* Be vigilant for signs and symptoms of hypercalcemia, especially in patients with a history of calcium-related issues or those taking other calcium-containing products or vitamin D.
* The elemental calcium content of calcium acetate is approximately 25%.
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*This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and institutional protocols for complete and up-to-date details before making any clinical decisions.*
