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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 phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted in the feces.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Starting Dose:** 2 tablets (667 mg calcium acetate per tablet) orally with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels.
* **Maximum Dose:** Generally not to exceed 8-12 tablets per day, depending on meal content and individual response. The total daily elemental calcium intake should be monitored, as excessive calcium can lead to hypercalcemia. Specific maximums are often guided by local protocols and patient tolerance.
## Pediatric Dosing
* Data is limited. Dosing should be individualized and initiated cautiously under specialist supervision. Starting doses are typically lower than adult doses and titrated based on response and tolerance.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in patients with ESRD. However, careful monitoring of serum calcium and phosphate is crucial.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Certain conditions where calcium absorption may be increased or phosphate excretion decreased (e.g., concomitant use of high doses of calcium supplements or vitamin D analogs).
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, anorexia, thirst, frequent urination, lethargy, muscle weakness, bone pain, confusion, arrhythmias), hypophosphatemia.
* **Less Common:** Gastrointestinal upset (nausea, vomiting, diarrhea, constipation).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer antibiotics at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids containing magnesium or aluminum:** Concomitant use may increase the risk of gastrointestinal side effects and electrolyte imbalances.
* **Vitamin D analogs and calcium supplements:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Calcium:** Monitor regularly, especially during dose titration and in patients with a history of hypercalcemia or conditions predisposing to it.
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing.
* **Electrolytes:** Monitor serum magnesium and potassium as needed.
* **BUN and Creatinine:** Monitor as clinically indicated.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Individualize dosage based on serum phosphate levels and dietary intake.
* Be vigilant for signs and symptoms of hypercalcemia.
* The target serum phosphate level is typically below 5.5 mg/dL, but may vary based on clinical guidelines.
* Consider the total elemental calcium content from all sources when managing patients on calcium-based phosphate binders.
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*Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information and consult relevant clinical guidelines before making any treatment decisions.*
