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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 dietary phosphorus in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 2 tablets (approximately 133 mg elemental calcium per tablet) orally with meals.
* **Titration:** Dose should be individualized based on serum phosphorus levels. Typical maintenance doses range from 2 to 16 tablets per day, divided among meals.
* **Maximum Dose:** Doses up to 8000 mg of calcium acetate (approximately 16 tablets) per day have been used. The total daily elemental calcium intake from all sources (including supplements and diet) should not exceed 2000 mg.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under the guidance of a nephrologist.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue if hypercalcemia occurs.
* **Renal Impairment:** Dose adjustment is generally not required for CKD patients as the drug is intended for this population. However, careful monitoring of calcium levels is crucial.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, diarrhea, abdominal pain.
* **Serious:** Severe hypercalcemia (symptoms include lethargy, confusion, bradycardia, bone pain, calcification of soft tissues).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours before or 6 hours after.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Other Calcium-Containing Products:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Phosphorus:** Monitor regularly (frequency determined by clinical status).
* **Serum Calcium:** Monitor regularly, especially during initial titration and dose changes. Aim for serum calcium levels within the normal range.
* **Alkaline Phosphatase:** May be monitored.
* **BUN and Creatinine:** Monitor renal function.
## Clinical Pearls
* Administer with meals to effectively bind dietary phosphorus.
* Monitor for signs and symptoms of hypercalcemia.
* Total daily elemental calcium intake from all sources should not exceed 2000 mg.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information with the official product labeling and consult with a qualified healthcare provider.*
