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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 an insoluble calcium phosphate precipitate that is then excreted in the feces.
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
* **Starting Dose:** 667 mg (1 gram calcium acetate) orally with meals.
* **Titration:** Dose should be individualized based on serum phosphate levels. Titrate upward in increments of 667 mg to 1333 mg (1 to 2 grams calcium acetate) per meal as needed to control serum phosphate.
* **Maximum Dose:** Generally, no specific maximum dose is established, but doses typically range from 4 to 12 grams of calcium acetate per day divided among meals. The goal is to maintain serum phosphate between 3.5 and 5.5 mg/dL.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established. Consultation with a pediatric nephrologist is recommended for individualized dosing based on patient weight, serum phosphate, and calcium levels.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in patients with CKD.
* **Hepatic Impairment:** No dose adjustment is typically required.
* **Concurrent Medications:** Administration should be spaced at least 1 hour apart from oral antibiotics (tetracyclines, fluoroquinolones) and levothyroxine.
## Contraindications
* Hypercalcemia.
* Known hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, diarrhea.
* **Serious:** Vascular calcification, aluminum intoxication (if used with aluminum-containing antacids), hypophosphatemia.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics; administer at least 1 hour apart.
* **Levothyroxine:** Calcium acetate can decrease the absorption of levothyroxine; administer at least 1 hour apart.
* **Calcium Channel Blockers:** Concurrent use may lead to additive hypercalcemia.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
* **Antacids (aluminum-containing):** Increased risk of aluminum toxicity and hypercalcemia.
## Monitoring
* **Serum Calcium:** Monitor regularly, especially in patients with a history of hypercalcemia or those taking vitamin D supplements. Target serum calcium levels are typically within the normal range or slightly above depending on patient-specific goals.
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dose titration.
* **Serum Magnesium and Albumin:** Monitor as needed.
* **Signs and Symptoms of Hypercalcemia:** Headache, nausea, vomiting, constipation, abdominal pain, confusion, lethargy, bone pain, polyuria, polydipsia.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* When switching from other phosphate binders (e.g., sevelamer), monitor calcium and phosphate levels closely as the dose may need adjustment.
* Be vigilant for signs of hypercalcemia, especially in patients with underlying conditions that predispose to it or those concurrently taking vitamin D or calcium supplements.
* Calcium acetate contains approximately 25% elemental calcium by weight.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making therapeutic decisions.*
