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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, typically those with chronic kidney disease (CKD). It binds to dietary phosphate in the gastrointestinal tract, forming an insoluble calcium phosphate precipitate that is then excreted.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Dosing is individualized based on serum phosphate levels.**
* **Typical starting dose:** 667 mg (equivalent to 169 mg elemental calcium) orally with each meal.
* **Dose titration:** Increase dose gradually as needed to control serum phosphate levels.
* **Maximum dose:** Generally not to exceed 3000 mg (760 mg elemental calcium) per day, divided with meals.
## Pediatric Dosing
* **Limited data available.**
* Dosing should be individualized and guided by pediatric nephrology recommendations.
* One source suggests a starting dose of 10-20 mg/kg/day of elemental calcium, divided with meals. Monitor serum phosphate closely.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustment needed for CKD patients as the drug is intended for them. However, careful monitoring of calcium and phosphate levels is crucial.
* **Hepatic Impairment:** No specific dose adjustment needed.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions that predispose to hypercalcemia (e.g., certain malignancies, metastatic bone disease, sarcoidosis).
## Adverse Effects
* **Most common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Ectopic calcifications, cardiac arrhythmias (secondary to hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Amlodipine:** Concomitant use may increase the risk of hypercalcemia. Monitor calcium levels.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Calcium Channel Blockers:** Hypercalcemia may potentiate cardiovascular effects.
## Monitoring
* **Serum phosphate levels:** Monitor regularly to assess efficacy and guide dosing.
* **Serum calcium levels:** Monitor regularly to prevent and detect hypercalcemia.
* **Serum intact parathyroid hormone (iPTH) levels:** Monitor as part of the management of CKD-mineral bone disorder.
* **Alkaline phosphatase:** Monitor as an indicator of bone turnover.
* **24-hour urine calcium excretion:** May be monitored in non-dialysis CKD patients to assess calcium absorption and risk of hypercalciuria.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Patient education on dietary phosphate restriction is essential for effective management.
* Be aware of the potential for cumulative calcium load and the risk of hypercalcemia, especially in patients also receiving calcium supplements or vitamin D analogs.
* Consider alternative phosphate binders if hypercalcemia or constipation is significant.
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*Disclaimer: This information is intended for clinical use and does not replace professional medical advice. Always verify current prescribing information with the official product labeling and relevant guidelines before making any clinical decisions.*
