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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 to dietary phosphate in the gastrointestinal tract, preventing its absorption and thereby lowering serum phosphate levels.
### Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
### Adult Dosing
* **Initial dose:** 667 mg (equivalent to 169 mg elemental calcium) orally with each meal.
* **Titration:** Dose should be adjusted based on serum phosphate levels. The goal is to reduce serum phosphate to less than 6 mg/dL.
* **Maximum dose:** Doses up to 3335 mg (equivalent to 847 mg elemental calcium) orally with each meal have been used, but higher doses increase the risk of hypercalcemia.
### Pediatric Dosing
* **Dosing is not well-established.** Dosing in children should be individualized and guided by serum phosphate levels and tolerance. Caution is advised due to the risk of hypercalcemia and potential effects on bone growth.
### Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue the medication.
* **Concurrent medications:** Space administration of calcium acetate at least 1 hour apart from other oral medications, especially fluoroquinolones, tetracyclines, iron supplements, and thyroid hormones, to prevent chelation and reduced absorption.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
### Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Severe hypercalcemia (symptoms include confusion, lethargy, muscle weakness, arrhythmias), vascular calcification.
### Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can form insoluble complexes with these antibiotics, reducing their absorption. Separate administration by at least 1 hour.
* **Iron Supplements:** Calcium can decrease the absorption of oral iron. Separate administration.
* **Thyroid Hormones:** Calcium can decrease the absorption of thyroid hormones. Separate administration.
* **Digoxin:** Hypercalcemia from calcium acetate can potentiate digoxin toxicity. Monitor cardiac function closely.
* **Vitamin D Analogs:** May increase the risk of hypercalcemia.
### Monitoring
* **Serum phosphate:** Regularly monitor serum phosphate levels (initially weekly, then monthly once stable).
* **Serum calcium:** Regularly monitor serum calcium levels (initially weekly, then monthly once stable).
* **AlHos:** Monitor aluminum levels if aluminum-containing antacids are used concurrently.
### Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* The total daily elemental calcium intake from all sources (diet, supplements, binders) should be monitored to avoid exceeding recommended limits and causing hypercalcemia.
* For patients on dialysis, calcium acetate is often preferred over calcium carbonate due to a lower risk of aluminum absorption and hypercalcemia, especially when phosphorus levels are difficult to control.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider and refer to the official prescribing information for the most current and complete drug details before making any treatment decisions.*
