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## Calcium Acetate
### Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. 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
* **Dosage is highly individualized and titrate**d to achieve target serum phosphate levels.
* **Starting dose:** Typically 667 mg (which provides 169 mg of elemental calcium and 1000 mg of acetate) taken with meals.
* **Titration:** Dose may be increased in increments of 667 mg per meal.
* **Maximum dose:** Commonly cited maximum is 4000 mg of calcium acetate per day (which provides 1014 mg of elemental calcium). However, some sources suggest higher doses may be used cautiously under close monitoring. The target serum phosphate level is usually < 5.5 mg/dL.
### Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under the guidance of a nephrologist.
### Dose Adjustments
* **Renal Impairment:** Dose adjustment is based on serum phosphate and calcium levels.
* **Hypercalcemia:** Discontinue or reduce dose if serum calcium exceeds the target range (goal is typically < 10.5 mg/dL or as per local protocol).
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Concurrent use with medications that can cause hypercalcemia.
### Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Adynamic bone disease (with long-term excessive calcium intake), calcification of soft tissues.
### Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease absorption. Separate administration by at least 2 hours before and 6 hours after.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease absorption. Separate administration by at least 4 hours.
* **Cation-Donating Medications:** Concurrent use with other calcium-containing products or antacids can increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia can increase digoxin toxicity.
* **Thiazide Diuretics:** Can increase serum calcium levels.
### Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., weekly to monthly) to guide dosing.
* **Serum Calcium:** Monitor regularly. If serum calcium is elevated, consider dose reduction or interruption.
* **Alkaline Phosphatase:** Monitor periodically.
* **Electrolytes:** Monitor periodically.
### Clinical Pearls
* Administer with meals to ensure adequate binding of dietary phosphate.
* The amount of elemental calcium per dose varies by product strength and formulation. Always verify the elemental calcium content when calculating doses or assessing risk of hypercalcemia.
* Educate patients on signs and symptoms of hypercalcemia (e.g., constipation, bone pain, confusion, nausea, frequent urination).
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*This information is for educational purposes only and does not substitute for professional medical advice. Always verify current prescribing information with the manufacturer's package insert and consult with a healthcare professional.*
