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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 works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption and lowering serum phosphate levels.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 667 mg orally, administered with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. The goal is to maintain serum phosphate levels below 5.5 mg/dL.
* **Maximum Dose:** Doses up to 4000 mg (approximately 2500 mg of elemental calcium) per day have been used, divided with meals. Careful monitoring is required at higher doses.
## Pediatric Dosing
* **General:** Dosing in pediatric patients is not well-established and should be individualized under specialist guidance.
* **Example (limited data):** Doses of 1.5-3.0 g/day divided with meals have been used in some pediatric populations. Monitor serum phosphate and calcium levels closely.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in CKD patients.
* **Hepatic Impairment:** No specific adjustment is generally recommended, but monitor for hypercalcemia.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Concomitant use of intravenous calcium.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Cardiovascular events (related to hypercalcemia), extraskeletal calcification.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours before or 6 hours after.
* **Thyroid Hormones:** Calcium may decrease absorption. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Aluminum-containing antacids:** Avoid concomitant use due to increased risk of aluminum toxicity and hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor regularly, especially at higher doses or in patients with a history of hypercalcemia. Goal serum calcium should be individualized but typically maintained within the normal range.
* **Alkaline Phosphatase:** Monitor for changes.
* **Renal Function:** Monitor as clinically indicated.
## Clinical Pearls
* Calcium acetate should be taken with meals to maximize phosphate binding.
* Hypercalcemia is a significant concern, particularly with higher doses or in patients also receiving calcium supplements or vitamin D analogs.
* Monitor serum calcium and phosphate levels frequently, especially during dose titration.
* If hypercalcemia occurs, reduce the dose of calcium acetate or discontinue and consider alternative therapies.
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*This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult current prescribing information and relevant clinical guidelines before making any treatment decisions.*
