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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 phosphorus 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
* **Initial Dose:** 667 mg (2 tablets) orally with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. The goal is to reduce serum phosphate to less than 6 mg/dL.
* **Maximum Dose:** Generally not to exceed 4000 mg per day (12 tablets) divided with meals.
## Pediatric Dosing
* Dosing for pediatric patients is not well established and should be determined by a specialist based on individual patient needs and monitoring.
## Dose Adjustments
* **Renal Impairment:** Dose adjustments are not typically made for renal impairment, as the drug is used in CKD patients. However, careful monitoring of serum calcium and phosphate is crucial.
* **Hepatic Impairment:** No specific dose adjustments are recommended.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Patients with a history of nephrolithiasis (calcium-containing stones).
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Cardiovascular events (related to hypercalcemia), adynamic bone disease (with long-term high doses).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours (before or after).
* **Thyroid Hormones (Levothyroxine):** Calcium salts can impair the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Certain Antifungals (e.g., Ketoconazole, Itraconazole):** Absorption may be decreased.
* **Antacids containing calcium:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor frequently until normalized, then monitor regularly (e.g., every 2-4 weeks).
* **Serum Calcium:** Monitor frequently, especially during initiation and dose titration, and periodically thereafter. Be aware of the potential for hypercalcemia.
* **Albumin:** Used to correct serum calcium levels when interpreting calcium values.
* **Alkaline Phosphatase:** May be monitored as an indicator of bone turnover.
* **Signs/Symptoms of Hypercalcemia:** Monitor for nausea, vomiting, constipation, abdominal pain, polyuria, polydipsia, weakness, confusion.
## Clinical Pearls
* Administer with meals to effectively bind dietary phosphorus.
* Monitor serum calcium levels closely, as hypercalcemia is a significant risk. If hypercalcemia occurs, reduce the dose or discontinue.
* For patients with both CKD and hypercalcemia, other phosphate binders may be considered.
* Educate patients on the importance of taking medication with meals and reporting any symptoms of hypercalcemia.
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***Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information or a qualified healthcare provider for any questions regarding drug therapy. Dosing and recommendations may vary based on individual patient factors and local protocols.*
