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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 phosphate in the gastrointestinal tract, forming insoluble calcium phosphate which is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Initial Dose:** 133 mg (1 gram) to 500 mg (3.5 grams) of calcium acetate administered orally with meals. Dosing should be individualized based on serum phosphate levels.
* **Titration:** Doses are typically increased in increments of 250 mg to 500 mg of calcium acetate per meal.
* **Maximum Dose:** No defined maximum dose, but doses exceeding 3.5 grams (4 tablets of 250 mg elemental calcium) per meal may increase the risk of hypercalcemia.
## Pediatric Dosing
* Limited data available for pediatric use. Dosing is not well-established and requires careful titration and monitoring under specialist guidance.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium levels exceed the target range (typically < 10.5 mg/dL or < 2.6 mmol/L).
* **Hypocalcemia:** May require increased dosage if phosphate levels are controlled but calcium is low, though this is less common.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Renal calculi (history of calcium-containing kidney stones).
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, adynamic bone disease (with long-term use and high doses).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can chelate with these antibiotics, reducing their absorption. Separate administration by at least 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Cation-Donating Products:** Use with other calcium-containing products or vitamin D analogs can increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Regularly monitor to guide dosing and assess efficacy.
* **Serum Calcium:** Regularly monitor to prevent and manage hypercalcemia. Target levels should be individualized but generally aim for within the normal range or slightly above, depending on institutional protocol.
* **Intact Parathyroid Hormone (iPTH):** Monitor as part of overall CKD mineral and bone disorder management.
* **Alkaline Phosphatase:** Monitor as an indicator of bone turnover.
## Clinical Pearls
* Administer with meals to effectively bind dietary phosphate.
* Dosing is individualized and requires frequent adjustments based on laboratory values.
* Consider the elemental calcium content when calculating doses and monitoring for hypercalcemia. Each 500 mg tablet of calcium acetate contains approximately 125 mg of elemental calcium.
* Vigilance for signs and symptoms of hypercalcemia (e.g., nausea, vomiting, polyuria, constipation, confusion) is crucial.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions. Dosing may vary based on patient-specific factors and local protocols.*
