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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, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 667 mg (equivalent to 169 mg elemental calcium) orally with each meal.
* **Titration:** Dose should be individualized based on serum phosphate levels. The goal is to reduce serum phosphate to < 5.5 mg/dL.
* **Maximum dose:** Doses up to 4000 mg per day (1000 mg per meal) have been used, but caution is advised due to potential for hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients has not been well established. Individualize based on serum phosphate levels and monitor closely. Typical starting doses have ranged from 10-20 mg/kg/day of elemental calcium divided with meals.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or temporarily discontinue. Correct underlying causes of hypercalcemia (e.g., excessive vitamin D intake).
* **Concurrent medications:** Separate administration of calcium acetate from certain medications (e.g., fluoroquinolones, tetracyclines, bisphosphonates, thyroid hormones) by at least 2 hours before and 4-6 hours after.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, diarrhea.
* **Serious:**ascular calcification, cardiac events, gastrointestinal obstruction.
## Key Drug Interactions
* **Vitamin D and its analogs:** Increased risk of hypercalcemia.
* **Calcium channel blockers:** Potential for decreased absorption of calcium channel blockers.
* **Tetracyclines and Fluoroquinolones:** Decreased absorption of these antibiotics.
* **Digoxin:** Hypercalcemia may increase the risk of cardiac arrhythmias with digoxin.
## Monitoring
* **Serum phosphate:** Monitor regularly to assess efficacy and guide dose titration.
* **Serum calcium:** Monitor frequently, especially during dose titration and in patients with risk factors for hypercalcemia. Target serum calcium levels are generally between 8.5-10 mg/dL.
* **Serum magnesium and alkaline phosphatase:** May be monitored periodically.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Monitor for signs and symptoms of hypercalcemia (e.g., confusion, lethargy, nausea, vomiting, constipation, polyuria, polydipsia).
* Ensure adequate hydration to help prevent constipation.
* Consider the total elemental calcium content when considering other calcium-containing supplements or medications.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and clinical guidelines before making therapeutic decisions.*
