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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.
### Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
### Adult Dosing
* **Initial Dose:** 667 mg orally with meals.
* **Titration:** Dose should be individualized based on serum phosphate levels. Typical maintenance doses range from 1334 mg to 2001 mg per meal.
* **Maximum Dose:** Some sources suggest a maximum of 4000 mg per day, but individualize based on response and tolerability. Doses should be taken with each meal.
### Pediatric Dosing
* Dosing in pediatric patients is not well-established. Consult specialized pediatric resources.
### Dose Adjustments
* **Renal Impairment:** Dose is adjusted based on serum phosphate levels. Patients with CKD require ongoing monitoring and adjustment.
* **Hepatic Impairment:** No specific dose adjustments are generally recommended.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
### Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, abdominal pain, diarrhea.
* **Serious:** Calciphylaxis, cardiac arrhythmias (associated with hypercalcemia).
### Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concurrent use with other calcium-containing products may increase the risk of hypercalcemia.
* **Digitalis Glycosides:** Hypercalcemia may increase the risk of digitalis toxicity.
### Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., weekly or bi-weekly) to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor regularly to prevent or manage hypercalcemia.
* **Alkaline Phosphatase:** Monitor periodically.
* **Electrolytes:** Monitor periodically.
### Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphate.
* The dose should be titrated to achieve a target serum phosphate level (often < 5.5 mg/dL, but goal may vary).
* Patients with hypercalcemia should have their dose reduced or discontinued. If hypercalcemia persists, consider reducing calcium intake from other sources.
* Consider the total calcium load from all sources.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive guidance. Patient-specific factors may necessitate deviations from general recommendations.*
