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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to manage hyperphosphatemia in patients with chronic kidney disease (CKD). It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption and thus lowering serum phosphate levels.
## Primary Indications
* Management of hyperphosphatemia in patients with chronic kidney disease on dialysis.
## Adult Dosing
* **Starting Dose:** 667 mg (1 gram of calcium acetate, containing approximately 25% elemental calcium by weight) orally three times daily with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Doses can be increased up to 1.33 grams (2 grams of calcium acetate) orally with meals, up to a maximum of 13.3 grams (20 grams of calcium acetate) per day.
* **General Guideline:** Aim for serum phosphate levels below 6 mg/dL.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized based on clinical response and laboratory parameters. Consult specific pediatric guidelines or specialist advice.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is typically required as it is intended for patients with CKD. However, monitor calcium and phosphate levels closely.
* **Hepatic Impairment:** No dose adjustment is typically required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Use with caution in patients with active kidney stones.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), nausea, vomiting, constipation, diarrhea, abdominal pain.
* **Serious:** Vascular calcification, cardiac arrhythmias (due to hypercalcemia), hypophosphatemia.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can reduce the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Thyroid Hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Other Oral Medications:** Due to potential for binding, it is generally recommended to administer other oral medications at least 1 hour before or 3 hours after calcium acetate.
## Monitoring
* **Serum Calcium:** Monitor frequently, especially at initiation and during dose adjustments. Target serum calcium levels should be maintained within the normal range.
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dose titration.
* **Serum Bicarbonate:** Monitor for potential metabolic alkalosis.
* **Electrolytes:** Monitor sodium, potassium, and chloride.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Hypercalcemia is a dose-limiting toxicity and can lead to serious complications. Monitor calcium levels closely and reduce the dose if hypercalcemia occurs.
* Ensure adequate hydration to help prevent constipation and reduce the risk of kidney stones.
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*Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information and consult relevant clinical guidelines before making treatment decisions.*
