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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 works by binding to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted in the feces.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 667 mg (2 tablets) orally with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Monitor serum phosphate levels closely and titrate the dose upwards as needed.
* **Maximum Dose:** The maximum recommended dose is 4000 mg per day (12 tablets) divided with meals. Higher doses have not been extensively studied and may increase the risk of hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients with ESRD is not well-established. Dosing should be guided by serum phosphate levels and calcium levels, with caution due to the risk of hypercalcemia and aluminum toxicity (if co-administered with aluminum-containing antacids, though this combination should be avoided).
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, the dose of calcium acetate should be reduced or temporarily discontinued.
* **Concomitant Medications:** Calcium acetate can affect the absorption of other medications. Separate administration of calcium acetate from other oral medications by at least 1 hour before or 3 hours after.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Use in patients with urolithiasis or a history of nephrolithiasis.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Severe hypercalcemia (symptoms include confusion, lethargy, muscle weakness, cardiac arrhythmias, coma), vascular calcification.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 1 hour before or 3 hours after.
* **Thyroid Hormones:** Calcium acetate can impair the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Antacids:** Concurrent use with aluminum-containing antacids can lead to aluminum toxicity. Avoid this combination.
* **Digoxin:** Hypercalcemia induced by calcium acetate may potentiate cardiac toxicity of digoxin.
* **Certain Antihypertensives (e.g., thiazide diuretics):** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Regularly monitor serum phosphate levels to guide dosing.
* **Serum Calcium:** Monitor serum calcium levels frequently, especially at the initiation of therapy and with dose adjustments, to prevent and manage hypercalcemia. Target serum calcium levels should be based on clinical guidelines and patient-specific factors.
* **Alkaline Phosphatase:** May be monitored in patients with CKD.
* **Signs and Symptoms of Hypercalcemia:** Educate patients and monitor for symptoms.
## Clinical Pearls
* Calcium acetate is most effective when taken with meals to maximize phosphate binding.
* Educate patients on the importance of adhering to the prescribed dosing schedule with meals.
* Monitor for and manage hypercalcemia proactively. A common target for corrected calcium is below 10.5 mg/dL (2.62 mmol/L).
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete details. Always verify drug information with an up-to-date resource before making clinical decisions.*
