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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
* **Dosing is individualized based on serum phosphate levels and dietary intake.**
* **Starting dose:** 667 mg (13.3 mEq calcium) orally three times daily with meals.
* **Titration:** Dose should be gradually increased, monitoring serum phosphate levels, until adequate control is achieved.
* **Maximum dose:** Generally considered to be 4 g per day, which is 2000 mg (40 mEq calcium) administered three times daily with meals.
### Pediatric Dosing
* **Safety and efficacy in pediatric patients have not been established.** Dosing should be determined by a pediatric nephrologist based on individual patient assessment.
### Dose Adjustments
* **Renal Impairment:** Not applicable as it's used in ESRD.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
* **Monitor Calcium Levels:** If hypercalcemia develops, the dose of calcium acetate should be reduced or discontinued. Consider reducing other calcium-containing medications or vitamin D supplements.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
### Adverse Effects
* **Common:** Hypercalcemia (especially with concomitant vitamin D therapy), constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, potential for calcium-acetate-phosphate precipitates in the GI tract.
### Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer oral tetracyclines/quinolones at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concomitant use may increase the risk of hypercalcemia.
* **Vitamin D and its analogs:** Increased risk of hypercalcemia.
### Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing. Target levels are typically <5.5 mg/dL.
* **Serum Calcium:** Monitor regularly, especially when initiating or increasing doses, or in patients taking other calcium-containing products or vitamin D. Target levels are typically within the normal range or slightly above, as per institutional guidelines.
* **Serum Magnesium and Alkaline Phosphatase:** May be monitored periodically.
### Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphate.
* Patients should be educated about the symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, fatigue, increased urination) and to report them promptly.
* The overall calcium load from all sources (medications, diet) should be considered in managing patients.
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*This information is intended for healthcare professionals. Always verify current prescribing information and consult with a pharmacist or physician for patient-specific advice.*
