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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
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
### Adult Dosing
* **Starting Dose:** 667 mg (1 gram of calcium acetate) orally with each meal.
* **Titration:** Doses should be individualized based on serum phosphate levels. The goal is to reduce serum phosphate to < 5.5 mg/dL.
* **Maximum Dose:** Generally, up to 2 grams (three 667 mg tablets or two 1 gram tablets) orally three times daily with meals. Some sources suggest a maximum of 4 grams per day.
### Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized by a specialist.
### Dose Adjustments
* **Renal Impairment:** Calcium acetate is primarily used in patients with CKD. Dosing is guided by serum phosphate and calcium levels.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
### Adverse Effects
* **Common:** Hypercalcemia (especially if calcium intake is excessive), nausea, vomiting, constipation, diarrhea.
* **Serious:** Severe hypercalcemia leading to cardiac arrhythmias, vascular calcification, hypotension, confusion, or coma.
### Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids containing magnesium or aluminum:** Concomitant use may increase the risk of hypercalcemia.
* **Vitamin D and its analogs:** May increase the risk of hypercalcemia.
### Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., weekly or bi-weekly initially, then monthly once stable) to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor regularly, as hypercalcemia is a significant risk. Target serum calcium levels should be established by the prescriber.
* **BUN and Creatinine:** Monitor renal function.
* **Alkaline Phosphatase:** Monitor for bone disease.
### Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* The amount of elemental calcium per dose varies by product strength (e.g., 667 mg of calcium acetate contains approximately 169 mg of elemental calcium).
* Careful monitoring of both serum phosphate and calcium is crucial for optimal efficacy and safety.
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***Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider for any medical condition or treatment. Dosing recommendations may vary based on individual patient factors and local protocols.*
