Please check your internet connection and try again.
## Calcium Acetate
### Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD). It binds to dietary phosphate in the gastrointestinal tract, preventing its absorption and promoting its excretion.
### Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
### Adult Dosing
* **Dosage Range:** 667 mg to 2000 mg (elemental calcium 133 mg to 400 mg) per dose.
* **Frequency:** Administer with each meal. The total daily dose should be individualized based on serum phosphate levels.
* **Maximum Dose:** Typically, no more than 2000 mg per meal (400 mg elemental calcium) is recommended, but total daily intake of elemental calcium should not exceed 4000 mg from all sources.
### Pediatric Dosing
* Dosing for pediatric patients is not well-established and should be individualized under specialist guidance.
### Dose Adjustments
* **Hyperphosphatemia:** Increase dose gradually if serum phosphate remains elevated.
* **Hypocalcemia:** Decrease dose if hypocalcemia occurs.
* **Concurrent Calcium Supplementation:** Total calcium intake (from calcium acetate, dietary sources, and other supplements) should be monitored to avoid hypercalcemia.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Concomitant use of other calcium-containing phosphate binders.
### Adverse Effects
* **Common:** Hypercalcemia (signs include nausea, vomiting, constipation, abdominal pain, confusion, lethargy, anorexia), hypocalcemia (signs include paresthesias, muscle cramps, tetany).
* **Less Common:** Gastrointestinal upset (nausea, vomiting, diarrhea).
### 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 (e.g., Levothyroxine):** Calcium acetate can decrease the absorption of thyroid hormones. Administer at least 4 hours apart.
* **Biphosphonates:** Concurrent use may decrease the absorption of biphosphonates. Administer at least 2 hours before calcium acetate.
* **Certain Antacids:** Concurrent use can increase calcium levels.
### Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., weekly or bi-weekly initially) to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor regularly to detect and prevent hypercalcemia.
* **Serum Magnesium and Alkaline Phosphatase:** May be monitored periodically.
* **Bicarbonate Levels:** Monitor, especially in patients with metabolic acidosis.
### Clinical Pearls
* Administer calcium acetate with meals to maximize its phosphate-binding capacity.
* Individualize the dose based on serum phosphate levels and patient tolerance.
* Educate patients on signs and symptoms of hypercalcemia and hypocalcemia.
* Be mindful of total calcium intake from all sources.
***
*This information is intended for clinical use and does not replace professional medical advice. Always verify current prescribing information with the official product labeling or other reliable resources.*
