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## Calcium Acetate
### Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with end-stage renal disease (ESRD).
### Primary Indications
* **Hyperphosphatemia:** Management of hyperphosphatemia in patients with chronic kidney disease on dialysis.
### Adult Dosing
* **Dosage:** Dosing is individualized based on serum phosphate levels.
* **Starting Dose:** Typically 667 mg (elemental calcium 169 mg) orally with each meal.
* **Titration:** May be increased up to 2 g (elemental calcium 508 mg) orally with each meal.
* **Maximum Dose:** Generally not to exceed 4 g (elemental calcium 1016 mg) per day. Doses higher than this are not well-studied.
### Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be guided by expert clinical judgment and specific protocols.
### Dose Adjustments
* **Renal Impairment:** Not applicable as it is primarily used in ESRD patients.
* **Hepatic Impairment:** No specific dose adjustment is recommended.
### Contraindications
* Hypercalcemia
* Hypersensitivity to calcium acetate or any component of the formulation.
### Adverse Effects
* **Common:** Nausea, vomiting, constipation, diarrhea, hypercalcemia (especially if excessive doses are used or in patients with impaired renal function).
* **Serious:** Hypercalcemia can lead to cardiac arrhythmias, confusion, delirium, and coma.
### Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer oral antibiotics at least 2 hours before or 3 hours after calcium acetate.
* **Levothyroxine:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia induced by calcium acetate can potentiate digoxin toxicity.
### Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor regularly, especially with higher doses or in susceptible patients, to prevent hypercalcemia.
* **Serum Magnesium and Albumin:** May be useful in interpreting calcium levels.
### Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Monitor for signs and symptoms of hypercalcemia (e.g., constipation, nausea, abdominal pain, frequent urination, bone pain, muscle weakness, confusion, fatigue).
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*Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and local institutional protocols for definitive patient care decisions.*
