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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, often associated with chronic kidney disease. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Phosphate Binder:** Dosing is highly individualized and titrate based on serum phosphate levels.
* Typical starting dose: 667 mg (13.3 mEq calcium) orally three times daily with meals.
* Dose adjustments are made to maintain serum phosphate below 5.5 mg/dL.
* Maximum dose: Typically 2000 mg (40 mEq calcium) orally three times daily.
## Pediatric Dosing
* Dosing is not well-established and requires careful titration by a clinician experienced in pediatric nephrology. Consult local protocols or specialized literature.
* Some sources suggest starting doses around 10-20 mg/kg/day of elemental calcium, divided into doses with meals.
## Dose Adjustments
* **Renal Impairment:** While typically used in ESRD, caution is advised in patients with moderate renal impairment due to risk of hypercalcemia and calcium accumulation.
* **Hepatic Impairment:** No specific dose adjustment is typically required, but monitor calcium levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Concurrent use with intravenous aluminum-containing antacids or phosphate-binding gels.
## Adverse Effects
* **Common:** Hypercalcemia (most significant risk), constipation, nausea, vomiting, anorexia, abdominal pain.
* **Serious:** Arrhythmias (secondary to hypercalcemia), calciphylaxis, nephrolithiasis.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones (e.g., Ciprofloxacin, Doxycycline):** Calcium acetate can decrease absorption. Separate administration by at least 2 hours before or 6 hours after.
* **Bisphosphonates (e.g., Alendronate):** Calcium acetate can reduce absorption. Separate administration.
* **Digoxin:** Hypercalcemia associated with calcium acetate can increase the risk of digoxin toxicity.
* **Calcium Channel Blockers:** Monitor for potential additive effects.
* **Thiazide Diuretics:** Can increase serum calcium levels and the risk of hypercalcemia.
* **Aluminum-containing Antacids/Phosphate Binders:** Avoid concurrent use due to increased risk of aluminum toxicity.
## Monitoring
* **Serum Phosphate:** Regularly monitor to guide dosing.
* **Serum Calcium:** Regularly monitor (e.g., weekly initially, then monthly). Target range is typically between 8.5 and 10.5 mg/dL, but may be adjusted based on clinical context.
* **Serum Magnesium and Alkaline Phosphatase:** May be monitored.
* **Signs and symptoms of hypercalcemia:** Assess regularly.
## Clinical Pearls
* Must be taken with meals to effectively bind dietary phosphate.
* Dose titration is crucial to balance phosphate control with the risk of hypercalcemia.
* Educate patients on the importance of taking medication with meals and reporting symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, bone pain).
* Consider the total elemental calcium content when assessing for hypercalcemia risk, especially in patients taking multiple calcium-containing products.
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**Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health or treatment. Drug information can change rapidly.
