Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, primarily in the setting of chronic kidney disease (CKD).
## Primary Indications
* **Hyperphosphatemia:** Management of elevated serum phosphorus levels in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Phosphate Binding:** Dosing is individualized based on serum phosphate levels and dietary intake.
* Starting doses typically range from 1 to 2 grams (equivalent to 13.2 to 26.4 mEq elemental calcium) administered orally with meals.
* Doses can be increased incrementally up to a maximum of 8 grams per day.
* **Important:** Each gram of calcium acetate contains approximately 13.2 mEq of elemental calcium. Dosing should target maintaining serum phosphate below 6 mg/dL.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be managed by a pediatric nephrologist. Dosing varies widely based on age, weight, and serum phosphate levels.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it's primarily used in patients with ESRD.
* **Hepatic Impairment:** No specific adjustments are typically required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Patients with a history of calcium stones.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea, abdominal pain, dyspepsia.
* **Serious:** Vascular calcification, cardiac arrhythmias (associated with hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Oral calcium acetate can significantly decrease the absorption of these antibiotics. Administer these antibiotics at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may decrease bisphosphonate absorption. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia associated with calcium acetate can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dosing and assess efficacy.
* **Serum Calcium:** Monitor regularly, especially with higher doses or if clinical signs of hypercalcemia are present. Correct for serum albumin if necessary.
* **Renal function:** Monitor as indicated by clinical status.
* **Alkaline Phosphatase:** May be monitored in patients with bone disease.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* It is crucial to monitor both serum calcium and phosphate levels to prevent hypercalcemia and ensure efficacy.
* Patients should be educated about the risk of hypercalcemia symptoms (e.g., nausea, vomiting, constipation, increased urination, bone pain, confusion).
* The formulation and indication for use (e.g., as a phosphate binder) are distinct from calcium supplements used for bone health.
***
*Disclaimer: This information is intended for healthcare professionals and is not a substitute for clinical judgment. Always refer to the most current prescribing information and local institutional guidelines.*
