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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 binds to dietary phosphate in the gastrointestinal tract, preventing its absorption and lowering serum phosphate levels.
### Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
### Adult Dosing
* **Initial dose:** 667 mg (which provides 169 mg elemental calcium) orally with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Target serum phosphate is typically less than 6 mg/dL. Doses can be increased up to 3335 mg (834 mg elemental calcium) per meal.
* **Maximum recommended dose:** Patients may require up to 3335 mg calcium acetate (834 mg elemental calcium) per meal.
### Pediatric Dosing
* Dosing is not well-established in pediatric patients. Consultation with a pediatric nephrologist is recommended.
### Dose Adjustments
* **Renal impairment:** No dose adjustment needed for renal impairment, as the drug is primarily for patients with CKD. However, hypercalcemia is a significant concern and requires careful monitoring and potential dose reduction or discontinuation.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Concomitant use with intravenous aluminum-containing products.
### Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, cardiac arrhythmias (secondary to hypercalcemia), calciphylaxis.
### Key Drug Interactions
* **Tetracyclines and fluoroquinolones:** Calcium acetate can reduce the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Thyroid hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Certain calcium channel blockers:** Hypercalcemia may potentiate the effects of calcium channel blockers.
* **Biphosphonates, sodium fluoride, and other oral mineral supplements:** Avoid concurrent administration due to potential for reduced absorption.
### Monitoring
* Serum phosphate levels (monitor closely after initiation and dose adjustments).
* Serum calcium levels (monitor closely to prevent hypercalcemia).
* Alkaline phosphatase.
* BUN and creatinine.
* Signs and symptoms of hypercalcemia.
### Clinical Pearls
* Administer calcium acetate with meals to ensure effective binding of dietary phosphate.
* Adjust the dose based on serum phosphate levels, aiming for the target range.
* Be vigilant for signs and symptoms of hypercalcemia (e.g., constipation, nausea, excessive thirst, frequent urination, confusion, bone pain).
* If hypercalcemia occurs, reduce the dose or discontinue the medication.
* Consider the total elemental calcium intake from all sources to avoid exceeding the recommended daily limit and increasing the risk of hypercalcemia and calcification.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and clinical guidelines for definitive guidance.
