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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 works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease requiring dialysis.
## Adult Dosing
* **Dosage:** Typically initiated at 667 mg (equivalent to 169 mg elemental calcium and 133 mg acetate) to 1333 mg (equivalent to 338 mg elemental calcium and 267 mg acetate) administered orally three times daily with meals.
* **Titration:** Doses are adjusted based on serum phosphate levels. The goal is to maintain serum phosphate below 6 mg/dL.
* **Maximum Dose:** Target doses vary, but serum calcium levels should be monitored closely; excessive calcium intake can lead to hypercalcemia. Individualize based on phosphate levels and calcium-x-phosphate product.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be individualized based on clinical response, serum phosphate, and serum calcium levels. Consult specialized pediatric nephrology resources for guidance.
## Dose Adjustments
* **Renal Impairment:** No dose adjustment is required, as the drug is used in patients with CKD. However, careful monitoring of serum calcium and phosphate is crucial.
* **Hepatic Impairment:** No specific adjustments are typically needed, but hypercalcemia should be monitored.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Patients with a tendency toward constipation or those on medications that cause constipation should be monitored closely.
## Adverse Effects
* **Common:** Constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Hypercalcemia (symptoms include confusion, lethargy, anorexia, constipation, polyuria, polydipsia, cardiac arrhythmias), hyperphosphatemia.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease 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.
* **Biphosphonates and Sodium Fluoride:** Calcium acetate can decrease the absorption of these agents. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia induced by calcium acetate can potentiate digoxin toxicity.
* **Thiazide Diuretics:** Increased risk of hypercalcemia.
* **Vitamin D Analogs:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Regularly monitor to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor regularly. Target calcium levels are typically between 8.5-10 mg/dL.
* **Corrected Calcium:** Consider correcting for serum albumin if available.
* **Calcium-Phosphate Product:** Monitor and aim to keep below 55 mg²/dL².
* **Electrolytes:** Monitor for other electrolyte imbalances.
## Clinical Pearls
* Administer calcium acetate *with meals* to effectively bind dietary phosphate.
* Dosing should be highly individualized based on serum phosphate levels and tolerance.
* Vigilant monitoring for hypercalcemia is critical, especially in patients receiving other calcium-containing products or vitamin D analogs.
* If constipation occurs, doses may need to be reduced or a laxative may be considered.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current official prescribing information and relevant clinical guidelines for complete and up-to-date details before making any treatment decisions.*
