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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, forming insoluble calcium phosphate, which is then excreted in the feces.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Usual Starting Dose:** 1-2 tablets (667 mg to 1334 mg of calcium acetate) with each meal.
* **Titration:** Dosing should be individualized based on serum phosphate levels.
* **Maximum Dose:** Doses up to 20 tablets per day have been used, but higher doses increase the risk of hypercalcemia. Titrate to achieve serum phosphate goal, typically < 6 mg/dL, while avoiding hypercalcemia.
* **Administration:** Administer with meals. Tablets should be chewed thoroughly before swallowing.
## Pediatric Dosing
Dosing in pediatric patients is not well-established. Individualization based on serum phosphate and calcium levels is required, and consultation with a pediatric nephrologist is recommended.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue the medication. Assess and correct other causes of hypercalcemia (e.g., vitamin D therapy).
* **Renal Impairment:** Use with caution in patients with moderate renal impairment due to risk of calcium accumulation.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Patients with urolithiasis or a history of urolithiasis associated with calcium.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Severe hypercalcemia, vascular calcification, gastrointestinal obstruction.
## 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 may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concurrent use may increase calcium absorption and the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Fat-soluble vitamins:** May decrease absorption.
## Monitoring
* **Serum Calcium:** Monitor regularly, especially when initiating therapy or increasing the dose.
* **Serum Phosphate:** Monitor regularly to assess efficacy.
* **Serum Magnesium and Albumin:** To aid in the interpretation of serum calcium levels.
* **Electrolytes and Renal Function:** Periodically.
## Clinical Pearls
* Must be taken with meals for effective phosphate binding.
* Chewable tablets should be thoroughly chewed for optimal efficacy.
* Close monitoring for hypercalcemia is crucial, as this is a common and potentially serious side effect.
* Individualize dosing based on patient response and tolerance.
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**Disclaimer:** This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant literature for complete details before making any clinical decisions.
