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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, primarily in chronic kidney disease. It binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate complexes that are then excreted.
## Primary Indications
* Treatment of hyperphosphatemia in patients with chronic kidney disease on dialysis.
## Adult Dosing
* **Dosage is individualized based on serum phosphate levels.**
* **Initial dose:** 2 tablets (668 mg elemental calcium) PO with meals.
* **Titration:** Increase dose gradually as needed to control serum phosphate.
* **Maximum dose:** 16 tablets (5344 mg elemental calcium) per day. Doses higher than 8 tablets per day are generally not recommended without careful monitoring.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and requires careful consideration of individual needs and serum phosphate levels. Consult pediatric nephrology guidelines.
## Dose Adjustments
* **Renal Impairment:** Dose must be adjusted based on serum calcium and phosphate levels. Patients with severe renal impairment are at increased risk of hypercalcemia.
* **Hypercalcemia:** Treatment should be interrupted or dose reduced if hypercalcemia occurs.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Concurrent use of intravenous calcium.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea.
* **Serious:** Severe hypercalcemia, hypophosphatemia.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease absorption. Separate administration by at least 2 hours.
* **Levothyroxine:** Calcium acetate can decrease absorption. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
* **Calcium Channel Blockers:** Concomitant use of calcium-containing products can potentiate effects.
* **Thiazide Diuretics:** Increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor regularly, especially in the initial stages of therapy and with dose adjustments, to prevent hypercalcemia. Target normal serum calcium levels.
* **Electrolytes:** Monitor electrolytes periodically.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Educate patients on the importance of regular monitoring of serum calcium and phosphate.
* Be aware of the signs and symptoms of hypercalcemia (e.g., confusion, lethargy, nausea, vomiting, constipation, polyuria, polydipsia) and hypophosphatemia (e.g., muscle weakness, bone pain, paresthesia).
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*This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant guidelines for complete details. Dosing may vary based on individual patient factors and local protocols.*
