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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, typically associated with chronic kidney disease (CKD). It works by binding dietary phosphorus in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 667 mg (13.3 mEq elemental calcium) orally with meals.
* **Titration:** Doses should be adjusted based on serum phosphorus levels. Doses can be increased gradually.
* **Maximum dose:** Up to 1334 mg (26.6 mEq elemental calcium) orally with meals, up to 4 times daily, for a total maximum daily dose of 5336 mg (106.4 mEq elemental calcium).
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under specialist guidance.
## Dose Adjustments
* **Renal Impairment:** Dose adjustments are inherently part of the management of hyperphosphatemia in CKD. Monitor serum calcium and phosphorus closely.
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Patients with constipation or impaction due to the risk of worsening these conditions.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, dry mouth.
* **Serious:** Severe hypercalcemia (may lead to cardiac arrhythmias, confusion, coma), gastrointestinal obstruction.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia associated with calcium products may increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the serum calcium level.
## Monitoring
* **Serum Phosphorus:** Regularly monitor to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor closely, especially at the initiation of therapy and with dose adjustments, to prevent and detect hypercalcemia. Target serum calcium should be within the normal range or as per institutional guidelines.
* **Alkaline Phosphatase:** Monitor as indicated.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphorus binding.
* The elemental calcium content of calcium acetate is approximately 25%. Each 667 mg tablet contains approximately 169 mg of elemental calcium.
* For patients who cannot swallow tablets, chewable formulations are available.
* Be aware of the potential for accumulation of calcium, especially in patients with reduced renal function.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and institutional protocols for complete and up-to-date guidance before making any clinical decisions.
