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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 end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 1330 mg to 2660 mg (665 mg to 1330 mg elemental calcium) administered orally with meals.
* **Titration:** Doses should be individualized based on serum phosphate levels. Goal serum phosphate is typically < 5.5 mg/dL.
* **Maximum Dose:** Generally not to exceed 4000 mg (2000 mg elemental calcium) per day.
## Pediatric Dosing
* **Dosing is not well-established in pediatric patients.** Dosing should be individualized based on serum phosphate levels and clinical response under specialist guidance.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is not typically required in patients with CKD as the drug is used to *treat* hyperphosphatemia in this population. However, careful monitoring for hypercalcemia is crucial.
* **Hepatic Impairment:** No specific dose adjustments are recommended.
## Contraindications
* Hypercalcemia.
* History of hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia (manifesting as constipation, nausea, vomiting, abdominal pain, anorexia, polyuria, polydipsia, weakness), hypophosphatemia.
* **Less Common:** Arrhythmias, bone pain, calcification of soft tissues.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones (e.g., Levothyroxine):** Calcium acetate can reduce the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Biphosphonates, Sodium Fluoride, Antacids containing aluminum or magnesium:** Concurrent use may alter absorption and increase risk of adverse effects.
## Monitoring
* **Serum Calcium:** Monitor frequently, especially during dose titration, to prevent or manage hypercalcemia. Target serum calcium levels should be individualized, but generally aim for the upper end of the normal range.
* **Serum Phosphate:** Monitor regularly to assess efficacy.
* **Alkaline Phosphatase:** Monitor as an indicator of bone turnover.
* **Renal Function:** Monitor kidney function periodically.
## Clinical Pearls
* Administer calcium acetate **with meals** to maximize phosphate binding.
* Be aware of the risk of **hypercalcemia**, especially in patients receiving other calcium-containing products or vitamin D analogs.
* Individualize dosing to achieve target phosphate levels while avoiding hypercalcemia.
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*This information is intended for healthcare professionals. Always verify current prescribing information and consult with appropriate resources before making clinical decisions.*
