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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.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Starting Dose:** 2 tablets (approximately 1332 mg calcium acetate) with meals.
* **Titration:** Dose should be titrated gradually based on serum phosphate levels. Aim for serum phosphate levels below 6 mg/dL.
* **Maximum Dose:** There is no established maximum dose, but clinical response and tolerance should guide therapy. Monitor for hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized by a clinician experienced in pediatric nephrology. Generally, lower doses are used, and careful monitoring is required.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in patients with ESRD. Dose adjustment is guided by serum phosphate and calcium levels.
* **Hepatic Impairment:** No specific dose adjustments are necessary.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Concurrent use with medications that rely on gastrointestinal absorption that may be significantly reduced by calcium acetate (e.g., certain antibiotics, thyroid hormones).
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, anorexia, increased urination, thirst), hypophosphatemia.
* **Serious:** Ectopic calcifications, cardiac valvular calcification, vascular calcification.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can significantly decrease the absorption of these antibiotics. Separate administration by at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones (e.g., Levothyroxine):** Calcium salts can reduce the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Biphosphonates:** Calcium acetate may decrease the absorption of bisphosphonates. Separate administration by at least 2 hours before or 24 hours after bisphosphonates.
* **Antacids containing magnesium or aluminum:** Concomitant use may increase the risk of hypermagnesemia or hyperaluminemia, respectively, and should be avoided.
## Monitoring
* **Serum Phosphate:** Regularly monitor to guide dose titration and efficacy.
* **Serum Calcium:** Monitor regularly (at least every 3 days initially, then weekly) to prevent and detect hypercalcemia. Target serum calcium levels should be individualized, but generally aim to keep below 10.5 mg/dL.
* **Electrolytes:** Monitor other electrolytes as clinically indicated.
* **Alkaline Phosphatase:** Monitor as an indicator of bone turnover.
## Clinical Pearls
* Administer calcium acetate with meals or immediately after to maximize phosphate binding.
* Be vigilant for signs and symptoms of hypercalcemia. If hypercalcemia occurs, discontinue calcium acetate and reduce dietary calcium intake.
* Consider the potential for reduced absorption of other medications when co-administered.
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**Disclaimer:** This information is intended for clinical pharmacy professionals and should not replace the most current prescribing information or professional judgment. Always verify current product information and local protocols before making therapeutic decisions.
