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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with chronic kidney disease (CKD).
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
Dose is highly individualized based on serum phosphorus levels and dietary phosphorus intake.
* **Initial dose:** 667 mg (equivalent to 13.3 mEq elemental calcium) orally with each meal.
* **Titration:** Dose should be adjusted based on serum phosphorus levels. Typical maintenance doses range from 1334 mg to 2668 mg per day, divided with meals.
* **Maximum:** Doses exceeding 2668 mg/day are generally not recommended due to the risk of hypercalcemia.
## Pediatric Dosing
Dosing in pediatric patients is not well established and should be determined by a specialist. Generally, doses are initiated at lower levels and carefully titrated.
## Dose Adjustments
* **Renal Impairment:** Dose adjustments are not necessary in patients with CKD as the drug is used for this indication. However, close monitoring for hypercalcemia is crucial.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
## Contraindications
* Hypercalcemia.
* History of hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, anorexia.
* **Serious:** Cardiovascular calcification, renal calculi, gastrointestinal obstruction.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours before and 4-6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concomitant use may reduce the absorption of bisphosphonates. Separate administration by at least 2 hours.
* **Calcium Channel Blockers:** Increased risk of hypercalcemia. Monitor calcium levels closely.
## Monitoring
* **Serum Phosphorus:** Monitor regularly to guide dose titration.
* **Serum Calcium:** Monitor frequently, especially when initiating or adjusting doses, and periodically during therapy, to detect and manage hypercalcemia. Target serum calcium levels should be individualized but generally aim for the low end of the normal range.
* **Serum Magnesium and Phosphate:** Monitor periodically.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphorus.
* Patients should adhere to dietary phosphorus restrictions.
* Discontinue calcium acetate if serum calcium levels exceed the upper limit of normal or if signs and symptoms of hypercalcemia occur.
* Consider the total calcium load from all sources (diet, supplements, antacids) when managing patients on calcium acetate.
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*This information is intended for clinical decision support and does not replace professional judgment or the need to consult the official prescribing information. Always verify current prescribing information before making any clinical decisions.*
