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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 phosphorus in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 667 mg calcium acetate (equivalent to 133 mg elemental calcium and 105 mg acetate) per meal.
* **Titration:** Doses should be titrated based on serum phosphorus levels. Doses are typically increased by 667 mg per meal every 1-2 weeks.
* **Maximum dose:** Individualized based on patient response and tolerance, but generally not to exceed 3000 mg elemental calcium per day (approximately 14-15 tablets of 667 mg strength per day).
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under specialist guidance. Limited data suggests doses may range from 10-30 mg elemental calcium/kg/day divided with meals, not to exceed adult maximums.
## Dose Adjustments
* **Renal Impairment:** No specific dose adjustment is recommended in patients with CKD, as the drug is primarily used in this population. However, close monitoring of serum calcium and phosphorus is crucial.
* **Hepatic Impairment:** No dose adjustment is necessary.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Development of vascular and soft tissue calcification, especially with prolonged use or elevated calcium levels.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer oral antibiotics at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concurrent use may increase serum calcium levels.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
## Monitoring
* **Serum Phosphorus:** Monitor regularly (e.g., before initiating therapy, at dose titration, and monthly thereafter) to assess efficacy.
* **Serum Calcium:** Monitor regularly (e.g., before initiating therapy, at dose titration, and monthly thereafter) to detect and prevent hypercalcemia. Target serum calcium levels are generally within the normal range or slightly above, as defined by local guidelines.
* **Alkaline Phosphatase:** Monitor periodically.
* **Symptoms of Hypercalcemia:** Patients should be educated to report symptoms such as constipation, nausea, vomiting, polyuria, polydipsia, weakness, and confusion.
## Clinical Pearls
* Administer calcium acetate with or immediately after meals to maximize phosphorus binding.
* Patients often require a significant number of tablets per day to achieve adequate phosphorus control.
* Switching to calcium acetate from other phosphate binders may require dose adjustments.
* Co-administration with vitamin D or its analogues may increase the risk of hypercalcemia.
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*This information is intended for healthcare professionals. Please consult the official prescribing information for the most current and comprehensive details.*
