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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 in the feces.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Dosage:** Initiate at 667 mg (1 gram) of calcium acetate orally with each meal.
* **Titration:** Increase dose gradually as needed to lower serum phosphate levels.
* **Maximum Dose:** Generally not to exceed 4000 mg (6 grams) per day. Doses should be individualized based on serum phosphate levels and calcium levels. The amount of elemental calcium per dose will vary depending on the product formulation.
## Pediatric Dosing
* There is no established FDA-approved pediatric dosing for calcium acetate. Use in pediatric patients should be based on clinical judgment and expert consultation. Dosing is often extrapolated from adult data but requires careful monitoring of serum calcium and phosphate.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue. Monitor serum calcium levels closely.
* **Renal Impairment (non-ESRD):** Use with caution and monitor calcium and phosphate levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions that may predispose to hypercalcemia such as certain malignancies or granulomatous diseases.
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include nausea, vomiting, constipation, abdominal pain, polyuria, polydipsia, muscle weakness, confusion), hypophosphatemia.
* **Less Common:** Paradoxical worsening of hyperphosphatemia (if doses are insufficient), gastrointestinal upset.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Thyroid Hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids containing magnesium or aluminum:** Concurrent use can lead to excessive accumulation of aluminum or magnesium.
* **Calcium Channel Blockers:** May potentiate hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing. Target levels are typically below 5.5 mg/dL.
* **Serum Calcium:** Monitor regularly to prevent and manage hypercalcemia. Target levels are typically within the normal range or slightly elevated, as per institutional guidelines for CKD patients.
* **PTH (Parathyroid Hormone):** Monitor as part of overall CKD mineral and bone disorder management.
## Clinical Pearls
* Calcium acetate should be taken with meals to maximize phosphate binding.
* Patients should be educated about the signs and symptoms of hypercalcemia and instructed to report them promptly.
* It is crucial to differentiate between calcium acetate doses and the amount of elemental calcium provided.
* For patients with CKD, some elevation in serum calcium may be acceptable and even desired to help suppress PTH, but persistent or severe hypercalcemia must be avoided.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant literature, and exercise clinical judgment. Dosing and management strategies can vary based on individual patient factors and local protocols.
