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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, commonly seen in chronic kidney disease. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Starting dose:** 667 mg (2 mEq calcium) orally with each meal.
* **Titration:** Dose should be individualized based on serum phosphate levels. Titrate upwards by one tablet per meal, increasing by 667 mg per dose, as needed.
* **Maximum dose:** While not explicitly defined, doses exceeding 10-12 tablets per day are rarely needed and increase the risk of hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be guided by specialist recommendations and careful monitoring of serum calcium and phosphate levels.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia develops, reduce the dose or discontinue.
* **Concomitant calcium supplements or vitamin D:** These may increase the risk of hypercalcemia.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, hypophosphatemia.
* **Serious:** Vascular calcification, cardiac events, gastrointestinal obstruction.
## 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:** May decrease absorption. Separate administration by at least 2 hours.
* **Antacids containing magnesium or aluminum:** May increase the risk of adverse effects.
## Monitoring
* **Serum phosphate levels:** Monitor regularly, especially during dose titration.
* **Serum calcium levels:** Monitor regularly to prevent or manage hypercalcemia. Target serum calcium levels should be individualized.
* **Serum magnesium and alkaline phosphatase:** May be monitored periodically.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Encourage adequate fluid intake to help prevent constipation.
* Patients should be educated about signs and symptoms of hypercalcemia (e.g., nausea, vomiting, abdominal pain, increased thirst, frequent urination, muscle weakness, bone pain, confusion).
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions. Dosing and management may vary based on individual patient factors and local protocols.
