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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, often associated with chronic kidney disease. It binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate that is then excreted in feces.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 667 mg (1 gram) of calcium acetate administered orally with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Doses can be increased in increments of 667 mg per meal if needed.
* **Maximum Dose:** Generally not to exceed 4000 mg (6 grams) of calcium acetate per day, which equates to 1333 mg per meal for three meals. However, this can vary based on individual tolerance and response.
## Pediatric Dosing
* Dosing in pediatric patients has not been well-established. Consultation with a pediatric nephrologist is recommended. Some sources suggest starting with 10-15 mg/kg/day of elemental calcium (from calcium acetate) divided into 3 doses with meals.
## Dose Adjustments
* No specific dose adjustments are necessary for renal or hepatic impairment beyond the intended use in patients with ESRD.
* Serum calcium levels must be monitored closely, and the dose adjusted to maintain serum calcium within the target range (typically <11 mg/dL).
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Concurrent use with intravenous calcium salts.
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern), constipation, nausea, vomiting, abdominal pain.
* **Less Common:** Diarrhea, dry mouth, headache, anorexia.
* **Rare:** Hypotension, cardiac arrhythmias, mental status changes, calcification of soft tissues.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of oral tetracyclines and quinolone antibiotics. Separate administration by at least 2 hours.
* **Levothyroxine:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor closely, especially at initiation and with dose adjustments, to prevent and manage hypercalcemia. Target levels are generally <11 mg/dL.
* **Alkaline Phosphatase:** May be monitored in chronic kidney disease patients.
* **Electrolytes:** Monitor periodically.
## Clinical Pearls
* Administer calcium acetate with meals to maximize dietary phosphate binding.
* Patient education regarding signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, bone pain) is crucial.
* The goal of therapy is to reduce serum phosphate, but avoiding hypercalcemia is paramount.
* Consider the amount of elemental calcium provided by the dose (667 mg calcium acetate provides approximately 169 mg of elemental calcium).
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**Disclaimer:** This information is intended for healthcare professionals and should not replace independent clinical judgment. Always consult the most current prescribing information, institutional protocols, and patient-specific factors before making therapeutic decisions.
