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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.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initiation:** Typically 2 tablets (667 mg elemental calcium per tablet) orally with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Doses can be increased by 1-2 tablets per meal as needed.
* **Maximum:** Recommended maximum dose is 12 tablets (8004 mg elemental calcium) per day. However, monitor serum calcium levels closely; doses exceeding 7 tablets (4669 mg elemental calcium) per day are associated with hypercalcemia.
## Pediatric Dosing
Dosing in pediatric patients is not well established and should be individualized under specialist guidance. Close monitoring of calcium and phosphate levels is crucial.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue therapy.
* **Hypocalcemia:** May require calcium supplementation.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Ventricular fibrillation.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, abdominal pain, diarrhea.
* **Serious:** Vascular calcification, cardiac arrhythmias.
## 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 (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Calcium acetate may reduce the absorption of bisphosphonates. Administer bisphosphonates at least 30 minutes before calcium acetate or separate by several hours.
* **Antacids:** Concurrent use may increase serum calcium levels.
## Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., before initiating, 1 week, 1 month, then every 3 months).
* **Serum Calcium:** Monitor regularly, especially when initiating or adjusting dose. Target serum calcium is typically within the normal range (e.g., 8.4-9.5 mg/dL).
* **Alkaline Phosphatase:** Monitor periodically.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Always consider the elemental calcium content when calculating doses and monitoring for hypercalcemia. Each 667 mg tablet contains approximately 169 mg of elemental calcium.
* Patients on calcium acetate are at increased risk for hypercalcemia. Educate patients on symptoms and to report them promptly.
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**Disclaimer:** This information is for educational purposes only and does not constitute medical advice. Always verify current prescribing information with the official drug labeling or a qualified healthcare professional.
