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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, forming insoluble calcium phosphate, which is then excreted in the feces.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 667 mg (1 gram) orally with meals.
* **Titration:** Doses should be individualized based on serum phosphorus levels.
* **Typical Dose Range:** 1332 mg to 2668 mg per day (2 to 4 grams) divided with meals.
* **Maximum Dose:** Generally not to exceed 4000 mg per day (6 grams), though higher doses may be used cautiously under close monitoring.
## 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 divided with meals, titrated to phosphorus levels.
## Dose Adjustments
* No specific dose adjustments are required for hepatic impairment.
* Dose must be adjusted based on serum phosphorus levels and calcium levels. If serum phosphorus is below 4 mg/dL, the dose should be reduced or interrupted.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Certain conditions that predispose to hypercalcemia, such as metastatic bone disease or sarcoidosis.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), nausea, vomiting, constipation, diarrhea, abdominal pain, anorexia.
* **Serious:** Severe hypercalcemia, cardiac arrhythmias, hypophosphatemia, milk-alkali syndrome.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics by forming chelates. Administer these antibiotics at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones (e.g., Levothyroxine):** Calcium acetate can decrease the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Other Calcium-Containing Products:** Concomitant use can increase the risk of hypercalcemia.
* **Antacids (calcium-containing):** Increases the risk of hypercalcemia and aluminum toxicity if aluminum-containing antacids are also used.
## Monitoring
* **Serum Phosphorus:** Monitor closely at baseline and regularly during treatment to guide dose titration.
* **Serum Calcium:** Monitor regularly (e.g., weekly when initiating or changing dose, then monthly) to prevent and detect hypercalcemia. Goal serum calcium is generally within the normal range or slightly above, depending on institutional guidelines and patient-specific factors.
* **Alkaline Phosphatase:** May be monitored to assess response in patients with bone disease.
* **BUN and Creatinine:** Monitor renal function.
## Clinical Pearls
* Administer with meals to maximize phosphorus binding.
* Pill burden can be high; consider formulations with higher calcium acetate content per tablet if available and appropriate.
* Educate patients on signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, bone pain, confusion).
* Concurrent use of vitamin D or its analogs may increase the risk of hypercalcemia.
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**Disclaimer:** This information is intended for healthcare professionals and does not substitute for comprehensive drug information resources or clinical judgment. Always verify current prescribing information and guidelines before making therapeutic decisions.
