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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
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
* **Initial Dose:** 500 mg to 1000 mg (approximately 1 to 2 tablets) with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. The goal is to maintain serum phosphate below 5.5 mg/dL.
* **Maximum Dose:** Generally, up to 4000 mg per day (8 tablets) divided with meals. However, caution is advised due to the risk of hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be managed by a physician experienced in pediatric nephrology.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium exceeds the target goal.
* **Concomitant Vitamin D Therapy:** Patients taking vitamin D or its analogs may require lower doses of calcium acetate due to increased calcium absorption.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Certain conditions leading to hypercalcemia (e.g., metastatic bone disease, primary hyperparathyroidism).
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Severe hypercalcemia (symptoms include confusion, lethargy, muscle weakness, arrhythmias, polyuria, polydipsia), adynamic bone disease (with long-term use).
## 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 these agents.
* **Levothyroxine:** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Binds to other medications:** May reduce the absorption of other drugs that require an acidic environment for absorption or are bound by cations.
## Monitoring
* **Serum Calcium:** Monitor regularly, especially when initiating therapy or changing doses. Target serum calcium levels are typically between 8.4 mg/dL and 9.5 mg/dL or as per local protocol.
* **Serum Phosphate:** Monitor regularly to guide dose titration.
* **Alkaline Phosphatase:** Monitor periodically.
* **Electrolytes:** Monitor as clinically indicated.
## Clinical Pearls
* Administer calcium acetate **with meals** to effectively bind dietary phosphate.
* The dose should be adjusted based on individual patient response, with a goal of achieving serum phosphate levels below 5.5 mg/dL while avoiding hypercalcemia.
* Patients should be advised to report symptoms of hypercalcemia.
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*This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and institutional protocols for complete details and to ensure patient safety.*
