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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 works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* **Hyperphosphatemia** in patients with end-stage renal disease (ESRD).
## Adult Dosing
The initial dose is typically 667 mg (equivalent to 169 mg elemental calcium) administered orally with meals. The dose should be titrated based on serum phosphate levels.
* **Target:** Serum phosphate < 5.5 mg/dL.
* **Maximum:** Generally considered 4000 mg per day (approximately 1000 mg elemental calcium), though some sources suggest up to 6670 mg (1690 mg elemental calcium) may be used with careful monitoring. Titrate slowly, increasing by one tablet (667 mg) per meal at a time, and reassess serum phosphate in 1-2 weeks.
## Pediatric Dosing
Dosing for pediatric patients is not well established and should be individualized by a physician.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in CKD patients.
* **Hepatic Impairment:** No dose adjustment needed.
## Contraindications
* Hypercalcemia.
* Conditions leading to hypercalcemia, such as metastatic bone disease or primary hyperparathyroidism.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Most Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Cardiovascular events (due to hypercalcemia), bone pain, calciphylaxis (rare).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Levothyroxine:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Calcium acetate can decrease the absorption of biphosphonates. Separate administration by at least 30 minutes.
* **Certain Antacids:** Concurrent use may increase the risk of hypercalcemia.
## Monitoring
* **Serum Calcium and Phosphate:** Monitor frequently, especially during dose titration and periodically thereafter. Target serum phosphate < 5.5 mg/dL. Maintain serum calcium within the normal range (typically 8.5-10.0 mg/dL, though target may vary based on guidelines).
* **Alkaline Phosphatase:** Monitor periodically.
* **Signs and Symptoms of Hypercalcemia:** Assess regularly.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Dose titration should be guided by serum phosphate levels, aiming for the lowest effective dose.
* Be aware of the potential for hypercalcemia and monitor serum calcium levels closely.
* Patient education regarding symptoms of hypercalcemia is crucial.
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*Disclaimer: This information is intended for clinical use only. Always consult the most current prescribing information and relevant clinical guidelines for complete details, as recommendations may vary.*
