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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
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dosing:** Typically initiated at 667 mg to 1 gram (1000 mg) orally three times daily with meals.
* **Titration:** Dose should be adjusted based on serum phosphate levels. Target serum phosphate is generally less than 5.5 mg/dL.
* **Maximum Dosing:** There is no established maximum dose, but doses exceeding 4 grams (4000 mg) per day are rarely used and require careful monitoring due to the risk of hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well established. Dosing should be individualized based on clinical response and serum phosphate levels, with careful monitoring for adverse effects.
## Dose Adjustments
* **Renal Impairment:** Calcium acetate is used in ESRD patients. However, dose adjustments are based on serum phosphate and calcium levels, not GFR.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions leading to hypercalcemia, such as sarcoidosis, certain malignancies, or primary hyperparathyroidism.
## Adverse Effects
* **Common:** Nausea, vomiting, constipation, diarrhea.
* **Serious:** Hypercalcemia (symptoms include anorexia, nausea, vomiting, constipation, abdominal pain, polyuria, polydipsia, muscle weakness, bone pain, confusion, lethargy, cardiac arrhythmias), hypophosphatemia, milk-alkali syndrome.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** 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.
* **Other Calcium-Containing Products:** Concomitant use can increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor regularly (at least weekly during initiation and titration, then monthly). Note that corrected calcium may be more informative in some patients.
* **BUN and Creatinine:** Monitor periodically.
* **Symptoms of Hypercalcemia:** Educate patients on symptoms and assess regularly.
## Clinical Pearls
* Administer calcium acetate **with meals** to maximize phosphate binding.
* If patients require calcium supplements for other reasons, this should be considered in the overall calcium intake to avoid hypercalcemia.
* When switching from other phosphate binders, monitor serum calcium and phosphate closely as dosing may need adjustment.
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**Disclaimer:** This information is intended for clinical use and does not substitute for professional medical judgment. Always consult the most current prescribing information and relevant guidelines for complete details and to ensure patient safety. Dosing and recommendations may vary based on individual patient factors and local protocols.
