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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, preventing its absorption and lowering serum phosphate levels.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Dosage:** Start with 2 tablets (667 mg elemental calcium per tablet) by mouth with meals.
* **Titration:** Gradually increase the dose to lower serum phosphate to target levels (typically < 5.5 mg/dL). Doses can be increased by 1-2 tablets per meal.
* **Maximum Dose:** The recommended maximum dose is 4 grams (approximately 16 tablets) per day, divided with meals.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under specialist guidance. Some sources suggest starting doses of 10-12 mg/kg/day of elemental calcium, divided with meals.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is primarily used in patients with ESRD.
* **Hepatic Impairment:** No dose adjustment is typically required.
## Contraindications
* Hypercalcemia.
* History of hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia (especially if dose exceeds requirements or with concomitant vitamin D therapy), nausea, vomiting, constipation, diarrhea, abdominal pain.
* **Serious:** Calciphylaxis, cardiac arrhythmias (associated with hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours (before or after).
* **Thyroid Hormones (e.g., Levothyroxine):** Calcium can interfere with the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium can reduce the absorption of bisphosphonates. Separate administration by at least 2 hours.
* **Strips (e.g., Digoxin):** Hypercalcemia can potentiate cardiac effects of digoxin.
* **Vitamin D and analogs:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor closely, especially during dose titration, to achieve target levels.
* **Serum Calcium:** Monitor regularly, particularly in patients with a history of hypercalcemia or those taking vitamin D. Target serum calcium levels are generally 8.4-9.5 mg/dL.
* **Serum Magnesium and Alkaline Phosphatase:** May be monitored periodically.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphate.
* If a patient is on a low-phosphate diet, the dose of calcium acetate may need to be reduced.
* Patients with hypercalcemia should have their dose reduced or discontinued, and their vitamin D intake should be evaluated.
* Consider switching to a different phosphate binder if hypercalcemia persists despite dose reduction.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information with the manufacturer's product monograph and consult relevant clinical guidelines before making any treatment decisions.*
