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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 that is then excreted.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Dosage:** Typically initiated at 133 mg (1 mmol elemental calcium) to 333 mg (2.5 mmol elemental calcium) per 1000 mg of dietary phosphate, taken with meals.
* **Titration:** Doses should be individualized based on serum phosphate levels.
* **Maximum dose:** Generally, no more than 667 mg (5 mmol elemental calcium) per meal. Doses exceeding 667 mg per meal are uncommon. Individual total daily dose can reach up to 3000 mg (22.5 mmol elemental calcium), but should be guided by serum phosphate and calcium levels.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be individualized with caution, guided by expert consultation and careful monitoring of serum calcium and phosphate.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium exceeds the target range (often < 11.5 mg/dL or institution-specific upper limit).
* **Hypocalcemia:** May require calcium supplementation.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Use with caution in patients with arterial calcification or active calciphylaxis.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, metastatic calcification, hypophosphatemia.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease absorption of levothyroxine. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Antacids:** Concurrent use may increase the risk of hypercalcemia.
* **Vitamin D:** Concurrent use can potentiate the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., before initiating, 1 week after dose change, every month thereafter for 3 months, then every 3 months).
* **Serum Calcium:** Monitor regularly (e.g., before initiating, 1 week after dose change, every month thereafter for 3 months, then every 3 months). Target levels are typically maintained below 11.5 mg/dL.
* **Serum Magnesium and Alkaline Phosphatase:** Monitor periodically.
## Clinical Pearls
* Administer calcium acetate with or immediately after meals to maximize phosphate binding.
* If multiple phosphate binders are needed, consider spacing administration to optimize absorption of other medications.
* Hypercalcemia is a significant concern, especially in patients taking vitamin D or with vitamin D intoxication.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making any clinical decisions.*
