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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with chronic kidney disease (CKD). It binds to dietary phosphorus 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:** 667 mg (1 gram of calcium acetate) orally with each meal.
* **Titration:** Dose should be adjusted based on serum phosphorus levels. Monitor phosphorus levels within 1-2 weeks of any dose adjustment.
* **Maximum Dose:** Doses up to 1334 mg (2 grams of calcium acetate) per dose (with meals) have been used.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established. Consultation with a pediatric nephrologist is recommended.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue.
* **Concurrent Calcium-Containing Medications:** Use with caution to avoid exceeding the total daily calcium intake recommendation.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Ectopic calcifications, cardiac valve calcification, vascular calcification, hypophosphatemia.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate may decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after the antibiotic.
* **Levothyroxine:** Calcium may decrease the absorption of levothyroxine. Administer levothyroxine at least 4 hours apart from calcium acetate.
* **Fatty Acid Supplements (e.g., Calcium Carbonate):** Concurrent use may increase the risk of hypercalcemia.
* **Calcium Salts:** Concomitant use can lead to excessive calcium intake and hypercalcemia.
## Monitoring
* Serum phosphorus levels (target generally < 5.5 mg/dL, but goal may vary based on guidelines).
* Serum calcium levels (monitor for hypercalcemia; target generally < 10.5 mg/dL, but goal may vary).
* Alkaline phosphatase.
* Potential signs and symptoms of hypercalcemia (e.g., confusion, lethargy, nausea, constipation, polyuria, polydipsia).
## Clinical Pearls
* Calcium acetate is most effective when taken with meals to bind dietary phosphorus.
* Monitor serum calcium and phosphorus levels closely, especially during initiation and titration.
* Adjust dose to maintain serum phosphorus within the target range while avoiding hypercalcemia.
* Be aware of potential interactions with other medications that can affect absorption.
* Educate patients on the importance of taking medication with meals and reporting symptoms of hypercalcemia.
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*Disclaimer: This information is intended for clinical use and does not replace professional judgment. Always consult the most current prescribing information and clinical guidelines for definitive guidance.*
