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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
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
### Adult Dosing
* **Dosage:** Initiate at 667 mg (equivalent to 169 mg elemental calcium) with each meal.
* **Titration:** Gradually increase dose based on serum phosphate levels. Typical doses range from 1333 mg to 2668 mg per meal.
* **Maximum:** Up to 5336 mg per day (divided among meals). Monitor serum calcium levels closely, as the maximum elemental calcium intake should generally not exceed 2000 mg/day from all sources.
### Pediatric Dosing
* Dosing is not well-established in pediatric patients. Consultation with a pediatric nephrologist or clinical pharmacist specializing in pediatrics is recommended.
### Dose Adjustments
* **Hypercalcemia:** Reduce or discontinue dose if serum calcium exceeds the upper limit of normal (typically >10.5 mg/dL).
* **Hypophosphatemia:** Reduce dose if serum phosphate falls below the desired target.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions leading to hypercalcemia, such as metastatic bone disease or certain renal conditions.
### Adverse Effects
* **Common:** Hypercalcemia, hypophosphatemia, constipation, nausea, vomiting.
* **Serious:** Adynamic bone disease (with prolonged use at high doses), vascular calcification.
### Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer antibiotics at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may decrease bisphosphonate absorption. Separate administration.
* **Antacids:** Avoid concurrent use to prevent excessive calcium intake and potential hypercalcemia.
* **Vitamin D:** May increase the risk of hypercalcemia.
### Monitoring
* **Serum Phosphate:** Monitor at least weekly until phosphate levels are controlled, then monthly. Target serum phosphate is generally <5.5 mg/dL.
* **Serum Calcium:** Monitor at least weekly until calcium levels are stable, then monthly.
* **Alkaline Phosphatase:** Monitor periodically.
* **Signs and Symptoms of Hypercalcemia:** Monitor for nausea, vomiting, constipation, abdominal pain, increased thirst and urination, confusion, and fatigue.
### Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Tablet must be chewed or crushed for full effect.
* The calcium content of calcium acetate is approximately 25.5% by weight (169 mg elemental calcium per 667 mg tablet).
* Consider alternative phosphate binders if hypercalcemia is problematic.
* Ensure adequate dietary phosphorus intake or supplementation if hypophosphatemia develops.
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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 and consult with a qualified healthcare provider before making any treatment decisions.*
