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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 in the feces.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Initial dose:** 667 mg (1 gram) orally with each meal.
* **Titration:** Doses should be adjusted based on serum phosphate levels. Typical doses range from 1333 mg to 2000 mg (2 to 3 grams) orally with meals.
* **Maximum dose:** No specific maximum dose is established, but doses are titrated to achieve target phosphate levels.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established. Use is generally guided by adult recommendations and clinical judgment, often starting at lower doses and titrating cautiously.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in patients with ESRD.
* **Hepatic Impairment:** No dose adjustment necessary.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions that may lead to hypercalcemia (e.g., certain cancers, sarcoidosis).
## Adverse Effects
* **Common:** Hypercalcemia (signs include nausea, vomiting, constipation, polyuria, confusion, lethargy, anorexia).
* **Less Common:** Hypophosphatemia, gastrointestinal upset (nausea, diarrhea).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** 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 absorption. Separate administration by at least 4 hours.
* **Biphosphonates:** Concurrent use may reduce biphosphonate absorption. Separate administration.
## Monitoring
* **Serum Calcium:** Monitor regularly, especially at the initiation of therapy or dose changes, to avoid hypercalcemia. Target serum calcium levels should be individualized.
* **Serum Phosphate:** Monitor regularly to assess efficacy. Target serum phosphate levels are typically <5.5 mg/dL in patients on dialysis.
* **Alkaline Phosphatase:** May be monitored to assess bone disease.
## Clinical Pearls
* Calcium acetate must be taken with meals to be effective as a phosphate binder.
* The elemental calcium content of calcium acetate is approximately 25.5%.
* Patients should be advised to report symptoms of hypercalcemia.
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**Disclaimer:** This information is intended for clinical use and does not replace professional medical advice. Always verify current prescribing information and consult with a healthcare professional before making any treatment decisions.
