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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 phosphorus in the gastrointestinal tract, preventing its absorption and lowering serum phosphorus levels.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Hyperphosphatemia:** Start at 500 mg to 1000 mg (2-4 mEq elemental calcium) orally with meals.
* Dose should be titrated based on serum phosphorus levels, typically aiming for a target of less than 5.5 mg/dL.
* Maximum dose is generally considered 4000 mg (16 mEq elemental calcium) per day, divided among meals. Doses may vary based on local protocol and patient response.
## Pediatric Dosing
* There is limited established pediatric dosing for calcium acetate. Dosing is typically based on age and weight, and should be individualized by a clinician experienced in pediatric nephrology.
* Some sources suggest starting doses around 10-12 mg/kg/day of elemental calcium, divided with meals, but this requires careful titration and monitoring.
## Dose Adjustments
* No specific dose adjustments are typically required for hepatic impairment.
* Dose adjustments are guided by serum phosphorus levels and calcium levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, diarrhea.
* **Serious:** Development of hypercalcemia, especially when co-administered with vitamin D or calcium supplements. Gastrointestinal obstruction or perforation (rare).
## 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:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids containing magnesium or aluminum:** May increase the risk of hypermagnesemia or aluminum toxicity.
* **Vitamin D and calcium supplements:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Phosphorus:** Regularly monitor serum phosphorus levels, typically within weeks of initiating or adjusting therapy, and then periodically as clinically indicated.
* **Serum Calcium:** Monitor serum calcium levels closely, especially with higher doses or concurrent use of vitamin D or calcium supplements, to prevent hypercalcemia. Target serum calcium levels are generally between 8.0 to 9.5 mg/dL.
* **Other Electrolytes:** Monitor electrolytes (e.g., magnesium, bicarbonate) as clinically indicated.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphorus binding.
* Tablet form should be chewed thoroughly before swallowing to optimize efficacy.
* Hypercalcemia is the most common and serious adverse effect. Patients should be educated about symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, abdominal pain, fatigue, confusion, frequent urination).
* Adjust dose based on trended phosphorus and calcium levels, not single readings.
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*This information is intended for educational purposes and does not substitute for current prescribing information. Always verify the latest drug information with official product labeling and consult with a healthcare professional.*
