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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption and lowering serum phosphate levels.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Initial dose:** 2 tablets (133 mg elemental calcium per tablet) with each meal.
* **Titration:** Increase dose gradually to control serum phosphate levels. Maximum dose is typically 16-20 tablets per day, divided among meals.
* **Elemental Calcium Content:** Each tablet contains approximately 133 mg of elemental calcium.
* **Target:** Serum phosphate < 5.5 mg/dL. Dosing should be individualized based on serum phosphate levels and tolerance.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under specialist care. Available data suggests a starting dose of 10-15 mg/kg/day of elemental calcium, divided into 3 doses with meals. Monitor phosphate levels closely.
## Dose Adjustments
* No specific adjustments for hepatic impairment.
* For renal impairment, dose adjustments are based on serum phosphate and calcium levels. Avoid in patients with hypercalcemia.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, renal calculi.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may reduce absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concomitant use may increase risk of hypercalcemia.
## Monitoring
* Serum phosphate levels (should be monitored regularly, especially during dose titration).
* Serum calcium levels (monitor closely for hypercalcemia, aim for corrected calcium < 11 mg/dL).
* Alkaline phosphatase.
* Fluid and electrolyte balance.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Corrected calcium should be monitored closely; hypercalcemia is a common and serious adverse effect.
* Patients may require reduced doses of other calcium-containing phosphate binders if switching to calcium acetate.
* Educate patients on signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, bone pain, confusion).
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for complete details.*
