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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
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Starting dose:** 667 mg (equivalent to 169 mg elemental calcium) administered orally with each meal.
* **Titration:** Dosage should be titrated based on serum phosphate levels. Target serum phosphate is typically less than 6 mg/dL. Doses can be increased by one 667 mg tablet per meal at a time.
* **Maximum dose:** Most guidelines suggest a maximum of 4000 mg (10 tablets) per day, but some sources may recommend higher if tolerated and needed for phosphate control. Actual maximum may vary based on tolerability and clinical response.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be individualized under specialist care. Some sources suggest starting doses based on age and weight, for example:
* 1-5 years: 200-400 mg/meal
* 6-12 years: 400-800 mg/meal
* >12 years: 800-1000 mg/meal
* Careful monitoring of calcium and phosphate levels is crucial.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium levels exceed the upper limit of normal (typically > 10.5 mg/dL).
* **Renal Impairment:** No dose adjustment is typically needed as the drug acts locally in the GI tract. However, monitoring calcium and phosphate is essential.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Use with caution in patients with active kidney stones.
## Adverse Effects
* **Common:** Nausea, vomiting, constipation, diarrhea.
* **Serious:** Hypercalcemia, hypophosphatemia. Symptoms of hypercalcemia include anorexia, dry mouth, metallic taste, nausea, vomiting, constipation, abdominal pain, polyuria, polydipsia, weakness, headache, confusion, lethargy, and cardiac arrhythmias.
## 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 (e.g., Levothyroxine):** Calcium can reduce the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Biphosphonates and Antiretrovirals:** Concurrent use may decrease absorption. Separate administration.
## Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., monthly or as clinically indicated) to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor regularly to prevent or manage hypercalcemia.
* **Serum Magnesium and Alkaline Phosphatase:** May be monitored periodically.
## Clinical Pearls
* Administer with meals to ensure adequate binding of dietary phosphate.
* Chewable tablets should be thoroughly chewed before swallowing.
* Patients should be instructed to report symptoms of hypercalcemia.
* Ensure adequate hydration.
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*This information is intended for healthcare professionals and does not replace independent clinical judgment. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*
