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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.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Initial Dose:** 2 tablets (667 mg elemental calcium per tablet) orally with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Increase dose gradually by 1-2 tablets per meal if serum phosphate remains above target (typically < 5.5 mg/dL).
* **Maximum Dose:** No strict maximum is established, but doses exceeding 12 tablets per day are generally not recommended without careful monitoring of calcium levels. Monitor serum calcium levels closely.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be determined by a nephrologist based on individual needs and careful monitoring.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium levels exceed the upper limit of normal. Dosage adjustments are crucial to prevent hypercalcemia, especially when co-administered with calcium supplements or vitamin D analogs.
* **Concomitant Medications:** May interfere with absorption of certain medications (see Key Drug Interactions).
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Nausea, vomiting, constipation, diarrhea, abdominal pain.
* **Serious:** Hypercalcemia (manifestations include anorexia, nausea, vomiting, constipation, abdominal pain, polyuria, polydipsia, muscle weakness, bone pain, cardiac arrhythmias), hypophosphatemia.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** 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 acetate can reduce the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium acetate can decrease bisphosphonate absorption. Separate administration by at least 2 hours before or 6 hours after calcium acetate.
* **Calcium Channel Blockers:** Concurrent use with calcium supplements may potentiate hypercalcemia.
* **Vitamin D Analogs:** Increased risk of hypercalcemia. Closely monitor calcium and phosphate levels.
## Monitoring
* **Serum Phosphate:** Monitor regularly (e.g., weekly initially, then monthly or as indicated) to assess efficacy and titrate dose.
* **Serum Calcium:** Monitor regularly (e.g., weekly initially, then monthly or as indicated) to prevent and manage hypercalcemia.
* **Alkaline Phosphatase:** Monitor as indicated.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* If patients are taking other medications that may interact, consider timing of administration.
* Calcium acetate is a source of elemental calcium; assess total daily calcium intake from all sources to avoid excessive calcium accumulation.
* Monitor for signs and symptoms of hypercalcemia.
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**Disclaimer:** This information is intended for clinical use and does not replace professional judgment. Always verify current prescribing information with the official product labeling and consult relevant guidelines or resources before making clinical decisions.
