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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, typically associated with chronic kidney disease.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease.
## Adult Dosing
* Dosing is highly individualized and titrates to achieve target serum phosphate levels.
* Administer with meals or snacks to effectively bind dietary phosphate.
* Typical starting dose: 2 tablets (668 mg elemental calcium) orally with each meal.
* Dose may be increased incrementally.
* Maximum recommended dose: Generally not to exceed 12 tablets (4008 mg elemental calcium) per day, but may be influenced by individual tolerance and serum calcium levels.
## Pediatric Dosing
* Data is limited. Dosing is typically managed by a pediatric nephrologist based on individual assessment.
## Dose Adjustments
* **Renal Impairment:** Contraindicated in patients with hypercalcemia. Requires careful monitoring of serum calcium and phosphate levels due to impaired phosphate excretion and risk of calcium accumulation.
* **Hepatic Impairment:** No specific dose adjustments are necessary, but monitor calcium and phosphate levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, abdominal pain.
* **Serious:** Calciphylaxis (rare but severe), cardiac arrhythmias (associated with hypercalcemia).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease absorption. Separate administration by at least 2 hours before and 4-6 hours after.
* **Levothyroxine:** Calcium acetate can decrease absorption. Administer at least 4 hours apart.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Antacids containing magnesium or aluminum:** Concurrent use can lead to increased magnesium or aluminum absorption.
## Monitoring
* **Serum Calcium:** Regularly monitor, especially with the initiation or dose adjustment of calcium acetate or concurrent medications affecting calcium. Target levels vary but generally aim to avoid hypercalcemia.
* **Serum Phosphate:** Monitor regularly to assess efficacy.
* **Serum Magnesium:** Monitor periodically.
* **Alkaline Phosphatase:** Monitor periodically.
## Clinical Pearls
* Administering calcium acetate with meals is crucial for its intended mechanism of action.
* Routinely monitor for signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, polyuria, bone pain).
* Consider alternative phosphate binders if hypercalcemia is persistent or severe.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and pertinent literature before making clinical decisions.*
