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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, typically associated with chronic kidney disease. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
The typical starting dose is 133 mg (1 gram of calcium acetate) administered orally with meals. Doses should be adjusted to achieve a target serum phosphorus level (often < 5.5 mg/dL).
* **Maximum Dose:** Doses up to 333 mg (2.5 grams of calcium acetate) per meal have been used, but this should be guided by patient response and tolerance.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized based on patient weight, serum phosphorus levels, and clinical response. Consultation with a pediatric nephrologist is recommended.
## Dose Adjustments
* **Renal Impairment:** Dose should be reduced in patients with significant renal impairment outside of standard dialysis protocols or with other causes of impaired calcium excretion.
* **Hypercalcemia:** If hypercalcemia occurs, the dose of calcium acetate should be reduced or discontinued.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions leading to metastatic calcification.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Arrhythmias (associated with hypercalcemia), vascular calcification, hypophosphatemia.
## 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.
* **Biphosphonates, Sodium Fluoride:** Calcium acetate can decrease their absorption. Separate administration.
* **Digitalis Glycosides:** Hypercalcemia induced by calcium acetate can increase the risk of digitalis toxicity.
* **Thiazide Diuretics:** Can increase serum calcium levels, potentiating the risk of hypercalcemia.
## Monitoring
* **Serum Phosphorus:** Monitor regularly, especially during dose adjustments.
* **Serum Calcium:** Monitor regularly to detect and prevent hypercalcemia.
* **Serum Magnesium and Alkaline Phosphatase:** May be useful in assessing overall mineral and bone disorder.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Chewable tablets should be thoroughly chewed before swallowing.
* Patients should be educated on signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, frequent urination, thirst, bone pain).
* Consider alternative phosphate binders if adequate control is not achieved or if hypercalcemia is problematic.
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*This information is intended for healthcare professionals. Please consult the most current prescribing information for complete details and to verify recommendations.*
