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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, particularly those with chronic kidney disease (CKD). It works by binding to dietary phosphorus in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted in the feces. ## Primary Indications * **Hyperphosphatemia:** Management of elevated serum phosphorus levels in patients with end-stage renal disease (ESRD) or other forms of CKD. ## Adult Dosing The goal is to lower serum phosphorus towards normal. Dosing is highly individualized based on serum phosphorus levels and dietary phosphorus intake. * **Initial Dosing:** Typically starts at 667 mg (1 tablet or 5 mL of suspension) with each meal. * **Titration:** Dosage is adjusted based on serum phosphorus levels. Doses can be increased up to 4 tablets or 20 mL of suspension per meal. * **Maximum Dose:** Generally not to exceed 4000 mg (20 tablets or 100 mL of suspension) per day. Doses should be divided among meals. ## Pediatric Dosing Dosing in pediatric patients should be individualized and is often based on total calcium intake and phosphorus levels. Specific established pediatric dosing can be variable and may depend on institutional protocols. * **General Guideline:** May start at 13.3 mg/kg/day divided into 3 doses with meals. * **Titration:** Adjust based on serum phosphorus and calcium levels. * **Maximum Dose:** Generally not to exceed the adult maximum of 4000 mg/day. Close monitoring of calcium levels is crucial. ## Dose Adjustments * **Renal Impairment:** Dose adjustments are critical and dictated by serum phosphorus and calcium levels. Patients with CKD already have impaired renal function, so careful titration is essential to avoid hypercalcemia. * **Hypercalcemia:** If hypercalcemia occurs, the dose should be reduced or temporarily discontinued. ## Contraindications * **Hypercalcemia:** Known hypersensitivity to calcium acetate or any component of the formulation. * **Hypercalciuria:** Conditions predisposing to hypercalcemia (e.g., certain malignancies, sarcoidosis). ## Adverse Effects * **Hypercalcemia:** Most common and serious adverse effect. Symptoms include nausea, vomiting, constipation, abdominal pain, dry mouth, increased urination, bone pain, confusion, lethargy, and cardiac arrhythmias. * **Gastrointestinal:** Nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia. * **Other:** Hypermagnesemia, hyperphosphatemia (rarely, with excessive intake). ## Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours. * **Thyroid Hormones:** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours. * **Antacids:** Concurrent use with other calcium-containing antacids may increase the risk of hypercalcemia. * **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity. * **Fat-soluble Vitamins:** May potentially decrease absorption. ## Monitoring * **Serum Phosphorus:** Regularly monitor to guide dosing. * **Serum Calcium:** Crucial to monitor frequently, especially during initiation and dose titration, to prevent and manage hypercalcemia. Ensure the product of serum calcium and phosphorus is below 55 mg²/dL². * **Alkaline Phosphatase:** May be monitored. * **Electrolytes:** Periodic monitoring of magnesium and potassium may be warranted. ## Clinical Pearls * Administer calcium acetate with meals to effectively bind dietary phosphorus. * Chewable tablets should be chewed thoroughly for optimal efficacy. * When switching from other phosphate binders, carefully monitor phosphorus and calcium levels. * Monitor for signs and symptoms of hypercalcemia. * Patients should be educated on dietary phosphorus restriction alongside medication. *** **Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for complete and up-to-date details before making any treatment decisions. Dosing and management may vary based on individual patient factors and local protocols.