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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 phosphorus 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
* **Initiation:** Typically 2 tablets (667 mg elemental calcium per tablet) taken orally with meals.
* **Titration:** Dosage should be adjusted based on serum phosphorus levels. The goal is to maintain serum phosphorus below 6 mg/dL.
* **Maximum:** Generally not to exceed 12 tablets (4002 mg elemental calcium) per day. Dosing depends on individual patient response and dietary phosphorus intake.
## Pediatric Dosing
* Limited established dosing guidelines for pediatric patients. Dosing should be individualized under the guidance of a pediatric nephrologist.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in patients with kidney disease.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
* **Use with Antacids:** Concurrent use of calcium acetate with other calcium-containing products or other antacids should be approached with caution to avoid excessive calcium intake.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia (elevated serum calcium levels), constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, cardiac valvular calcification, hypotension, arrhythmias.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Levothyroxine:** Calcium acetate can decrease absorption of levothyroxine. Separate administration by at least 4 hours.
* **Certain Antiretrovirals:** Calcium acetate may affect the absorption of some antiretroviral medications. Consult specific drug information.
* **Other Calcium-Containing Products/Antacids:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Calcium:** Monitor routinely, especially during initiation or dose adjustments, to prevent hypercalcemia. Ideal serum calcium levels are typically between 8.5 to 10 mg/dL.
* **Serum Phosphorus:** Monitor regularly to assess efficacy and guide dose titration.
* **Alkaline Phosphatase:** Monitor periodically.
* **Parathyroid Hormone (PTH):** Monitor periodically.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphorus.
* Patients should be educated on the signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, confusion).
* The total daily elemental calcium intake from all sources (medications, diet, supplements) should be considered to avoid exceeding recommended limits and causing hypercalcemia.
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**Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult the most current prescribing information and guidelines for specific patient management. Dosing and management may vary based on individual patient factors and local protocols.
