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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce hyperphosphatemia in patients with chronic kidney disease (CKD). It binds to dietary phosphate in the gastrointestinal tract, forming an insoluble calcium phosphate precipitate that is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Starting Dose:** 2 tablets (667 mg elemental calcium per 1000 mg calcium acetate) orally with meals.
* **Titration:** Doses should be titrated based on serum phosphate levels. Doses can range from 2 to 8 tablets per day, divided among meals.
* **Maximum Dose:** Typically 8 tablets daily in divided doses, but may be higher based on individual patient response and tolerability. Must be individualized based on serum phosphate and calcium levels.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized under specialist guidance.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is indicated for patients with ESRD.
* **Hepatic Impairment:** No specific dose adjustments are typically required, but caution should be exercised due to potential for calcium accumulation.
* **Hypercalcemia:** Dose should be reduced or discontinued if serum calcium levels exceed the therapeutic goal or become symptomatic.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Certain conditions associated with hypercalcemia (e.g., metastatic calcifications).
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, dry mouth, anorexia.
* **Serious:** 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.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids containing magnesium or aluminum:** May increase the risk of hypercalcemia or aluminum toxicity.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Vitamin D and its analogs:** Increased risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly as directed by prescriber to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor regularly to prevent or manage hypercalcemia. Target serum calcium is typically 8.0-9.5 mg/dL (2.0-2.4 mmol/L), but may vary.
* **Albumin-corrected calcium:** Important for assessing true calcium levels, especially in patients with hypoalbuminemia.
* **Electrolytes:** Monitor other electrolytes as indicated.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Ensure adequate patient education on the importance of taking medication with food and monitoring for signs/symptoms of hypercalcemia.
* Consider the elemental calcium content when calculating total daily calcium intake from all sources.
* If a patient develops hypercalcemia, consider reducing or discontinuing calcium acetate and assessing other calcium or vitamin D sources.
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**Disclaimer:** This information is intended for healthcare professionals and does not replace the need to consult current official prescribing information and guidelines. Always verify current drug information before making clinical decisions.
