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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with end-stage renal disease (ESRD). It works by binding to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted in the feces.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 667 mg (13.3 mEq elemental calcium) orally with each meal.
* **Titration:** Dosage should be adjusted based on serum phosphorus levels. The goal is typically to maintain serum phosphorus < 5.5 mg/dL. Typical doses range from 1332 mg to 3996 mg (26.6 mEq to 79.8 mEq elemental calcium) divided among meals.
* **Maximum dose:** Not to exceed 7992 mg (159.6 mEq elemental calcium) per day.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized based on clinical response and serum phosphorus levels. Doses as low as 15-20 mg/kg/day of elemental calcium divided into 3-4 doses have been used.
## Dose Adjustments
* **Renal Impairment:** Use with caution. Patients with ESRD are at risk for hypercalcemia. Monitor calcium and phosphorus levels closely.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia (which can manifest as nausea, vomiting, constipation, polyuria, weakness, confusion, arrhythmias), hypophosphatemia.
* **Less Common:** Gastrointestinal upset, dry mouth, anorexia.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer these agents at least 2 hours before or 6 hours after calcium acetate.
* **Bisphosphonates:** Concurrent use may decrease bisphosphonate absorption. Separate administration by at least 30 minutes, preferably longer.
* **Thyroid Hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Calcium Channel Blockers:** Hypercalcemia can potentiate the effects of calcium channel blockers.
## Monitoring
* Serum calcium levels.
* Serum phosphorus levels.
* Serum magnesium and alkaline phosphatase levels may also be monitored.
* Signs and symptoms of hypercalcemia.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* The amount of elemental calcium per tablet varies by formulation. Always calculate the dose based on elemental calcium and the patient's individual needs.
* Hypercalcemia is a significant concern, especially in patients with concomitant vitamin D therapy.
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*This information is intended for clinical professionals and does not replace official prescribing information. Always verify with the most current drug monograph for your jurisdiction.*
