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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 phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 1-2 tablets (approximately 500 mg elemental calcium/tablet) with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Doses can be increased incrementally, 1-2 tablets per meal, as needed.
* **Maximum dose:** Generally, up to 16 tablets (8000 mg) per day divided with meals, but actual maximum tolerated dose is determined by patient response and tolerance to avoid hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients with CKD is not well established. Doses are typically initiated at the lower end of adult dosing (e.g., 1 tablet with meals) and titrated cautiously under close monitoring.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium levels exceed the therapeutic goal or approach the upper limit of normal.
* **Concurrent medications:** May require adjustment based on interactions (see Key Drug Interactions).
## Contraindications
* Hypercalcemia.
* History of hypersensitivity to calcium acetate.
* Patients with metastatic calcification.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, diarrhea.
* **Serious:** Calciphylaxis, cardiac arrhythmias (secondary to hypercalcemia).
## 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 (levothyroxine):** Calcium acetate can impair the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Co-administration may reduce bisphosphonate absorption. Separate administration by at least 2 hours.
* **Calcium channel blockers:** May increase the risk of hypercalcemia. Monitor calcium levels closely.
## Monitoring
* **Serum calcium:** Regularly monitor, especially at initiation and dose adjustments. Target is generally below 10.5 mg/dL.
* **Serum phosphate:** Monitor to assess efficacy.
* **Serum magnesium and potassium:** Monitor periodically.
* **Alkaline phosphatase:** Monitor periodically.
## Clinical Pearls
* Administer with meals to effectively bind dietary phosphate.
* Tablet must be chewed or crushed for optimal efficacy, especially in patients with altered GI motility or who have difficulty swallowing whole tablets.
* Patient education regarding signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, bone pain) is crucial.
* The dose is based on the elemental calcium content. Ensure the correct formulation is used.
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**Disclaimer:** This information is intended for clinical use and is not a substitute for professional medical advice. Always consult current prescribing information and relevant guidelines for definitive patient management.
