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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, typically associated 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 * **Dosage:** Start with 2 tablets (approximately 1330 mg calcium acetate) by mouth with meals. * **Titration:** Increase dosage gradually to control serum phosphorus levels. * **Maximum Dose:** The maximum recommended dose is 8 tablets per day, divided among meals. Dosing should be individualized based on serum phosphorus levels. ## Pediatric Dosing * Dosing in pediatric patients is not well-established and should be determined by a clinician experienced in pediatric nephrology. Doses are generally lower than in adults and guided by serum phosphorus levels and tolerance. ## Dose Adjustments * No specific dose adjustments are recommended for hepatic impairment. * Dose adjustments are primarily driven by serum phosphorus and calcium levels. ## Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate or any component of the formulation. * Certain conditions like nephrolithiasis or a history of hypercalcemia may warrant caution. ## Adverse Effects * **Common:** Hypercalcemia (signs include nausea, vomiting, constipation, anorexia, abdominal pain, fatigue, lethargy, mental confusion, thirst, polyuria, muscle weakness, bone pain, dizziness, headache, arrhythmias, stupor, coma), constipation. * **Less Common:** Gastrointestinal upset, dry mouth, metallic taste. ## 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 may increase the risk of hypercalcemia. * **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity. * **Vitamin D and its analogues:** Can potentiate the risk of hypercalcemia. ## Monitoring * **Serum Phosphorus:** Monitor regularly to assess efficacy and guide dose titration. * **Serum Calcium:** Monitor frequently (e.g., at baseline, after 1 week, then monthly) to prevent and detect hypercalcemia. Target serum calcium levels should be individualized. * **Alkaline Phosphatase:** Monitor in patients with chronic kidney disease. ## Clinical Pearls * Administer calcium acetate **with meals** to effectively bind dietary phosphorus. * Individualize dosing based on serum phosphorus and calcium levels. * Be vigilant for signs and symptoms of hypercalcemia, especially in patients with risk factors. * Consider the timing of administration with other oral medications to avoid drug interactions. --- *This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions.*