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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, forming insoluble calcium phosphate, which is then excreted in the feces.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
The typical starting dose is 1-2 tablets (667 mg elemental calcium per tablet) with meals. Doses should be titrated based on serum phosphate levels. The usual maintenance dose ranges from 2-16 tablets per day, divided among meals. The maximum recommended dose is 16 tablets (approximately 4000 mg elemental calcium) per day. Specific titration guidelines may vary by local protocol.
## Pediatric Dosing
Safety and efficacy in pediatric patients have not been established. Dosing in pediatric populations is not well-defined and should be determined by a specialist based on individual patient needs and response.
## Dose Adjustments
Dose adjustments are based on serum phosphate and calcium levels. Increases in calcium acetate dose should be carefully monitored for hypercalcemia.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions associated with hypercalcemia (e.g., metastatic bone disease, certain renal conditions).
## Adverse Effects
* **Common:** Hypercalcemia (most serious), constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Rare:** Hyperphosphatemia (due to increased intestinal absorption), hypocalcemia (paradoxical), hypersensitivity reactions.
## Key Drug Interactions
* **Tetracyclines and quinolone antibiotics:** Calcium acetate can decrease the absorption of these agents. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Bisphosphonates, sodium fluoride, phenytoin:** Concurrent use may decrease absorption. Separate administration by at least 2 hours.
* **Thiazide diuretics:** May increase the risk of hypercalcemia. Monitor calcium levels closely.
* **Digoxin:** Hypercalcemia associated with calcium acetate may potentiate cardiac toxicity of digoxin.
* **Vitamin D analogues:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum phosphate levels:** Monitor frequently to guide dosing.
* **Serum calcium levels:** Monitor regularly to detect and prevent hypercalcemia. Target serum calcium levels should be maintained within the normal range, typically not exceeding 10.5 mg/dL.
* **Alkaline phosphatase levels.**
* **Signs and symptoms of hypercalcemia:** (e.g., constipation, nausea, vomiting, polyuria, bone pain, confusion).
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* The elemental calcium content per tablet is approximately 667 mg.
* Monitor for both hypercalcemia and hyperphosphatemia. While its primary use is to lower phosphate, excessive calcium intake can lead to hypercalcemia.
* Consider patient's total calcium intake from all sources (diet, supplements, other medications).
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions.
