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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, typically those with chronic kidney disease (CKD) on dialysis.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Starting dose:** 500 mg to 1000 mg (1 to 2 tablets) orally with meals.
* **Titration:** Dose should be titrated based on serum phosphate levels.
* **Maximum dose:** Typically not to exceed 4000 mg (8 tablets) per day, but may vary based on individual patient response and tolerance. Doses are often prescribed as a specific number of tablets per meal.
## Pediatric Dosing
* **General:** Dosing is not well-established and should be individualized under specialist guidance.
* **Limited data:** Some sources suggest starting at 500 mg/m²/day divided into 3-4 doses with meals. Monitor phosphate levels closely.
## Dose Adjustments
* **Renal Impairment:** Dose adjusted based on serum phosphate levels. Patients with CKD require careful monitoring.
* **Hepatic Impairment:** No specific dose adjustment needed, but monitor calcium and phosphate levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Concurrent use with intravenous calcium solutions.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea, abdominal pain.
* **Serious:** Severe hypercalcemia (symptoms include confusion, lethargy, muscle weakness, cardiac arrhythmias), calcification of soft tissues.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer these agents at least 2 hours before or 6 hours after calcium acetate.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concurrent use may increase the risk of hypercalcemia.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* Serum calcium levels (especially at initiation and dose changes).
* Serum phosphate levels (regularly, based on clinical status).
* Alkaline phosphatase.
* BUN and creatinine.
* Signs and symptoms of hypercalcemia.
## Clinical Pearls
* Administer calcium acetate **with meals** to effectively bind dietary phosphate.
* Monitor calcium-phosphate product; aim to keep it below 55 mg²/dL².
* Ensure adequate phosphate restriction in the diet.
* Be aware of the potential for calcium accumulation and hypercalcemia, especially in patients receiving other calcium supplements or vitamin D analogs.
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*This information is intended for clinical decision-making and does not replace the need to consult official prescribing information and institutional protocols. Always verify current drug information before administration.*
