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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. 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:** Management of elevated serum phosphate levels in patients with end-stage renal disease (ESRD) requiring dialysis.
## Adult Dosing
* **Initial Dose:** 2 tablets (1334 mg elemental calcium) orally with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Doses can be increased by 1-2 tablets per meal as needed.
* **Maximum Dose:** Generally limited to 12 tablets (8004 mg elemental calcium) per day. Higher doses may increase the risk of hypercalcemia.
## Pediatric Dosing
Dosing in pediatric patients is not well established and should be determined by a physician experienced in pediatric nephrology. Caution is advised due to the potential for altered calcium absorption and bone mineralization.
## Dose Adjustments
* **Renal Impairment:** Dose must be individualized and guided by serum calcium and phosphate levels. Patients with CKD require close monitoring.
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions causing hypercalcemia, such as hyperparathyroidism, sarcoidosis, multiple myeloma, or metastatic bone cancer.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, abdominal pain.
* **Less Common:** Hypersensitivity reactions.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics by forming chelates. Separate administration by at least 2 hours (before or after calcium acetate).
* **Digoxin:** Hypercalcemia associated with calcium acetate can increase the risk of digoxin toxicity. Monitor cardiac function closely.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia when co-administered with calcium acetate.
## Monitoring
* **Serum Phosphate:** Monitor regularly, especially during dose titration.
* **Serum Calcium:** Monitor regularly; adjust dose to maintain serum calcium within the target range (typically up to 10.5 mg/dL, but local protocols may vary).
* **PTH levels:** May be monitored as part of overall management of CKD-MBD.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphate.
* The elemental calcium content per tablet is approximately 667 mg.
* Patients should be educated on signs and symptoms of hypercalcemia (e.g., constipation, nausea, confusion, bone pain, frequent urination).
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*This information is intended for healthcare professionals. Please consult the official prescribing information and relevant clinical guidelines for complete details, as well as any local protocols that may supersede this information.*
