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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, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* **Initial Dose:** Start with 667 mg (1 gram) orally with meals.
* **Titration:** Dose should be individualized based on serum phosphate levels. The goal is to lower serum phosphate to below 6 mg/dL.
* **Maximum Dose:** Typically up to 2999 mg (4.5 grams) per day, divided among meals. Higher doses may be used in some cases, but with increased risk of hypercalcemia. Dosing is often guided by local protocol.
## Pediatric Dosing
* Dosing is not well-established in pediatric patients. Use is generally limited to cases where benefits outweigh risks, and careful monitoring is essential.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in ESRD patients.
* **Hepatic Impairment:** No dose adjustment typically needed.
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium levels are elevated.
## Contraindications
* Hypercalcemia.
* Known hypersensitivity to calcium acetate.
* Concurrent use with IV calcium.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, diarrhea.
* **Serious:** Vascular calcification, arrhythmias (due to hypercalcemia), kidney stones.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours before or 6 hours after calcium acetate.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Vitamin D Analogs:** Increased risk of hypercalcemia.
## Monitoring
* Serum calcium levels regularly, especially when initiating or adjusting dose.
* Serum phosphate levels regularly.
* Electrolytes.
* Signs and symptoms of hypercalcemia.
## Clinical Pearls
* Administer with meals to effectively bind dietary phosphate.
* Monitor calcium-phosphate product; aim to keep below 55 mg²/dL².
* Consider the calcium content from other sources (e.g., vitamin D supplements, other antacids).
* Discontinuation may be necessary if hypercalcemia or symptoms of hypercalcemia occur.
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*Disclaimer: This information is intended for clinical decision-making support only and does not replace professional clinical judgment. Always refer to the most current prescribing information and institutional protocols.*
