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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 phosphorus in the gastrointestinal tract, forming insoluble calcium phosphate that is then excreted. ## Primary Indications * Hyperphosphatemia in patients with end-stage renal disease (ESRD) or advanced CKD. ## Adult Dosing * Dosing is individualized based on serum phosphate levels. * Initiate with 1-2 tablets (667 mg elemental calcium per tablet) with meals. * Titrate dose to achieve serum phosphate levels below 6 mg/dL. * Maximum recommended dose is typically 12 tablets (8000 mg elemental calcium) per day, divided with meals. ## Pediatric Dosing * Dosing in pediatric patients is not well-established and should be determined by a nephrologist based on individual patient needs and monitoring. ## Dose Adjustments * No specific dose adjustments are typically required for hepatic impairment. * Dose may need adjustment based on calcium and phosphate levels, and potential for hypercalcemia. ## Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate. * In patients receiving digoxin (due to risk of hypercalcemia exacerbating digitalis toxicity). ## Adverse Effects * **Common:** Hypercalcemia (signs include constipation, nausea, vomiting, abdominal pain, dry mouth, fatigue, headache, confusion, muscle weakness, bone pain), hypophosphatemia. * **Less Common:** Acidosis, itching. ## Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease absorption. Separate administration by at least 2 hours. * **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease absorption. Separate administration by at least 4 hours. * **Antacids (other than calcium-containing):** May increase risk of hypercalcemia. * **Digoxin:** Increased risk of digitalis toxicity due to potential for hypercalcemia. ## Monitoring * Serum phosphate levels (target < 6 mg/dL). * Serum calcium levels (target usually within normal limits, but monitor closely). * Alkaline phosphatase. * BUN and creatinine. ## Clinical Pearls * Administer with meals to maximize phosphate binding. * Monitor for signs and symptoms of hypercalcemia. * The amount of elemental calcium per dose is crucial for dosing calculations. Each 667 mg tablet contains approximately 169 mg of elemental calcium. *** *This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*