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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with hyperphosphatemia, typically associated with chronic kidney disease (CKD). ## Primary Indications * Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis. ## Adult Dosing * **Dosage:** Typically initiated at 2 tablets (667 mg elemental calcium per tablet) orally three times daily with meals. * **Titration:** Dose is adjusted based on serum phosphorus levels. May be increased up to 4 tablets orally three times daily with meals. * **Maximum Dose:** Not to exceed 12 tablets (4000 mg elemental calcium) per day. ## Pediatric Dosing * Data is limited. Dosing should be individualized under specialist guidance. Some sources suggest 1.25 to 2.5 g/m²/day divided into 3-4 doses with meals, adjusted based on response. ## Dose Adjustments * **Renal Impairment:** Dose should be carefully adjusted based on serum phosphorus and calcium levels. ## Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate. * Ventricular fibrillation. ## Adverse Effects * **Common:** Hypercalcemia (manifesting as nausea, vomiting, constipation, abdominal pain, anorexia, thirst, polyuria, confusion, lethargy, bone pain, kidney stones). * **Less Common:** Cardiac arrhythmias. ## Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate. * **Digoxin:** Concurrent use with calcium acetate can increase the risk of digoxin toxicity due to hypercalcemia. * **Thiazide Diuretics:** May increase the absorption of calcium and potentiate hypercalcemia. * **Vitamin D Analogs:** May increase the risk of hypercalcemia. ## Monitoring * Serum phosphorus levels (target typically < 5.5 mg/dL). * Serum calcium levels (monitor for hypercalcemia). * BUN and creatinine. * Serum magnesium and alkaline phosphatase. ## Clinical Pearls * Must be taken with meals to effectively bind dietary phosphorus. * Monitor calcium-x-phosphate product to avoid extraskeletal calcification. Target typically < 55 mg²/dL². * Consider dose reduction or discontinuation if hypercalcemia occurs. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*