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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 works by binding to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
Dosing is highly individualized based on serum phosphate levels and patient tolerance.
* **Starting dose:** 2 tablets (668 mg elemental calcium) with each meal.
* **Titration:** Increase dose gradually to achieve serum phosphate goal (typically < 5.5 mg/dL).
* **Maximum dose:** Generally not to exceed 16 tablets (5344 mg elemental calcium) per day.
* Doses should be adjusted based on serum calcium and phosphate levels.
## Pediatric Dosing
Dosing in pediatric patients is not well-established and should be individualized by a physician experienced in pediatric nephrology.
## Dose Adjustments
* **Renal Impairment:** Dose requires careful monitoring and adjustment due to risk of hypercalcemia and calcium accumulation.
* **Hepatic Impairment:** No specific dose adjustment is typically required, but monitor calcium levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Certain conditions associated with hypercalcemia such as metastatic bone disease or primary hyperparathyroidism.
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, dry mouth, polyuria, polydipsia, anorexia, weakness, muscle pain, bone pain, confusion, lethargy), hypophosphatemia.
* **Less Common:** Calcification of soft tissues, hypercalciuria, headache, hypertension.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease absorption. Separate administration by at least 2 hours before and 6 hours after.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity. Monitor closely.
* **Thiazide Diuretics:** Can increase serum calcium levels.
* **Vitamin D Analogs:** Can increase serum calcium levels.
## Monitoring
* **Frequent:** Serum calcium, serum phosphate, and alkaline phosphatase levels.
* **Periodic:** Serum magnesium, BUN, creatinine.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Monitor serum calcium levels closely, especially when initiating or adjusting doses, or in patients taking vitamin D or thiazide diuretics. A serum calcium level above 10.6 mg/dL requires dose reduction or interruption.
* Patients should be educated on signs and symptoms of hypercalcemia.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider for any health concerns or before making any decisions related to your health or treatment.
