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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with end-stage renal disease (ESRD). It binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate which is then eliminated in the feces. ## Primary Indications * Hyperphosphatemia in patients with end-stage renal disease (ESRD). ## Adult Dosing The typical starting dose is 2 capsules (667 mg calcium acetate per capsule) taken orally with meals. Doses should be titrated based on serum phosphate levels. The maximum recommended dose is 4-6 capsules with meals, totaling 10-15 mEq (20-30 mEq total daily) or 2668-4002 mg of calcium acetate. ## Pediatric Dosing Specific pediatric dosing is not well-established. Dosing should be individualized based on serum phosphate levels and clinical response, with caution. ## Dose Adjustments * **Renal Impairment:** Not applicable, as it is used in ESRD. * **Hepatic Impairment:** No dose adjustment is typically needed. * **Titration:** Dose should be adjusted to maintain serum phosphate levels between 3.5-5.5 mg/dL. ## Contraindications * Hypercalcemia. * Known hypersensitivity to calcium acetate. ## Adverse Effects * **Common:** Hypercalcemia, constipation, nausea, vomiting, dry mouth. * **Serious:** Development of hypercalcemia, particularly with concomitant vitamin D therapy. ## Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer these drugs at least 2 hours before or 6 hours after calcium acetate. * **Thyroid Hormones:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours. * **Digitalis Glycosides:** Hypercalcemia can increase the risk of cardiac arrhythmias with digitalis. ## Monitoring * Serum phosphate levels regularly. * Serum calcium levels regularly, especially when initiating or adjusting dose. * Alkaline phosphatase. ## Clinical Pearls * Administer with meals to maximize phosphate binding. * Monitor for signs and symptoms of hypercalcemia (e.g., constipation, nausea, increased urination, bone pain, confusion). * If hypercalcemia occurs, reduce the dose or discontinue the medication. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.*