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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, preventing its absorption and facilitating its excretion. ## Primary Indications * Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD). ## Adult Dosing * **Dosage is individualized based on serum phosphate levels.** * Starting dose: 2 tablets (approximately 1334 mg calcium acetate) orally with meals. * Titration: Dose should be adjusted to maintain serum phosphate levels below 6 mg/dL. * Typical maintenance dose: 2-4 tablets orally with meals. * **Maximum dose:** Generally not to exceed 16 tablets (approximately 10,672 mg calcium acetate) per day. ## Pediatric Dosing * Dosing is not well established in pediatric populations and should be individualized and managed by a physician experienced in pediatric nephrology. ## Dose Adjustments * **Renal Impairment:** While used in CKD, caution is advised, and serum calcium levels must be closely monitored due to potential for accumulation. * **Hepatic Impairment:** No specific adjustments recommended, but hypercalcemia should be monitored. ## Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate. * Conditions that may predispose to hypercalcemia, such as multiple myeloma, metastatic bone cancer, sarcoidosis. ## Adverse Effects * **Common:** Hypercalcemia (most significant concern), constipation, nausea, vomiting, diarrhea, abdominal pain. * **Serious:** Cardiovascular complications due to hypercalcemia (arrhythmias, calcification), hypophosphatemia. ## Key Drug Interactions * **Tetracyclines and Quinolones:** Calcium acetate can decrease absorption of these antibiotics; administer them at least 2 hours before or 6 hours after calcium acetate. * **Thyroid Hormones:** Calcium salts can decrease absorption; separate administration. * **Digoxin:** Hypercalcemia can potentiate digoxin toxicity. * **Bisphosphonates and Fluorides:** Concurrent use may decrease absorption of bisphosphonates and fluorides. ## Monitoring * **Serum Phosphate:** Regularly monitor to guide dosing and assess efficacy. * **Serum Calcium:** Monitor closely, especially at initiation and with dose adjustments, to prevent or manage hypercalcemia. Target serum calcium levels should be determined by the prescribing physician. * **Electrolytes:** Monitor periodically. * **Alkaline Phosphatase:** May be monitored in patients with bone disease. ## Clinical Pearls * Administer calcium acetate with meals to effectively bind dietary phosphate. * If a dose of calcium acetate is missed, take it with the next meal. Do not double the dose. * Patient education regarding signs and symptoms of hypercalcemia (e.g., constipation, nausea, bone pain, mental status changes, frequent urination) is crucial. * The acetate moiety is metabolized to bicarbonate, which can contribute to metabolic alkalosis, though this is less common with typical doses. **Disclaimer:** This information is for educational purposes only and does not substitute for professional medical advice. Always consult with a qualified healthcare provider to determine the appropriate treatment for your specific condition and to review the most up-to-date prescribing information.