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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, typically associated with chronic kidney disease. It works by binding to dietary phosphate in the gastrointestinal tract, forming an insoluble calcium phosphate precipitate that is then excreted.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Typical starting dose:** 1-2 tablets (approximately 667-1334 mg calcium acetate) with each meal.
* **Titration:** Doses should be adjusted based on serum phosphate levels.
* **Maximum dose:** Doses up to 2500 mg of calcium acetate (equivalent to approximately 10-12 tablets, depending on formulation) may be given with meals, but the total daily calcium intake from all sources should be monitored closely.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized by a clinician experienced in pediatric nephrology.
## Dose Adjustments
* No specific dose adjustments are typically recommended for hepatic impairment.
* Dose should be adjusted based on serum phosphate and calcium levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions that may predispose to hypercalcemia, such as certain conditions leading to increased calcium absorption or decreased calcium excretion.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, abdominal pain.
* **Serious:** Worsening hypercalcemia can lead to EKG changes, arrhythmias, confusion, stupor, coma, renal insufficiency, and soft tissue calcification.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Concurrent administration may decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity. Monitor closely.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Vitamin D and its analogs:** May enhance the absorption of calcium and increase the risk of hypercalcemia.
## Monitoring
* Serum phosphate levels (monitor frequently, especially during titration).
* Serum calcium levels (monitor regularly, and especially if hypercalcemia is suspected).
* Alkaline phosphatase.
* Signs and symptoms of hypercalcemia.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Individualize dosing based on patient's serum phosphate levels and tolerance.
* Be vigilant for signs and symptoms of hypercalcemia.
* Consider total calcium intake from all sources (diet, supplements, other medications) to prevent hypercalcemia.
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**Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information, contraindications, warnings, precautions, drug interactions, and adverse effects with the most recent official labeling and consult with a qualified healthcare provider.
