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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD). ## Primary Indications * Management of hyperphosphatemia in patients with end-stage renal disease (ESRD). ## Adult Dosing * **Dosing is individualized based on serum phosphate levels.** * **Typical starting dose:** 2 tablets (1332 mg calcium acetate, equivalent to 334 mg elemental calcium and 166 mg acetate) orally with meals. * **Titration:** Dosage is adjusted to maintain serum phosphate levels < 6 mg/dL. * **Maximum recommended dose:** 16 tablets (10656 mg calcium acetate) per day. ## Pediatric Dosing * **Limited data available.** Dosing in pediatric patients should be individualized and based on clinical judgment, serum phosphate levels, and established protocols. ## Dose Adjustments * **Renal Impairment:** Not applicable for patients with ESRD, as this is the primary indication. Careful monitoring of serum calcium and phosphate is crucial. * **Hepatic Impairment:** No specific adjustments are typically needed, but monitor calcium and phosphate levels. ## Contraindications * Hypercalcemia. * Conditions that may predispose to hypercalcemia (e.g., metastatic bone disease, certain granulomatous diseases). * Hypersensitivity to calcium acetate or any component of the formulation. ## Adverse Effects * **Common:** Hypercalcemia (symptoms include nausea, vomiting, constipation, abdominal pain, dry mouth, increased urination, thirst, anorexia, fatigue, weakness, headache, dizziness). * **Less Common:** Hypersensitivity reactions. ## Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease absorption of these antibiotics; administer at least 2 hours before or 3 hours after calcium acetate. * **Levothyroxine:** Calcium acetate can reduce the absorption of levothyroxine; separate administration by at least 4 hours. * **Bisphosphonates:** May decrease the absorption of bisphosphonates; administer bisphosphonates at least 1 hour before calcium acetate. * **Calcium Channel Blockers:** Hypercalcemia can potentiate the effects of calcium channel blockers. * **Thiazide Diuretics:** May increase the risk of hypercalcemia. * **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity. ## Monitoring * **Serum Phosphate:** Monitor regularly, aiming for levels < 6 mg/dL. * **Serum Calcium:** Monitor regularly to prevent and detect hypercalcemia. Adjust dosage if serum calcium exceeds normal limits. * **Alkaline Phosphatase:** May be monitored as an indicator of bone metabolism. * **Fluid and Electrolyte Balance.** ## Clinical Pearls * Administer calcium acetate **with meals** to effectively bind dietary phosphate. * Hypercalcemia is the most significant adverse effect; monitor serum calcium closely and adjust dose as needed. * Educate patients on signs and symptoms of hypercalcemia. * The elemental calcium content is approximately 16.7% by weight of calcium acetate. *** *Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always consult with a qualified healthcare provider and refer to the most current prescribing information for any medication.*