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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 in the feces.
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
* **Initial dose:** 2 tablets (667 mg elemental calcium and 334 mg acetate per tablet) orally with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Titrate by 1-2 tablets per meal as needed.
* **Maximum dose:** 16 tablets per day (divided among meals). The target serum phosphate level is generally <5.5 mg/dL.
## Pediatric Dosing
* Dosing in pediatric patients is not well established. Refer to specific pediatric guidelines or consult a pediatric nephrologist.
## Dose Adjustments
* **Renal impairment:** Not applicable, as it is used in patients with CKD.
* **Hepatic impairment:** No specific adjustments are recommended.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Conditions associated with hypercalcemia such as sarcoidosis, primary hyperparathyroidism, and certain malignancies.
## Adverse Effects
* **Common:** Hypercalcemia (most significant concern), nausea, vomiting, constipation, diarrhea.
* **Serious:** Cardiovascular events (due to hypercalcemia), calcification of soft tissues.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid hormones (e.g., levothyroxine):** Calcium acetate can impair absorption. Separate administration by at least 4 hours.
* **Certain Antiretrovirals (e.g., bictegravir, dolutegravir):** May reduce plasma concentrations. Separate administration.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thiazide diuretics:** Can increase serum calcium levels. Use with caution.
## Monitoring
* **Serum calcium and phosphate levels:** Monitor frequently, especially during initiation and dose adjustments, and regularly thereafter to prevent hypercalcemia and maintain target phosphate levels.
* **Serum magnesium and intact parathyroid hormone (iPTH) levels:** May be monitored periodically.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Monitor for signs and symptoms of hypercalcemia (e.g., constipation, bone pain, nausea, frequent urination, thirst, confusion).
* The elemental calcium content per tablet is approximately 169 mg. This is important to consider when assessing total daily calcium intake.
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*This information is intended for healthcare professionals. Always verify current prescribing information with the manufacturer's official product information or a trusted drug reference database before making clinical decisions.*
