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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with chronic kidney disease (CKD) on dialysis.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* Administer orally with meals.
* Starting dose: 2 tablets (approximately 1330 mg calcium acetate) with each meal.
* Titrate dose based on serum phosphate levels. Typical doses range from 2 to 4 tablets with each meal.
* Maximum recommended dose: 8 tablets per day. Some sources suggest up to 16 tablets per day, but caution is advised due to risk of hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized based on clinical response and serum calcium and phosphate levels.
## Dose Adjustments
* No specific dose adjustments are typically required for renal impairment, as this medication is primarily used in patients with ESRD. However, it is crucial to monitor calcium levels closely.
* Dose may need to be reduced or discontinued if hypercalcemia occurs.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Use with caution in patients with a history of calcium-containing kidney stones.
## Adverse Effects
* **Common:** Hypercalcemia (signs include constipation, nausea, vomiting, abdominal pain, dry mouth, thirst, polyuria, lethargy, headache, muscle weakness, bone pain), hypophosphatemia.
* **Less Common:** Arrhythmias, hypertension, itching, rash.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia can potentiate digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Vitamin D Analogs:** Increased risk of hypercalcemia.
## Monitoring
* Serum phosphate levels (monitor frequently during initiation and dose titration, then regularly as clinically indicated).
* Serum calcium levels (monitor frequently, especially during initiation and with dose changes, and at least monthly thereafter).
* Intact parathyroid hormone (PTH) levels.
* Alkaline phosphatase.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphate.
* The goal of therapy is to reduce serum phosphate levels, not necessarily to normalize calcium levels.
* Hypercalcemia is a significant risk and requires careful monitoring and dose adjustment. The "normal" serum calcium range in patients on dialysis may be higher than in the general population; consult local protocols.
* Calcium acetate contains approximately 16-17% elemental calcium by weight. Each 667 mg tablet contains approximately 10.6 mEq or 133 mg of elemental calcium.
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*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional guidelines for complete details and before making any treatment decisions.*
