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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
* **Initial dose:** 667 mg (approximately 13.3 mEq elemental calcium) administered orally with each meal.
* **Titration:** Dose should be individualized based on serum phosphate levels. Doses can be increased to achieve target phosphate levels.
* **Maximum dose:** Typically up to 2993 mg (approximately 60 mEq elemental calcium) per day, divided among meals. Individual doses should not exceed 2000 mg.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be individualized by a physician. General recommendations for younger children are often lower than for adults, starting with 1-2 tablets per meal.
## Dose Adjustments
* **Renal Impairment:** Dose adjustment is primarily based on serum phosphate and calcium levels. Patients with CKD require careful monitoring.
* **Hypercalcemia:** If hypercalcemia occurs, the dose should be reduced or discontinued.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions that may lead to hypercalcemia, such as metastatic bone disease.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting.
* **Less Common:** Dry mouth, headache, abdominal pain, diarrhea, rash.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease absorption. Administer at least 1 hour before or 3 hours after these antibiotics.
* **Thyroid Hormones:** Calcium acetate can decrease absorption. Administer at least 4 hours apart.
* **Calcium Channel Blockers:** May increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia associated with calcium acetate can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** Can increase serum calcium levels, increasing the risk of hypercalcemia.
## Monitoring
* **Serum Calcium and Phosphate:** Regularly monitor to guide dosing and prevent hypercalcemia and hypophosphatemia.
* **Serum Magnesium and Alkaline Phosphatase:** May be monitored periodically.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* The goal is to lower serum phosphate levels to below 6 mg/dL.
* Monitor serum calcium levels closely, as hypercalcemia is a significant risk, especially with high doses or in patients also receiving vitamin D analogs.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for definitive guidance.*
