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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
* **Initial dose:** 667 mg (13.3 mEq elemental calcium) orally three times daily with meals.
* **Titration:** Dosage should be adjusted based on serum phosphate levels. Target serum phosphate is typically less than 6 mg/dL. Titration should be done slowly, increasing by one 667 mg tablet per meal at a time.
* **Maximum dose:** No strict maximum dose is defined, but doses exceeding 6-7 tablets per day are generally not recommended due to risk of hypercalcemia.
## Pediatric Dosing
* Specific pediatric dosing for calcium acetate as a phosphate binder is not well established. Dosing should be individualized based on age, weight, and serum phosphate levels.
## Dose Adjustments
* **Renal Impairment:** Dosage should be carefully adjusted based on serum phosphate and calcium levels. Patients with CKD not on dialysis should be monitored closely.
* **Hepatic Impairment:** No specific dose adjustments are typically required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain, diarrhea.
* **Serious:** Vascular calcification, adynamic bone disease (with chronic oversuppression of PTH).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may decrease bisphosphonate absorption. Separate administration.
* **Calcium Channel Blockers:** Hypercalcemia can potentiate the effects of calcium channel blockers.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
## Monitoring
* Serum phosphate levels (monitor frequently after initiation or dose adjustment, then routinely as clinically indicated).
* Serum calcium levels (monitor frequently, especially during titration, to prevent hypercalcemia).
* Electrolytes.
* Alkaline phosphatase.
* Parathyroid hormone (PTH) levels (long-term monitoring).
## Clinical Pearls
* Calcium acetate must be taken with meals to be effective as a phosphate binder.
* The elemental calcium content of calcium acetate is approximately 25%.
* Monitor for symptoms of hypercalcemia: confusion, lethargy, nausea, vomiting, constipation, bone pain, polyuria, polydipsia.
* Be cautious when co-administering with other calcium-containing products or vitamin D.
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**Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and institutional protocols for definitive patient management.
