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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption and subsequent elevation in serum levels.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* **Dosing is individualized based on serum phosphate levels.**
* **Starting dose:** Typically 2 tablets (667 mg elemental calcium per 1000 mg calcium acetate) taken with each meal.
* **Titration:** Doses may be increased gradually to control serum phosphate levels.
* **Maximum dose:** Generally not to exceed 8-12 tablets per day, divided among meals. The exact maximum should be guided by patient response and tolerance, and serum calcium levels.
## Pediatric Dosing
* **Generally not recommended in pediatric patients due to limited data and risk of hypercalcemia.** Dosing, if considered, would require careful titration by a physician experienced in pediatric nephrology, with close monitoring.
## Dose Adjustments
* **Renal Impairment:** Dosing is for patients with ESRD. For patients with CKD not on dialysis, dose adjustments are critical to avoid hypercalcemia and should be guided by serum calcium and phosphate levels.
* **Concurrent medications:** See Drug Interactions.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Severe hypercalcemia or conditions leading to severe hypercalcemia (e.g., metastatic bone disease, certain malignancies).
## Adverse Effects
* **Most Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, anorexia, abdominal pain, fatigue, weakness, confusion, thirst, polyuria, bone pain).
* **Other:** Hypersensitivity reactions, gastrointestinal upset.
## 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:** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Bisphosphonates:** Concurrent use may reduce the efficacy of bisphosphonates. Separate administration by at least 2 hours.
* **Calcium Channel Blockers:** Potential for additive hypercalcemic effects. Monitor calcium levels closely.
* **Cardiac Glycosides (e.g., Digoxin):** Hypercalcemia can increase the risk of cardiac arrhythmias and digoxin toxicity.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dosing.
* **Serum Calcium:** Monitor regularly, ideally within 1 hour prior to the next scheduled dose, to detect and prevent hypercalcemia.
* **Intact Parathyroid Hormone (iPTH):** Monitor as part of CKD mineral and bone disorder management.
* **Alkaline Phosphatase:** Monitor as part of CKD mineral and bone disorder management.
## Clinical Pearls
* Administer calcium acetate **with meals** to maximize phosphate binding.
* Ensure patients are also receiving adequate dietary phosphate restriction.
* Be aware of the total elemental calcium intake from all sources (diet, supplements, medications).
* Patients should report any symptoms of hypercalcemia immediately.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and your healthcare provider for any medical advice, diagnosis, or treatment. Dosing and management may vary based on individual patient factors and institutional protocols.
