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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. Each 667 mg tablet contains approximately 169 mg of elemental calcium.
## Primary Indications
* **Hyperphosphatemia:** Treatment of elevated serum phosphorus levels in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 667 mg to 1334 mg (1-2 tablets) orally with each meal.
* **Titration:** Dosage should be titrated gradually based on serum phosphorus levels.
* **Maximum dose:** Generally not to exceed 8000 mg (12 tablets) per day.
## Pediatric Dosing
* Data on pediatric dosing is limited and often extrapolated from adult guidelines. Consult specific pediatric nephrology resources or institutional protocols.
## Dose Adjustments
* **Renal Impairment:** Dose must be carefully adjusted based on serum phosphorus and calcium levels.
* **Hypercalcemia:** If hypercalcemia occurs, the dose should be reduced or discontinued.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, adynamic bone disease (with long-term excessive use).
## 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 the antibiotic.
* **Levothyroxine:** Calcium can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia associated with calcium supplements can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase serum calcium levels, leading to hypercalcemia.
## Monitoring
* **Serum Phosphorus:** Monitor regularly (frequency depends on clinical status and dialysis schedule).
* **Serum Calcium:** Monitor regularly. Target serum calcium levels are typically between 8.0-9.5 mg/dL (adjusted for albumin).
* **Serum iPTH and Alkaline Phosphatase:** Monitor periodically to assess bone mineral metabolism.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Ensure adequate dietary calcium intake is considered when assessing serum calcium levels.
* Correcting metabolic acidosis may also improve phosphate control.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before making clinical decisions. Dosing may vary based on individual patient factors, laboratory results, and local guidelines.*
