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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 binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis.
## Adult Dosing
* **Initial dose:** 2 tablets (667 mg elemental calcium per 2 tablets) with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. The goal is to reduce serum phosphate to < 6 mg/dL. Titrate doses upward in increments of 1-2 tablets per meal.
* **Maximum dose:** Generally not to exceed 12 tablets (4002 mg elemental calcium) per day.
## Pediatric Dosing
* Data is insufficient to recommend a specific pediatric dose. Use should be based on clinical judgment and patient response.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose. If hypercalcemia persists, discontinue calcium acetate and consider alternative phosphate binders.
* **Renal Impairment:** Not applicable as it's primarily used in ESRD.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Conditions leading to hypercalcemia, such as metastatic bone disease or certain renal conditions.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, anorexia.
* **Less Common:** Hyperphosphatemia (ironically, if underdosed), abdominal pain, dry mouth.
## 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 calcium acetate.
* **Thyroid Hormones:** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Avoid concurrent use as it may increase the risk of hypercalcemia.
## Monitoring
* **Serum Calcium:** Monitor frequently, especially during dose initiation and titration, to prevent or manage hypercalcemia.
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dose adjustments.
* **Alkaline Phosphatase:** Monitor as an indicator of bone disease.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphate.
* A total daily intake of elemental calcium from all sources should not exceed 2 grams in patients with ESRD.
* Patients should be educated on symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, abdominal pain, frequent urination, thirst, confusion).
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**Disclaimer:** This information is intended for clinical use and does not replace the need to consult the official prescribing information or other relevant drug compendia. Dosing and management should be individualized based on patient-specific factors and institutional protocols. Always verify current prescribing information before making clinical decisions.
