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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, forming an insoluble calcium phosphate precipitate that is then excreted in the feces. ## Primary Indications * Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis. ## Adult Dosing * **Initial dose:** 2 tablets (667 mg elemental calcium per tablet) orally with meals. * **Titration:** Dose should be adjusted based on serum phosphate levels. The goal is to reduce serum phosphate to < 6 mg/dL. Doses can be increased by 1-2 tablets per meal increment as needed. * **Maximum dose:** No established maximum dose, but generally avoid exceeding doses that result in hypercalcemia. ## Pediatric Dosing * Dosing in pediatric patients is not well established and should be individualized based on clinical assessment and serum phosphate levels. ## Dose Adjustments * **Renal Impairment:** No dose adjustment is necessary as the drug is primarily used in ESRD patients. * **Hepatic Impairment:** No dose adjustment is necessary. ## Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate or any component of the formulation. ## Adverse Effects * **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, abdominal pain. * **Serious:** Adynamic bone disease (with excessive calcium intake), cardiovascular events (secondary to hypercalcemia). ## 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 can reduce the absorption of levothyroxine. Separate administration by at least 4 hours. * **Antacids containing magnesium or aluminum:** May increase the risk of hypermagnesemia or aluminum toxicity. * **Digoxin:** Hypercalcemia can potentiate digoxin toxicity. * **Thiazide diuretics:** May increase the risk of hypercalcemia. ## Monitoring * **Serum Phosphate:** Monitor regularly to guide dosing. * **Serum Calcium:** Monitor regularly, especially when initiating or adjusting dose, to prevent hypercalcemia. Target serum calcium levels are typically within the normal laboratory range. * **Alkaline Phosphatase:** Monitor periodically. ## Clinical Pearls * Administer calcium acetate with meals to maximize phosphate binding. * Divide the total daily dose among meals. * Educate patients on signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, bone pain, confusion). * Monitor for signs of adynamic bone disease in patients with very low PTH levels. *** **Disclaimer:** This information is intended for healthcare professionals and does not replace the need for professional clinical judgment or a thorough review of the most current prescribing information and relevant literature. Always verify current drug information with the manufacturer's labeling or a reliable drug information database before making clinical decisions.