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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 eliminated in the feces.
## Primary Indications
* Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD) requiring dialysis.
## Adult Dosing
* **Usual starting dose:** 1-2 tablets (each tablet contains 667 mg of calcium acetate, which provides 169 mg of elemental calcium and 13.4 mEq of acetate) with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Doses can be increased gradually.
* **Maximum dose:** Typically not to exceed 8 tablets per day, but may be higher in some cases based on clinical response and tolerance. The goal is to maintain serum phosphate below 6 mg/dL.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be individualized by a physician experienced in pediatric nephrology.
## Dose Adjustments
* **Renal impairment:** Dose adjustment is guided by serum phosphate and calcium levels.
* **Concurrent medications:** Avoid administering other calcium-containing products to prevent hypercalcemia.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Anephric patients receiving other calcium-containing antacids or supplements.
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, dry mouth, thirst, polyuria, fatigue, weakness, confusion), hyperphosphatemia.
* **Serious:** Severe hypercalcemia, hypocalcemia (paradoxical effect if phosphate is low), gastrointestinal upset.
## Key Drug Interactions
* **Tetracyclines and quinolones:** Calcium acetate can decrease the absorption of these antibiotics; administer them at least 1 hour before or 3 hours after calcium acetate.
* **Thyroid hormones (e.g., levothyroxine):** Calcium can impair absorption; separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium can interfere with absorption; administer bisphosphonates at least 2 hours before or 2 hours after calcium acetate.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
## Monitoring
* **Serum phosphate:** Monitor regularly to assess efficacy.
* **Serum calcium:** Monitor regularly to prevent and detect hypercalcemia. Aim for serum calcium levels within the normal range, typically 8.5-10.0 mg/dL, but target may vary based on institutional guidelines.
* **Alkaline phosphatase:** Monitor periodically.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Patients should be educated about symptoms of hypercalcemia and advised to report them promptly.
* Consider the total elemental calcium intake from all sources (diet, supplements, medications) to prevent hypercalcemia.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant guidelines before making any clinical decisions. Dosing may vary based on individual patient factors and local protocols.
