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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD).
## Primary Indications
* Management of hyperphosphatemia in end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 500 mg to 1000 mg (approximately 2-4 tablets) administered orally with each meal.
* **Titration:** Dose should be individualized based on serum phosphate levels. The goal is to reduce serum phosphate to less than 6 mg/dL.
* **Maximum Dose:** Up to 4000 mg (16 tablets) per day, divided with meals.
## Pediatric Dosing
* **Limited data:** Pediatric dosing is not well established. Dosing should be individualized by a physician experienced in pediatric nephrology, often starting at 10-15 mg/kg/day of elemental calcium, divided with meals, and titrated based on serum phosphate levels.
## Dose Adjustments
* Dose should be adjusted to maintain serum phosphate below 6 mg/dL.
* Monitor serum calcium levels closely; dose reduction or interruption may be necessary if hypercalcemia occurs.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Patients with metastatic calcification.
## Adverse Effects
* **Common:** Hypercalcemia (signs include constipation, nausea, vomiting, anorexia, abdominal pain, thirst, polyuria, confusion, lethargy, muscle weakness).
* **Less Common:** Hypersensitivity reactions.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate can decrease absorption of levothyroxine. Separate administration.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase serum calcium levels.
## Monitoring
* **Serum Phosphate:** Monitor regularly, typically every 1-2 weeks, to guide dose titration.
* **Serum Calcium:** Monitor regularly, especially when initiating or titrating therapy, and at least monthly thereafter.
* **Alkaline Phosphatase:** May be monitored in patients with renal osteodystrophy.
## Clinical Pearls
* Calcium acetate is most effective when taken with meals to bind dietary phosphate.
* Ensure patients are aware of the signs and symptoms of hypercalcemia.
* For patients on hemodialysis, administering calcium acetate with meals during dialysis sessions can be effective.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for complete details. Dosing and recommendations may vary.*
