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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD). It binds to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Treatment of hyperphosphatemia in end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 2 tablets (667 mg elemental calcium per tablet) orally with meals.
* **Titration:** Doses should be individualized based on serum phosphate levels. Incremental increases of 1-2 tablets per meal may be made as needed.
* **Typical maintenance range:** 4-8 tablets orally per day divided with meals.
* **Maximum dose:** Not well-established, but exceeding 12 tablets (4000 mg elemental calcium) per day is generally not recommended due to risk of hypercalcemia and vascular calcification.
## Pediatric Dosing
* Dosing is not well-established for pediatric patients. Use with caution and consider alternative agents. If used, titrate carefully to target serum phosphate levels.
## Dose Adjustments
* **Renal Impairment:** Not applicable, as it's used in ESRD.
* **Hepatic Impairment:** No dose adjustment necessary.
* **Hypercalcemia:** Dose reduction or discontinuation is required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Ventricular fibrillation.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, hypophosphatemia, metastatic calcification.
## Key Drug Interactions
* **Tetracyclines, Quinolones, Bisphosphonates, Thyroid hormones, Iron supplements, Antiretrovirals:** Calcium acetate can decrease the absorption of these drugs. Administer calcium acetate at least 2 hours before or 4-6 hours after these medications.
* **Vitamin D and its analogs:** May increase the risk of hypercalcemia.
## Monitoring
* **Serum calcium and phosphate levels:** Monitor frequently, especially during initiation and dose titration. Target serum phosphate levels generally aim for < 5.5 mg/dL.
* **Alkaline phosphatase.**
* **Signs and symptoms of hypercalcemia:** (e.g., nausea, vomiting, confusion, constipation, polyuria, bone pain).
## Clinical Pearls
* Administer all doses with meals to ensure optimal phosphate binding.
* Patients should be instructed on dietary phosphate restriction.
* Consider the total daily elemental calcium intake from all sources (medications, supplements, diet) to minimize risk of hypercalcemia. Each 667 mg calcium acetate tablet contains 169 mg of elemental calcium.
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*This information is intended for clinical use and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines for definitive treatment decisions.*
