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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
* **Hyperphosphatemia** in patients with end-stage renal disease (ESRD).
## Adult Dosing
* Administer orally with meals.
* Dose is individualized based on serum phosphate levels.
* Starting dose: 2 tablets (668 mg elemental calcium) by mouth with meals.
* Titrate dose to achieve serum phosphate below 6 mg/dL.
* Maximum recommended dose: 12 tablets (4008 mg elemental calcium) per day.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be individualized under specialist guidance. Limited data suggests doses of 1-2 tablets (334-668 mg elemental calcium) by mouth with meals.
## Dose Adjustments
* **Renal Impairment:** Dose should be carefully titrated to avoid hypercalcemia and aluminum toxicity (if co-administered with aluminum-containing products). Serum calcium and phosphate levels require frequent monitoring.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Concomitant use with aluminum-containing antacids or phosphate binders.
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, anorexia, abdominal pain, dry mouth, thirst, polyuria, confusion), hypophosphatemia.
* **Serious:** Gastrointestinal obstruction, calciphylaxis.
## Key Drug Interactions
* **Tetracyclines, Fluoroquinolones:** May decrease absorption. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
* **Vitamin D analogs:** May increase the risk of hypercalcemia.
* **Calcium channel blockers:** Some reports suggest hypercalcemia may reduce their efficacy.
* **Thiazide diuretics:** May increase serum calcium levels.
## Monitoring
* **Serum Calcium:** Monitor frequently, especially during dose initiation and titration. Target serum calcium levels vary by protocol but generally aim for the upper limit of normal.
* **Serum Phosphate:** Monitor regularly to guide dosing and assess efficacy.
* **Albumin:** Correct serum calcium levels for albumin.
* **Electrolytes:** Monitor periodically.
* **Renal function:** Monitor periodically.
## Clinical Pearls
* Calcium acetate must be taken with meals to be effective as a phosphate binder.
* The elemental calcium content of calcium acetate is approximately 25% by weight (1 tablet = 668 mg calcium acetate ≈ 169 mg elemental calcium).
* Over-correction of hyperphosphatemia can lead to hypophosphatemia, which can cause neurological and muscular symptoms.
* If hypercalcemia occurs, discontinue calcium acetate and reduce or stop calcium and vitamin D intake.
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*This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always verify current prescribing information with the official product labeling and consult with a qualified healthcare provider.*
