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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 works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
The typical starting dose is 2 tablets (667 mg elemental calcium per tablet) taken orally with meals. Dosing should be individualized based on serum phosphate levels. The goal is to reduce serum phosphate to less than 6 mg/dL. The maximum recommended dose is 8 tablets per day, divided among meals.
## Pediatric Dosing
Dosing in pediatric patients should be individualized based on serum phosphate levels and is not well-established. Consult specific pediatric guidelines or literature. A common starting dose for children aged 6 years and older may range from 1334 mg to 2668 mg of calcium acetate per day, divided with meals.
## Dose Adjustments
Dose adjustments should be based on serum phosphate levels. Increase dosage gradually if hyperphosphatemia persists. Monitor serum calcium levels closely; hypercalcemia is a significant concern. If hypercalcemia occurs, reduce the dose or discontinue the medication.
## Contraindications
* Hypercalcemia.
* History of hypersensitivity to calcium acetate.
* Certain conditions that may predispose to hypercalcemia, such as metastatic calcification.
## Adverse Effects
* **Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, anorexia, abdominal pain, thirst, polyuria, confusion, fatigue).
* **Less Common:** Hypophosphatemia, gastrointestinal upset (e.g., constipation, diarrhea, nausea).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer these antibiotics at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity. Monitor serum calcium and digoxin levels.
* **Antacids:** Concurrent use may increase the risk of hypercalcemia.
## Monitoring
* Serum phosphate levels (target < 6 mg/dL).
* Serum calcium levels (target upper limit typically < 10.5 mg/dL, but consult local guidelines).
* Serum magnesium and alkaline phosphatase levels may be monitored.
* Signs and symptoms of hypercalcemia.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Closely monitor serum calcium, as hypercalcemia is a frequent and potentially serious adverse effect.
* If hypercalcemia occurs, temporarily discontinue calcium acetate and reduce dietary calcium intake.
* Consider the total elemental calcium content when assessing for hypercalcemia risk. Each 667 mg tablet contains approximately 169 mg of elemental calcium.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for clinical judgment. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.*
