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## Calcium Acetate ### Overview Calcium acetate is a phosphate binder used to manage hyperphosphatemia in patients with chronic kidney disease (CKD). It binds to dietary phosphate in the gastrointestinal tract, preventing its absorption and lowering serum phosphate levels. ### Primary Indications * Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD). ### Adult Dosing * **Initial Dose:** 2 tablets (667 mg elemental calcium per tablet) orally with meals. * **Titration:** Doses should be adjusted based on serum phosphate levels. The goal is to maintain serum phosphate below 6 mg/dL. * **Maximum Dose:** Typically no more than 12 tablets (4002 mg elemental calcium) per day. However, doses up to 16 tablets (5336 mg elemental calcium) per day have been reported in clinical practice to achieve phosphate control. Individual titration is crucial. ### Pediatric Dosing * **Established Dosing:** Dosing in pediatric patients is not well-established and requires careful individualization by a physician experienced in pediatric nephrology. ### Dose Adjustments * **Renal Impairment:** Dose must be carefully titrated to achieve target phosphate levels while avoiding hypercalcemia. Patients with CKD require close monitoring. * **Hepatic Impairment:** No specific dose adjustments are typically required, but monitoring for hypercalcemia is still important. ### Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate or any component of the formulation. * Patients with a history of kidney stones (calcium oxalate). ### Adverse Effects * **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain. * **Serious:** Ectopic calcifications, cardiac arrhythmias (secondary to hypercalcemia), hypotension. ### Key Drug Interactions * **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate. * **Digoxin:** Hypercalcemia can potentiate digoxin toxicity. * **Thiazide Diuretics:** Can increase serum calcium levels. * **Vitamin D Analogs:** May increase the risk of hypercalcemia. ### Monitoring * **Serum Phosphate:** Regularly monitor serum phosphate levels to guide dosing. * **Serum Calcium:** Closely monitor serum calcium levels, especially during initiation and dose titration, to prevent and manage hypercalcemia. * **Alkaline Phosphatase:** Monitor levels as indicated. * **Renal Function:** Monitor serum creatinine and BUN. ### Clinical Pearls * Administer calcium acetate with meals to maximize phosphate binding. * A common target serum phosphate level is less than 6 mg/dL. * Correcting hyperphosphatemia may take several weeks. * Patients should be educated on the symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, frequent urination, confusion, fatigue, bone pain). *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant guidelines for complete and up-to-date details before making any treatment decisions.