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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. It works by binding to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis.
## Adult Dosing
* **Starting dose:** 667 mg (equivalent to 169 mg elemental calcium) orally with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Titrate by 667 mg to 1334 mg per meal increments every 1-2 weeks.
* **Maximum dose:** Generally not to exceed 4000 mg (equivalent to 1000 mg elemental calcium) per day, divided with meals.
## Pediatric Dosing
* **Safety and efficacy not established in pediatric patients.**
## Dose Adjustments
* **Renal Impairment:** Dosing is specifically for patients with ESRD on dialysis.
* **Hypercalcemia:** Reduce dose or discontinue if hypercalcemia occurs.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Nausea, vomiting, constipation, diarrhea, hypercalcemia.
* **Serious:** Hypercalcemia (symptoms include constipation, dry mouth, headache, loss of appetite, metallic taste, nausea, vomiting, fatigue, weakness, urinary frequency, abdominal pain, confusion, irregular heartbeat, stupor, coma).
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of oral tetracyclines and fluoroquinolones. Administer these antibiotics at least 2 hours before or 6 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate may decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Antacids:** Concomitant use may increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
## Monitoring
* Serum calcium levels should be monitored regularly, especially when initiating therapy or increasing the dose.
* Serum phosphate levels should be monitored to assess efficacy.
* Monitor for signs and symptoms of hypercalcemia.
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* Consider the elemental calcium content of calcium acetate (approximately 25% by weight) when assessing total daily calcium intake, especially in patients prone to hypercalcemia.
* For patients who develop hypercalcemia, dose reduction or discontinuation is necessary. If hypercalcemia persists, alternative phosphate binders may be required.
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*Disclaimer: This information is intended for educational purposes and does not substitute for professional medical advice. Always consult the most current prescribing information and a healthcare professional for any questions regarding medication use.*
