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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 dietary phosphate in the gastrointestinal tract, preventing its absorption. Each 667 mg tablet contains approximately 169 mg (8.45 mEq) of elemental calcium.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Initial dose:** 2 tablets orally with each meal.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Titrate dose upwards to achieve target serum phosphate levels (typically < 5.5 mg/dL).
* **Maximum dose:** Typically not to exceed 8 tablets per meal, but may be guided by local protocol and patient tolerance. Monitor for hypercalcemia.
## Pediatric Dosing
* Dosing in pediatric patients has not been well-established. Consult specialized pediatric resources or guidelines.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or discontinue.
* **Renal Impairment:** Primarily used in ESRD patients on dialysis. Dose adjustment in other forms of renal impairment is not typically applicable as the drug is intended to manage hyperphosphatemia in advanced CKD.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Intestinal obstruction, particularly with high doses or in patients with pre-existing GI motility issues. Development of calciphylaxis in susceptible patients.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer antibiotics at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate can decrease absorption. Separate administration by at least 4 hours.
* **Antacids containing magnesium or aluminum:** Concurrent use can lead to excessive calcium, magnesium, and aluminum accumulation.
* **Digoxin:** Hypercalcemia can potentiate cardiac effects of digoxin.
## Monitoring
* **Serum Phosphate:** Monitor regularly to assess efficacy and guide dose titration.
* **Serum Calcium:** Monitor regularly for signs of hypercalcemia. Target corrected calcium levels should be individualized but generally kept within the normal range.
* **Alkaline Phosphatase:** May be monitored in patients with CKD.
* **Signs/symptoms of hypercalcemia:** Lethargy, confusion, constipation, nausea, vomiting, polyuria, polydipsia.
## Clinical Pearls
* Administer with meals to effectively bind dietary phosphate.
* Crush tablets if needed for patients who have difficulty swallowing, but ensure they are taken with food.
* Ensure adequate hydration to help prevent constipation and renal complications.
* Monitor calcium levels closely, as excessive calcium intake can lead to vascular and soft tissue calcification.
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**Disclaimer:** This information is intended as a quick reference and does not replace comprehensive drug information resources. Always verify current prescribing information, contraindications, warnings, and patient-specific factors before making clinical decisions.
