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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, typically associated with chronic kidney disease (CKD). It binds 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).
## Adult Dosing
* **Initial Dose:** 2 tablets (667 mg elemental calcium per tablet) taken orally with each meal.
* **Titration:** Doses should be adjusted based on serum phosphate levels. Typical doses range from 2 to 4 tablets with each meal.
* **Maximum Dose:** Typically 12 tablets (approximately 4000 mg elemental calcium) per day. Higher doses may be used cautiously under close monitoring, but risk of hypercalcemia increases.
## Pediatric Dosing
* Dosing in pediatric patients is not well established and should be determined by a specialist based on individual clinical needs and careful monitoring.
## Dose Adjustments
* **Renal Impairment:** Dose should be adjusted carefully based on serum calcium, phosphate, and PTH levels. Patients with CKD are at increased risk of hypercalcemia.
* **Concurrent Medications:** Patients taking calcium supplements or vitamin D analogs may require dose adjustments to prevent hypercalcemia.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Use with caution in patients with history of kidney stones.
## Adverse Effects
* **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, anorexia.
* **Serious:** Hypercalcemia can lead to confusion, cardiac arrhythmias, renal failure, and coma.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease absorption. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia can potentiate digoxin toxicity. Monitor cardiac status closely.
* **Vitamin D Analogs and Calcium Supplements:** Increased risk of hypercalcemia.
* **Phosphate-Binding Binders (other than calcium-based):** Generally not given concurrently due to redundant effect.
## Monitoring
* **Frequent:** Serum calcium, serum phosphate, and alkaline phosphatase. Monitor at least weekly during initial dose titration, and then monthly or quarterly once stable.
* **Less Frequent:** PTH, electrolytes, magnesium, and renal function.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphate.
* Monitor for symptoms of hypercalcemia: thirst, frequent urination, abdominal pain, nausea, vomiting, constipation, muscle weakness, bone pain, confusion, and cardiac arrhythmias.
* The goal is to achieve serum phosphate levels < 6 mg/dL.
* Each 667 mg tablet of calcium acetate provides approximately 169 mg of elemental calcium.
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*This information is intended for healthcare professionals and does not replace professional judgment. Always verify current prescribing information and consult with a qualified healthcare provider for specific patient care decisions.*
