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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.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis.
## Adult Dosing
* **Starting Dose:** 667 mg (equivalent to 13.3 mEq elemental calcium and 169 mg acetate) orally three times daily with meals.
* **Titration:** Doses should be titrated based on serum phosphate levels. Maximum recommended dose is 3335 mg (equivalent to 66.7 mEq elemental calcium and 845 mg acetate) orally three times daily with meals.
* **General Target:** Aim for serum phosphate levels less than 6 mg/dL.
## Pediatric Dosing
* The use of calcium acetate in pediatric patients is not well-established. Dosing should be individualized based on clinical response and laboratory parameters, with close monitoring. Consult specialized pediatric nephrology resources for guidance.
## Dose Adjustments
* **Renal Impairment:** Dosing is primarily for patients with ESRD on dialysis. For patients with less severe renal impairment, dose adjustments are not well-defined, but caution and monitoring are warranted due to potential for calcium accumulation.
* **Hypercalcemia:** If hypercalcemia occurs, the dose should be reduced or discontinued.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Concomitant use of intravenous calcium.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Cardiovascular events secondary to hypercalcemia, milk-alkali syndrome (rare).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Biphosphonates:** Concurrent use may decrease the absorption of both medications. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Vitamin D Analogs:** Increased risk of hypercalcemia.
## Monitoring
* Serum calcium levels (total and ionized).
* Serum phosphate levels.
* Alkaline phosphatase.
* BUN and creatinine.
* Monitor for signs and symptoms of hypercalcemia (e.g., confusion, lethargy, nausea, constipation, bone pain, polyuria, polydipsia).
## Clinical Pearls
* Administer calcium acetate with meals to maximize phosphate binding.
* The goal of therapy is to control serum phosphate, not necessarily normalize calcium. However, hypercalcemia is a significant concern and must be monitored closely.
* Total daily elemental calcium intake from all sources (diet, supplements, medication) should be considered to avoid exceeding the recommended upper limit, especially in patients with CKD.
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*This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols before making clinical decisions.*
