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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, preventing its absorption. ### Primary Indications * Management of hyperphosphatemia in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis. ### Adult Dosing * **Dosage:** Start with 667 mg (equivalent to 169 mg of elemental calcium) orally with each meal. * **Titration:** Increase dose as needed based on serum phosphate levels. Doses can range from 1334 mg to 2668 mg per day, divided with meals. * **Maximum dose:** A typical maximum dose is 2668 mg per day (divided with meals). Higher doses may be used under close monitoring. ### Pediatric Dosing * Dosing in pediatric patients is not well-established and should be individualized based on serum phosphate levels and clinical response, under the guidance of a pediatric nephrologist. ### Dose Adjustments * **Renal Impairment:** Not applicable as it is indicated for patients with ESRD. * **Hepatic Impairment:** No specific adjustments are typically needed. ### Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate. * Hypersensitivity to any component of the formulation. ### Adverse Effects * **Common:** Hypercalcemia, nausea, vomiting, constipation, diarrhea, abdominal pain, dyspepsia. * **Serious:** Cardiovascular events (related to hypercalcemia), hypocalcemia (if phosphate binding is too effective and calcium intake is insufficient), intestinal obstruction. ### Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate. * **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours. * **Antacids:** Concurrent use with other calcium-containing antacids may increase the risk of hypercalcemia. * **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity. ### Monitoring * **Serum Phosphate:** Monitor regularly (e.g., before and during dialysis sessions, and between dialysis sessions) to guide dosing. Target levels are generally < 5.5 mg/dL, but individualized goals may apply. * **Serum Calcium:** Monitor regularly to prevent or manage hypercalcemia. * **Serum Magnesium and Alkaline Phosphatase:** May be monitored periodically. ### Clinical Pearls * Administer calcium acetate with each meal to maximize phosphate binding. * Patients should be educated on the importance of adhering to a low-phosphate diet. * Monitor for signs and symptoms of hypercalcemia (e.g., constipation, nausea, vomiting, confusion, lethargy, polyuria, polydipsia). * If hypercalcemia develops, reduce the dose of calcium acetate and consider reducing dietary calcium or phosphate intake. **Disclaimer:** This information is intended for healthcare professionals. Always verify current prescribing information and consult with a pharmacist or physician for individualized patient care.