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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) requiring dialysis.
## Adult Dosing
* **Initial dose:** 667 mg (1 gram calcium acetate) taken with each meal.
* **Titration:** Dosage should be adjusted to maintain serum phosphorus levels below 6 mg/dL. Doses can be increased gradually.
* **Maximum dose:** Generally not to exceed 4 grams per day (2.67 grams of elemental calcium).
## Pediatric Dosing
* No established specific pediatric dosing. Dosing should be individualized and guided by serum phosphorus levels and clinical response.
## Dose Adjustments
* No specific dose adjustments are required for hepatic impairment.
* Dosing should be guided by serum phosphorus and calcium levels. Hypercalcemia is a concern and requires dose reduction or interruption.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Ventricular fibrillation.
## Adverse Effects
* **Most common:** Nausea, vomiting, constipation, diarrhea, abdominal pain.
* **Serious:** Hypercalcemia (symptoms include constipation, bone pain, lethargy, confusion, nausea, vomiting, polyuria, polydipsia, cardiac arrhythmias).
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer antibiotics at least 1 hour before or 3 hours after calcium acetate.
* **Other Oral Medications:** Concurrent administration may decrease the absorption of other oral drugs. Separate administration by at least 2 hours.
* **Digitalis Glycosides:** Hypercalcemia can increase the risk of digitalis toxicity.
## Monitoring
* **Serum Phosphorus:** Regularly monitor to guide dosing and efficacy. Target levels generally < 6 mg/dL.
* **Serum Calcium:** Regularly monitor to prevent and manage hypercalcemia. Target levels vary, but aim to avoid levels > 10.5-11 mg/dL.
* **Alkaline Phosphatase:** Monitor for effects on bone metabolism.
## Clinical Pearls
* Calcium acetate should be taken with meals to effectively bind dietary phosphorus.
* The total daily elemental calcium intake from all sources (diet, supplements, medications) should be considered to avoid exceeding the recommended upper limit and increasing the risk of hypercalcemia and potential vascular calcification.
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**Disclaimer:** This information is intended for educational purposes and does not substitute for professional medical advice. Always verify current prescribing information with the official drug monograph or a healthcare professional.
