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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 or peritoneal dialysis.
## Adult Dosing
* **Hyperphosphatemia:** Start with 667 mg (equivalent to 169 mg elemental calcium) orally three times daily with meals.
* **Titration:** Dose should be individualized based on serum phosphate levels. Titrate upwards in increments of 667 mg per meal until serum phosphate is controlled or acceptable.
* **Maximum Dose:** While specific maximums are not universally defined, doses up to 5000 mg per day (7500 mg calcium acetate) have been used. Monitor calcium levels closely.
## Pediatric Dosing
* Dosing in pediatric patients is not well-established and should be determined by a specialist.
## Dose Adjustments
* **Renal Impairment:** Patients with CKD generally require this medication. However, hypercalcemia risk increases with declining renal function.
* **Hepatic Impairment:** No specific adjustments are typically needed.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Most Common:** Hypercalcemia (symptoms include constipation, nausea, vomiting, abdominal pain, anorexia, thirst, polyuria, confusion, fatigue, muscle weakness, bone pain), hypophosphatemia.
* **Other:** Acidosis, gastrointestinal upset, precipitates in dialysis lines.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Vitamin D Analogs:** Concomitant use can increase the risk of hypercalcemia.
* **Antacids (calcium-containing):** May increase the risk of hypercalcemia.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dosing.
* **Serum Calcium:** Monitor regularly, especially when initiating or titrating therapy, or in patients at risk for hypercalcemia. Goal is generally to keep serum calcium within the normal range or slightly elevated, avoiding hypercalcemia.
* **Serum Magnesium and Alkaline Phosphatase:** May be monitored periodically.
## Clinical Pearls
* Administer with meals to effectively bind dietary phosphate.
* If a patient is taking other oral medications, separate administration of calcium acetate by at least 1 hour before or 3 hours after other medications, particularly antibiotics.
* Hypercalcemia is a significant risk, particularly if co-administered with calcium supplements, calcium-containing phosphate binders, vitamin D, or thiazide diuretics.
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**Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.
