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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with chronic kidney disease (CKD). It works by binding dietary phosphorus in the gastrointestinal tract, preventing its absorption. Each 500 mg tablet contains approximately 125 mg of elemental calcium.
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
* **Dosage Range:** 2-4 tablets (1000-2000 mg) by mouth with meals.
* **Titration:** Doses should be individualized based on serum phosphorus levels. Titrate gradually to control serum phosphorus within target limits.
* **Maximum:** Generally, consider a total daily elemental calcium intake of no more than 2000 mg from all sources (dietary and supplements) to avoid hypercalcemia. However, specific maximums for calcium acetate therapy are not rigidly defined and depend on individual response and tolerance.
## Pediatric Dosing
* Information regarding pediatric use and dosing is not well-established and should be guided by specialist recommendations and careful monitoring. Dosing is typically based on age, weight, and serum phosphorus levels.
## Dose Adjustments
* **Renal Impairment:** Calcium acetate is used in CKD patients. Dose adjustments are based on serum phosphorus and calcium levels.
* **Hepatic Impairment:** No specific dose adjustments are usually required.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate or any component of the formulation.
* Patients with elevated serum calcium levels.
## Adverse Effects
* **Common:** Hypercalcemia (especially with excessive doses or in patients with impaired renal function), constipation, nausea, vomiting.
* **Serious:** Arrhythmias, adynamic bone disease.
## Key Drug Interactions
* **Antacids:** Concurrent use may increase the absorption of calcium, leading to hypercalcemia.
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after these medications.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thyroid Hormones:** Calcium acetate can decrease the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium acetate can decrease the absorption of bisphosphonates. Separate
