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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder. It works by binding to dietary phosphate in the gastrointestinal tract, preventing its absorption and lowering serum phosphate levels. ## Primary Indications - Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis. ## Adult Dosing - **Initial dose:** 133 mg/kg/day orally, divided into 3 or 4 doses with meals. - **Titration:** Increase dose gradually based on serum phosphate levels. - **Maximum dose:** Not to exceed 1667 mg/kg/day orally. - **Typical effective dose:** Ranges from 2000 mg to several grams per day, divided with meals. Dose is dependent on dietary phosphate intake and serum phosphate levels. ## Pediatric Dosing - **Use in pediatrics:** Data is limited and dosing should be individualized under specialist guidance. ## Dose Adjustments - No specific dose adjustments are needed for renal or hepatic impairment, as the drug is not renally excreted. - Dose adjustments are guided by serum phosphate and calcium levels. ## Contraindications - Hypercalcemia. - Hypersensitivity to calcium acetate. - Certain conditions associated with hypercalcemia (e.g., sarcoidosis, metastatic bone disease). ## Adverse Effects - **Common:** Hypercalcemia, constipation, nausea, vomiting, diarrhea. - **Serious:** Development of soft tissue calcification. ## 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. - **Digoxin:** Administration of oral calcium may increase the effects of digoxin. - **Thiazide diuretics:** May increase the risk of hypercalcemia. - **Vitamin D and its analogues:** May increase the risk of hypercalcemia. ## Monitoring - **Serum phosphate:** Monitor regularly to guide dosing. - **Serum calcium:** Monitor regularly to prevent and manage hypercalcemia. The goal is typically a serum calcium level within the normal range. - **Alkaline phosphatase:** May be monitored. ## Clinical Pearls - Administer with meals to optimize phosphate binding. - Monitor calcium-ionized levels, as total serum calcium can be misleading in patients with altered protein binding. - Dose should be adjusted to maintain serum phosphate levels as close to normal (2.5-5.5 mg/dL) as possible without causing significant hypercalcemia. *** *Disclaimer: This information is intended for clinical professionals and is not a substitute for professional medical advice. Always verify current prescribing information and consult with a qualified healthcare provider before making any treatment decisions.*