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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to manage hyperphosphatemia in patients with chronic kidney disease (CKD). It works by binding to dietary phosphate in the gastrointestinal tract, forming an insoluble calcium phosphate that is then excreted in the feces. ## Primary Indications * Management of hyperphosphatemia in patients with end-stage renal disease (ESRD). ## Adult Dosing * **Initial dose:** 2 tablets (668 mg elemental calcium) orally with each meal. * **Titration:** Dosage should be individualized based on serum phosphate levels. The goal is to reduce serum phosphate to less than 6 mg/dL. * **Maximum dose:** Generally not to exceed 16 tablets per day. Dosing should be guided by individual patient response and tolerance. ## Pediatric Dosing * Dosing in pediatric patients is not well-established and should be approached with caution. Consult specialized pediatric resources or guidelines. ## Dose Adjustments * **Renal Impairment:** Dose adjustments are typically based on serum phosphate and calcium levels. * **Hypercalcemia:** If hypercalcemia occurs, the dose should be reduced or discontinued. ## Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate or any component of the formulation. ## Adverse Effects * **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting. * **Serious:** Cardiovascular events associated with hypercalcemia, particularly in patients with CKD. ## Key Drug Interactions * **Tetracyclines and Quinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate. * **Thyroid Hormones:** Calcium may reduce the absorption of levothyroxine. Separate administration by at least 4 hours. * **Biphosphonates:** Calcium may decrease absorption. Separate administration. * **Calcium Channel Blockers:** Monitor for hypercalcemia, although clinical significance is debated. * **Digoxin:** Hypercalcemia can potentiate digoxin toxicity. ## Monitoring * **Serum phosphate:** Monitor regularly to assess efficacy and guide dose titration. * **Serum calcium:** Monitor regularly, especially when initiating or titrating therapy, to prevent or manage hypercalcemia. Target serum calcium levels should be individualized and discussed with the prescribing clinician. * **Serum alkaline phosphatase:** May be monitored in patients with renal osteodystrophy. ## Clinical Pearls * Administer calcium acetate with meals to effectively bind dietary phosphate. * Monitor for