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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD). It binds to dietary phosphate in the gastrointestinal tract, preventing its absorption.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) on dialysis.
## Adult Dosing
* **Initial Dose:** 2 tablets (668 mg elemental calcium) with each meal.
* **Titration:** Dose should be adjusted based on serum phosphate levels. Aim for serum phosphate < 6 mg/dL.
* **Maximum Dose:** Typically 16 tablets (5344 mg elemental calcium) per day, divided with meals. However, maximum dosage should be guided by patient response and tolerance, particularly regarding calcium levels.
## Pediatric Dosing
* Dosing for pediatric patients has not been well-established. Use with caution and individualize based on clinical assessment and serum phosphate levels. Some sources suggest initial doses of 1-2 tablets (334-668 mg) per meal.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia occurs, reduce the dose or temporarily discontinue.
* **Hypophosphatemia:** If hypophosphatemia occurs, reduce the dose.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Vascular calcification, cardiac valvular calcification, hypophosphatemia.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease absorption. Administer at least 2 hours before or 3 hours after these antibiotics.
* **Digoxin:** Hypercalcemia associated with calcium supplements can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** May increase the risk of hypercalcemia.
* **Sodium polystyrene sulfonate:** Concurrent use may lead to metabolic alkalosis or intestinal obstruction.
## Monitoring
* **Serum Phosphate:** Monitor regularly to guide dose adjustments.
* **Serum Calcium:** Monitor closely, especially during initiation and dose titration, to prevent hypercalcemia. Target serum calcium levels depend on local protocols and patient-specific factors.
* **Alkaline Phosphatase:** Monitor as an indicator of bone turnover.
## Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Dose titration is crucial and should be based on achieving target serum phosphate levels while avoiding hypercalcemia.
* Be aware of the potential for accumulation in patients with decreased renal or hepatic function.
* Educate patients on the importance of taking medication with meals and reporting symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, increased urination).
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**Disclaimer:** This information is intended for clinical use and does not replace professional judgment. Always consult the most current prescribing information and local protocols before administering any medication.
