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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus in patients with end-stage renal disease (ESRD). It is highly effective per milligram of elemental calcium due to its high solubility and binding capacity.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 667 mg to 1,334 mg (1 to 2 tablets/capsules) orally with each meal.
* **Titration:** Adjust based on serum phosphorus levels.
* **Maximum:** Doses exceeding 3,000 mg of elemental calcium per day are generally avoided to prevent hypercalcemia.
## Pediatric Dosing
* **Safety/Efficacy:** Not well-established in pediatric patients.
* **Dosing:** If used, dosing is off-label and typically based on local institutional protocols or nephrology consultation. Pediatric dosing usually requires strict monitoring of calcium-phosphorus product.
## Dose Adjustments
* **Renal Impairment:** No adjustment for the drug itself, as it is indicated for ESRD; however, dose must be lowered if hypercalcemia develops.
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium exceeds 10.5 mg/dL.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation.
* **Serious:** Metastatic calcification (if calcium-phosphorus product exceeds 55 mg²/dL²), severe hypercalcemia.
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Calcium binds these drugs, significantly reducing absorption. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Oral absorption may be reduced. Separate administration by at least 4 hours.
* **Bisphosphonates:** Reduces bisphosphonate absorption; separate by at least 2 hours.
## Monitoring
* **Serum Phosphorus:** Every 2–4 weeks during titration.
* **Serum Calcium:** Weekly during initiation; routine monitoring long-term.
* **Calcium-Phosphorus Product (Ca × P):** Target should generally be < 55 mg²/dL² to minimize vascular calcification risks.
## Clinical Pearls
* **Administration:** Must be taken with meals to bind dietary phosphorus. It has no effect on phosphate if taken without food.
* **Elemental Calcium:** 667 mg of calcium acetate provides approximately 169 mg of elemental calcium.
* **Calcium-Free Alternatives:** If patients develop hypercalcemia, consider switching to non-calcium-based binders (e.g., sevelamer, lanthanum) to avoid further calcium load.
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*Disclaimer: This information is for educational purposes only. Dosing, contraindications, and drug interactions change frequently. Always verify the most current prescribing information in a resource like Lexicomp or Micromedex and consult institutional protocols before prescribing or administering medication.*
