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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to manage hyperphosphatemia in patients with end-stage renal disease (ESRD). It is more soluble than calcium carbonate and provides a higher amount of elemental calcium, effectively binding dietary phosphate in the GI tract to form insoluble calcium phosphate for fecal excretion.
## Primary Indications
* Reduction of serum phosphorus 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.
* **Maintenance:** Titrate based on serum phosphate levels. Most patients require 2–4 tablets per meal.
* **Maximum:** Usually limited by the development of hypercalcemia.
## Pediatric Dosing
Safety and efficacy have not been established in pediatric patients. Use strictly per institutional protocol or specialist oversight; dosing is typically weight-based and titrated to serum phosphate/calcium targets.
## Dose Adjustments
* **Hypercalcemia:** If serum calcium levels rise above the target range, reduce the dose or switch to a non-calcium-based phosphate binder (e.g., sevelamer).
* **Renal Impairment:** Required; monitor calcium-phosphorus product to avoid metastatic calcification.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to calcium salts.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, and abdominal pain.
* **Serious:** Metastatic calcification (if calcium-phosphorus product exceeds >55 mg²/dL²), severe hypercalcemia.
## Key Drug Interactions
* **Quinolones/Tetracyclines:** Calcium significantly decreases absorption. Administer at least 2 hours before or 6 hours after.
* **Levothyroxine:** Separate administration by at least 4–6 hours to avoid binding and decreased absorption.
* **Bisphosphonates:** Calcium reduces absorption; separate doses by at least 2 hours.
## Monitoring
* **Serum Phosphorus:** Monitor at least every 2–4 weeks during initiation/titration.
* **Serum Calcium:** Monitor weekly initially, then monthly.
* **Calcium-Phosphorus Product:** Keep <55 mg²/dL².
* **Signs of Hypercalcemia:** Check for malaise, anorexia, nausea, vomiting, or confusion.
## Clinical Pearls
* **Timing:** Must be taken immediately before meals to maximize the binding of dietary phosphorus.
* **Content:** 667 mg of calcium acetate contains approximately 169 mg (8.45 mEq) of elemental calcium.
* **Avoid Vitamin D:** Use caution with concomitant Vitamin D therapy, as it increases calcium absorption and risk of hypercalcemia.
* **Adherence:** High pill burden is a common cause of treatment failure in dialysis populations; consider patient counseling on importance of mealtime dosing.
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*Disclaimer: This information is for educational purposes for healthcare professionals. Clinical practice varies by institution; always verify current prescribing information, laboratory reference ranges, and local protocols before administering medication.*
