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# Calcium acetate ## Overview Calcium acetate is a phosphate-binding agent used to control hyperphosphatemia in patients with end-stage renal disease (ESRD). It is highly soluble and provides high amounts of elemental calcium while minimizing the risk of systemic hypercalcemia compared to other calcium-based binders. ## Primary Indications * Reduction of serum phosphorus in patients with end-stage renal disease (ESRD) or chronic kidney disease (CKD) on dialysis. ## Adult Dosing * **Initial Dose:** 1334 mg (two 667 mg capsules/tablets) orally with each meal. * **Titration:** Adjust based on serum phosphorus levels. * **Maximum Dose:** Typically up to 2668 mg (four 667 mg capsules/tablets) per meal. Dosing beyond this is generally limited by gastrointestinal intolerance or risk of hypercalcemia. Consult local institutional protocols for specific titration steps. ## Pediatric Dosing * **Safety/Efficacy:** Well-established dosing is less definitive in clinical trials than in adults. * **Initial Dose:** Often initiated at 800 mg/m²/day or approximately 334–667 mg with each meal, titrated to serum phosphorus control. * **Guidance:** Use with extreme caution; prioritize pediatric nephrology specialist guidance. ## Dose Adjustments * **Hypercalcemia:** If calcium levels rise above the upper limit of normal, reduce the dose or switch to a non-calcium-based phosphate binder (e.g., sevelamer, lanthanum). * **Renal Impairment:** Primarily indicated for patients with CKD/ESRD; no dose adjustment for renal function is required beyond monitoring serum calcium and phosphorus. ## Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate. ## Adverse Effects * **Common:** Hypercalcemia, nausea, constipation, diarrhea, and vomiting. * **Serious:** Metastatic calcification (due to elevated calcium-phosphorus product). ## Key Drug Interactions * **Fluoroquinolones/Tetracyclines:** Calcium significantly decreases absorption. Separate administration by at least 2 hours. * **Levothyroxine:** Reduces absorption. Separate by at least 4 hours. * **Bisphosphonates:** Reduces absorption. Separate by at least 2 hours. * **Iron Supplements:** Calcium can inhibit absorption; space administration. ## Monitoring * **Serum Phosphorus:** Monitor at least monthly during titration. * **Serum Calcium:** Monitor weekly or bi-weekly during titration. * **Calcium-Phosphorus Product:** Keep <55 mg²/dL² to prevent tissue calcification. ## Clinical Pearls * **Administration:** Must be taken **with meals** to effectively bind dietary phosphorus. Taking it between meals is ineffective for phosphate control. * **Elemental Calcium:** 667 mg of calcium acetate provides approximately 169 mg of elemental calcium. * **Calculation:** Ensure the total daily elemental calcium load (from binders plus dietary intake or supplements) is monitored to avoid hypercalcemia. *** *Educational Disclaimer: This information is for educational purposes only. Clinical practice varies; always consult local institutional guidelines, the most recent product monograph, or a clinical pharmacist before prescribing or administering medication.*