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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to treat hyperphosphatemia in patients with chronic kidney disease (CKD). It provides a high calcium-to-phosphate binding ratio, effectively forming insoluble calcium phosphate in the gastrointestinal tract.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 2 capsules (or 1334 mg) orally with each meal.
* **Titration:** Adjust based on serum phosphate levels; commonly titrated to 3 or 4 capsules with meals.
* **Maximum:** Titration should be guided by serum calcium and phosphorus; avoid doses that induce hypercalcemia.
## Pediatric Dosing
Safety and efficacy have not been established in the pediatric population. Use is considered off-label and requires institutional protocol or specialist guidance. Dosing is typically extrapolated from adult data based on weight or body surface area under close supervision by a pediatric nephrologist.
## Dose Adjustments
* **Renal Impairment:** Not applicable (indicated for use in renal failure).
* **Hypercalcemia:** If hypercalcemia develops, reduce the dose or temporarily discontinue.
* **Vitamin D:** Reduce or discontinue vitamin D supplementation if hypercalcemia occurs.
## Contraindications
* Hypercalcemia.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, and abdominal pain.
* **Serious:** Metastatic soft tissue calcification (due to elevated calcium-phosphorus product).
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Calcium acetate reduces the absorption of these antibiotics. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Calcium salts reduce levothyroxine absorption. Administer at least 4 hours apart.
* **Bisphosphonates:** Reduces oral bioavailability. Administer separately.
## Monitoring
* **Serum Phosphorus:** Monitor periodically to ensure therapeutic range (typically 3.5–5.5 mg/dL).
* **Serum Calcium:** Monitor weekly during initial titration and monthly thereafter; watch for hypercalcemia (>10.5 mg/dL).
* **Calcium-Phosphorus Product:** Keep the product typically <55 mg²/dL² to minimize the risk of vascular calcification.
## Clinical Pearls
* **Administration:** It must be taken **with meals** to be effective as a phosphate binder.
* **Calcium Content:** Each 667 mg capsule contains approximately 169 mg (8.45 mEq) of elemental calcium.
* **Switching Agents:** If patients also require a non-calcium-based binder (e.g., sevelamer or lanthanum) to avoid hypercalcemia, prioritize those if calcium levels exceed target ranges.
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific contraindications via reliable clinical databases (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*
