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# Calcium Acetate
## Overview
Calcium acetate is a calcium salt primarily used as a phosphate binder due to its high calcium content (approx. 25% by weight) and superior binding capacity per gram compared to calcium carbonate.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 667 mg orally with each meal.
* **Titration:** Adjust based on serum phosphate levels. Typical range is 667 mg to 1,334 mg (1 to 2 capsules/tablets) per meal.
* **Maximum:** Dosing is often limited by the development of hypercalcemia.
## Pediatric Dosing
* **Safety/Efficacy:** Not well-established in pediatrics. Use is generally off-label and supervised by a pediatric nephrologist. Dosages are highly individualized based on serum phosphate and calcium levels.
## Dose Adjustments
* **Renal Impairment:** Required; monitor calcium-phosphorus product to avoid metastatic calcification.
* **Hypercalcemia:** Reduce dose or discontinue if serum corrected calcium exceeds the upper limit of normal or if the calcium-phosphorus product exceeds 55 mg²/dL².
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to calcium salts.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation.
* **Serious:** Metastatic soft tissue calcification, vascular calcification, cardiac arrhythmias (if severe hypercalcemia occurs).
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Reduced absorption due to chelation. Separate administration by at least 2–4 hours.
* **Levothyroxine:** Reduced absorption; separate by at least 4 hours.
* **Bisphosphonates:** Reduced absorption; separate dosing by at least 2 hours.
* **Thiazide Diuretics:** May increase risk of hypercalcemia by decreasing urinary calcium excretion.
## Monitoring
* **Serum Phosphorus:** Monitor weekly during initiation/titration.
* **Serum Calcium:** Monitor weekly during initiation/titration.
* **Calcium-Phosphorus Product:** Ensure target remains <55 mg²/dL².
* **Signs of Hypercalcemia:** Early symptoms include malaise, anorexia, nausea, and vomiting.
## Clinical Pearls
* **Binding Efficacy:** Must be taken **with meals** to effectively bind dietary phosphorus. It has no efficacy if taken between meals.
* **Calcium Load:** It provides a significant oral calcium load; patients should be advised to limit other calcium supplements to avoid excessive intake and hypercalcemia.
* **Dosing Variations:** Clinical protocols may vary significantly between dialysis centers. Always consult facility-specific guidelines or the attending nephrologist for patient-specific targets.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and individual patient factors may alter prescribing decisions. Always verify current prescribing information, institutional protocols, and pharmacokinetic data via updated clinical references (e.g., Lexicomp, UpToDate) before administering medication.
