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# Calcium acetate
## Overview
Calcium acetate is a calcium salt used primarily as a phosphate binder. It provides high calcium content and is more soluble than calcium carbonate, allowing for effective phosphate binding at lower elemental calcium doses.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial:** 1,334 mg (2 capsules/tablets) orally with each meal.
* **Titration:** Increase gradually based on serum phosphate levels.
* **Maximum:** Typically 3–4 tablets/capsules per meal. Monitor closely to avoid hypercalcemia.
## Pediatric Dosing
* **Safety/Efficacy:** Established dosing is not standardized; however, it is used off-label in pediatric nephrology.
* **Suggested range:** Often starts at 500–1,000 mg/m²/day or 30–50 mg/kg/day divided with meals, adjusted to maintain target serum phosphorus levels. Consult a pediatric nephrologist or local institutional protocol.
## Dose Adjustments
* **Renal Impairment:** Dosing must be titrated based on serum phosphorus and calcium levels.
* **Hypercalcemia:** Hold dose if serum calcium exceeds the upper limit of normal or if corrected calcium is >10.5 mg/dL.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Nephrolithiasis (calcium-containing stones).
## Adverse Effects
* **Common:** Nausea, vomiting, constipation, abdominal pain.
* **Serious:** Hypercalcemia, hypercalcemia-induced arrhythmias, soft-tissue calcification (if calcium-phosphate product >55 mg²/dL²).
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Calcium significantly decreases absorption. Administer antibiotics 2 hours before or 6 hours after calcium acetate.
* **Bisphosphonates:** Calcium reduces bisphosphonate absorption; separate by at least 2 hours.
* **Levothyroxine:** Calcium interferes with absorption; separate by at least 4 hours.
* **Iron Supplements:** Calcium reduces iron absorption; separate doses.
## Monitoring
* **Serum Phosphorus:** Monitor every 1–3 weeks during titration, then monthly.
* **Serum Calcium:** Monitor weekly during initiation and monthly thereafter.
* **Calcium-Phosphate Product:** Maintain <55 mg²/dL² to prevent metastatic calcification.
## Clinical Pearls
* **Administration:** Must be taken *with* meals to act as a phosphate binder. It is ineffective if taken on an empty stomach.
* **Comparison:** Calcium acetate binds twice as much phosphorus per gram as calcium carbonate.
* **Dietary Adherence:** This agent does not replace the need for a phosphorus-restricted diet.
* **Hypercalcemia risk:** Patients on concurrent Vitamin D analogs are at higher risk for hypercalcemia.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical guidelines and protocols vary by institution. Always verify specific dosing, safety profiles, and current prescribing information via official manufacturer labeling or local pharmacy-verified resources before administration.
