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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used primarily in patients with end-stage renal disease (ESRD). It is highly efficient at binding dietary phosphorus in the GI tract to form insoluble calcium phosphate, which is then excreted in the feces. It provides a higher calcium content per gram than calcium carbonate, with potentially lower systemic calcium absorption. ## Primary Indications Reduction of serum phosphorus in patients with ESRD (hyperphosphatemia). ## Adult Dosing * **Initial Dose:** 2 capsules/tablets (667 mg each) with each meal. * **Titration:** Adjust based on serum phosphate levels. Most patients require 3–4 capsules/tablets per meal to achieve target serum phosphorus. * **Maximum:** Dosing is individualized; safety limits are dictated by serum calcium levels and the Calcium x Phosphorus (Ca x P) product. ## Pediatric Dosing * **Safety/Efficacy:** Not well-established in pediatrics; use is off-label. * **Dosing:** Consult local institutional protocol or pediatric nephrology guidelines. Usually titrated based on weight and phosphate levels, starting at lower doses (e.g., 200–400 mg calcium equivalent) with meals. ## Dose Adjustments * **Hypercalcemia:** Reduce dose or discontinue if serum corrected calcium exceeds the upper limit of normal or if the Ca x P product exceeds 55 mg²/dL². * **Renal Impairment:** Standard therapy for ESRD; no dose modification required other than titration to phosphate response. ## Contraindications * Hypercalcemia. * Hypophosphatemia. * Known hypersensitivity to calcium salts. ## Adverse Effects * **Common:** Hypercalcemia, nausea, vomiting, constipation, abdominal pain. * **Serious:** Metastatic calcification (if Ca x P product is consistently elevated). ## Key Drug Interactions * **Fluoroquinolones/Tetracyclines:** Calcium significantly decreases absorption. Administer calcium acetate at least 2 hours before or 6 hours after these antibiotics. * **Levothyroxine:** Calcium interferes with absorption; separate doses by at least 4 hours. * **Oral Bisphosphonates:** Separate doses by at least 2 hours. ## Monitoring * **Serum Phosphorus:** Every 2–4 weeks during initiation/titration. * **Serum Calcium:** Weekly during early titration, then monthly to monitor for hypercalcemia. * **Ca x P Product:** Aim to keep < 55 mg²/dL². ## Clinical Pearls * **Administration:** Must be taken with meals to be effective as a phosphate binder; taking it between meals provides no benefit for phosphate control. * **Comparison:** Calcium acetate binds twice as much phosphate per milligram as calcium carbonate and carries a lower risk of metabolic alkalosis. * **Patient Education:** Instruct patients to avoid over-the-counter calcium supplements or vitamin D analogues while on this therapy to prevent severe hypercalcemia. *** *Disclaimer: This information is for educational purposes only. Clinical practice guidelines and drug information can change. Always verify current prescribing information, institutional protocols, and patient-specific contraindications via official sources (e.g., Lexicomp, UpToDate, or the manufacturer’s package insert) before prescribing or administering medication.*