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# Calcium Acetate
## Overview
Calcium acetate is a calcium salt used primarily as a phosphate binder. It provides a higher calcium content per gram compared to calcium carbonate and has higher phosphate-binding efficiency in the acidic environment of the stomach.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD).
## Adult Dosing
* Initial: 1,334 mg (two 667 mg capsules/tablets) orally with each meal.
* Titration: Adjust based on serum phosphate levels; titrate upwards to lower serum phosphorus to target levels.
* Maximum: Generally limited by the development of hypercalcemia. Monitor serum calcium levels closely if exceeding 3,000–4,000 mg daily.
## Pediatric Dosing
* Safety and efficacy have not been established in the pediatric population. Dosing is highly variable and institutional-specific; consultation with a pediatric nephrologist is mandatory.
## Dose Adjustments
* **Renal Impairment:** Required adjustments based on serum phosphorus and calcium concentrations.
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium exceeds the upper limit of normal or if the calcium-phosphorus product (>55 mg²/dL²) remains elevated.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia (unless secondary to treatment).
* Known hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, dry mouth.
* **Serious:** Metastatic tissue calcification, worsening of vascular calcification in patients with advanced CKD.
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Calcium significantly decreases absorption. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Calcium derivatives decrease absorption. Space doses by at least 4 hours.
* **Bisphosphonates:** Calcium reduces absorption; space by at least 2 hours.
* **Digoxin:** Increases risk of digitalis toxicity if hypercalcemia develops.
## Monitoring
* **Serum Phosphorus:** Monitor every 1–3 weeks during dose titration, then periodically.
* **Serum Calcium:** Monitor weekly during initial titration, then at least monthly.
* **Calcium-Phosphorus Product:** Target <55 mg²/dL².
## Clinical Pearls
* **Administration:** Must be taken with meals to effectively bind dietary phosphorus.
* **Potency:** Calcium acetate is significantly more effective at binding dietary phosphate than calcium carbonate due to higher solubility and lower pH-dependent binding.
* **Hypercalcemia Risk:** Monitor patients closely, especially those on concomitant vitamin D analogs or high-calcium dialysate, as these increase the risk of hypercalcemia.
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*Disclaimer: This information is for educational purposes only. Always verify dosing, contraindications, and drug interactions against the most current institutional protocols and the manufacturer’s official prescribing information (package insert) before administering any medication.*
