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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 than calcium carbonate and is more soluble at neutral pH, making it effective in limiting dietary phosphate absorption regardless of gastric acidity.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 2 capsules or 1 tablet (667 mg each) with each meal.
* **Titration:** Increase gradually based on serum phosphate levels to lower serum phosphate to a target range (typically < 5.5 mg/dL).
* **Maintenance:** Average dose is approximately 3 to 4 tablets/capsules per meal. Monitor serum calcium levels closely to avoid hypercalcemia.
## Pediatric Dosing
* **Safety/Efficacy:** Not well-established in pediatric patients. Use is generally based on clinician judgment and local institutional protocols, typically extrapolated from adult dosing titrated strictly to serum phosphate and calcium goals.
## Dose Adjustments
* **Renal Impairment:** Required; dose based on serum phosphorus and serum calcium.
* **Hypercalcemia:** If hypercalcemia develops, reduce dose or discontinue until normocalcemia is restored.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Nephrolithiasis (calcium-containing stones).
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Metastatic calcification (associated with high calcium-phosphorus product > 55 mg²/dL²), severe hypercalcemia.
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Reduced absorption; administer calcium acetate at least 2 hours before or 6 hours after these antibiotics.
* **Levothyroxine:** Reduced absorption; separate doses by at least 4 hours.
* **Bisphosphonates:** Reduced absorption; separate doses.
* **Calcium Channel Blockers:** Calcium may antagonize the effects of these medications.
## Monitoring
* **Serum Phosphorus:** Monitor regularly (e.g., every 2–4 weeks during titration).
* **Serum Calcium:** Monitor weekly during titration, then periodically.
* **Calcium-Phosphorus Product:** Keep < 55 mg²/dL² to minimize the risk of vascular and soft tissue calcification.
## Clinical Pearls
* **Administration:** Must be taken with meals to bind dietary phosphorus. Taking it between meals is ineffective for phosphate binding.
* **Calcium Load:** Ensure the patient is not taking additional calcium supplements (including calcium-based antacids) to avoid overdose.
* **Hypercalcemia Risk:** Calcium acetate carries a higher risk of hypercalcemia compared to sevelamer (a non-calcium-based phosphate binder); verify if the patient can tolerate a calcium-based regimen.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice varies by institution and patient-specific factors. Always verify current prescribing information, laboratory values, and institutional protocols before administering medication.
