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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used primarily to manage hyperphosphatemia in patients with end-stage renal disease (ESRD). It is highly soluble and provides more elemental calcium per gram than calcium carbonate, allowing for effective phosphate binding with lower-dose requirements.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD) on maintenance dialysis.
## Adult Dosing
* **Initial Dose:** 2 capsules/tablets (667 mg each) with each meal.
* **Titration:** Increase gradually based on serum phosphate levels.
* **Maximum:** Doses exceeding 12–16 capsules/tablets per day are typically limited by hypercalcemia; follow specific institutional protocols for titration increments.
## Pediatric Dosing
* **Safety/Efficacy:** Not well-established. Use is off-label and requires nephrology consultation.
* **Dosing:** Pediatric dosing is highly variable based on body surface area and renal function; must be determined by a pediatric nephrologist using institutional guidelines.
## Dose Adjustments
* **Renal Impairment:** Required for all patients (ESRD patients are the target population).
* **Hypercalcemia:** If serum calcium levels rise above the upper limit of normal, reduce or discontinue dose.
## Contraindications
* Hypercalcemia.
* Known hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia (most significant risk), nausea, constipation, vomiting.
* **Serious:** Metastatic calcification (due to elevated calcium-phosphorus product).
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Binds these antibiotics, significantly reducing bioavailability. Separate administration by at least 2 hours.
* **Bisphosphonates:** Reduces absorption. Separate by at least 2 hours.
* **Levothyroxine:** Reduces absorption. Maintain separation of at least 4 hours.
* **Calcium Supplements/Vitamin D:** Concurrent use increases the risk of severe hypercalcemia.
## Monitoring
* **Serum Phosphorus:** Monitor at least every 2–4 weeks during titration.
* **Serum Calcium:** Monitor weekly during initiation and monthly thereafter.
* **Calcium-Phosphorus Product (Ca × P):** Target <55 mg²/dL² to minimize the risk of metastatic calcification.
## Clinical Pearls
* **Timing:** Must be taken **with meals** to effectively bind dietary phosphate. Taking it outside of mealtimes renders it ineffective as a binder.
* **Elemental Calcium:** 667 mg of calcium acetate provides approximately 169 mg of elemental calcium.
* **Comparison:** Compared to calcium carbonate, calcium acetate has greater phosphate-binding capacity per mEq of calcium and is less dependent on gastric acid for dissolution.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice varies by institution; always verify current prescribing information, institutional protocols, and patient-specific factors before administering this medication.
