Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control serum phosphorus in patients with end-stage renal disease (ESRD). It provides higher elemental calcium per gram compared to other calcium salts, which may enhance phosphate binding efficiency but increases the risk of hypercalcemia.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD) on hemodialysis.
## Adult Dosing
* **Initial Dose:** 1,334 mg (two 667 mg capsules/tablets) orally with each meal.
* **Titration:** Adjust based on serum phosphorus levels. Titrate upward every 2–3 weeks to achieve goal serum phosphorus levels (typically <5.5 mg/dL).
* **Maximum Dose:** Generally 3,000 mg to 5,000 mg daily, divided with meals. Dosing exceeding these amounts may significantly increase the risk of hypercalcemia. Follow institutional protocols.
## Pediatric Dosing
* **Safety/Efficacy:** Not established; use is off-label.
* **Dosing:** Often extrapolated from adult data, typically 800–3,000 mg/day divided with meals, aiming for serum phosphorus control. Consultant nephrology oversight is mandatory.
## Dose Adjustments
* **Renal Impairment:** Required in the context of ESRD management; monitor serum calcium and phosphorus weekly during dose titration.
* **Hepatic Impairment:** No specific adjustments required.
## Contraindications
* **Hypercalcemia:** Absolute contraindication.
* **Hypersensitivity:** Known allergy to calcium acetate or excipients.
## Adverse Effects
* **Common:** Hypercalcemia (most significant risk), nausea, vomiting, constipation, abdominal pain.
* **Serious:** Metastatic calcification (vascular or soft tissue) occurring with prolonged hypercalcemia and high Ca x P product.
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Reduced absorption due to chelation; administer calcium acetate 2 hours before or 6 hours after these antibiotics.
* **Levothyroxine:** Oral absorption may be reduced; separate administration by at least 4 hours.
* **Bisphosphonates:** Reduced absorption; separate administration by at least 2 hours.
* **Vitamin D analogues:** Increases intestinal calcium absorption; concurrent use increases hypercalcemia risk.
## Monitoring
* **Serum Phosphorus:** Weekly during initiation/titration, then monthly.
* **Serum Calcium:** Weekly during initiation/titration, then monthly.
* **Calcium-Phosphorus Product (Ca x P):** Maintain <55 mg²/dL² to minimize calcification risk.
* **Symptoms of Hypercalcemia:** Monitor for confusion, lethargy, muscle weakness, and cardiac arrhythmias.
## Clinical Pearls
* **Administration:** Must be taken **with meals** to effectively bind dietary phosphate.
* **Choice of Binder:** Calcium-based binders are effective but limited by the risk of hypercalcemia, especially when used with concomitant vitamin D therapy or high-calcium dialysate.
* **Hypercalcemia Management:** If serum calcium exceeds the upper limit of normal, reduce or discontinue calcium acetate and/or vitamin D dose.
* **Patient Education:** Instruct patients to avoid over-the-counter calcium supplements or antacids containing calcium while taking this agent.
***
**Disclaimer:** This information is for educational purposes only. Prescribing practices, local institutional protocols, and patient-specific needs vary. Always verify current prescribing information, package inserts, and facility guidelines before administering any medication.
