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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels. It provides a higher calcium content per gram than other salts (e.g., calcium carbonate) and is more effective at binding dietary phosphate in the GI tract.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial dose:** 1,334 mg (2 capsules or 1 tablet) orally with each meal.
* **Titration:** Adjust based on serum phosphorus levels. Most patients require 2,000 mg to 4,000 mg daily consumed with meals to achieve target levels.
* **Maximum:** Dosing is individualized; monitor closely for hypercalcemia.
## Pediatric Dosing
Safety and efficacy have not been established. Dosing in children is off-label and varies by local institutional protocol; typically titrated based on phosphate levels and serum calcium concentration.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or discontinue temporarily.
* **Renal Impairment:** Required; monitor calcium-phosphorus (Ca x P) product.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia (unless secondary to therapeutic goals).
* Known hypersensitivity.
## Adverse Effects
* **Common:** Nausea, vomiting, diarrhea, constipation.
* **Serious:** Hypercalcemia (manifested as confusion, arrhythmias, or muscle weakness), soft tissue calcification (metastatic calcification).
## Key Drug Interactions
* **Tetracycline/Doxycycline:** Reduced absorption; administer calcium acetate 1 hour before or 3 hours after antibiotics.
* **Fluoroquinolones (e.g., ciprofloxacin):** Reduced absorption; separate by at least 2–4 hours.
* **Levothyroxine:** Reduced absorption; separate by at least 4 hours.
* **Bisphosphonates:** Decreased absorption; separate timing significantly.
## Monitoring
* **Serum Phosphorus:** Monitor weekly during titration, then monthly.
* **Serum Calcium:** Monitor weekly during titration, then monthly to avoid hypercalcemia.
* **Ca x P Product:** Target < 55 mg²/dL² to minimize the risk of vascular calcification.
## Clinical Pearls
* **Timing:** Must be taken with meals to be effective as a phosphate binder.
* **Calcium Overload:** Avoid concurrent use of other calcium-based supplements or vitamin D analogues without clinical necessity, as this increases the risk of hypercalcemia.
* **Patient Education:** Advise patients that missing a dose with a meal significantly reduces the medication's effectiveness for that meal.
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**Educational Disclaimer:** This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and patient-specific factors via reliable clinical databases (e.g., Lexicomp, Micromedex) or the manufacturer's official labeling before prescribing or administering medication.
