Please check your internet connection and try again.
# Calcium acetate
## Overview
Calcium acetate is a calcium-based phosphate binder used primarily in patients with end-stage renal disease (ESRD). It works by binding to dietary phosphate in the gastrointestinal tract to form insoluble calcium phosphate, which is subsequently excreted in the feces.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 1,334 mg (two 667 mg capsules/tablets) orally with each meal.
* **Titration:** Adjust based on serum phosphate levels to maintain target ranges (typically 3.5–5.5 mg/dL).
* **Maximum Dose:** Generally 2,000–3,000 mg per meal. Doses exceeding 3,000 mg/day of elemental calcium significantly increase the risk of hypercalcemia.
## Pediatric Dosing
* **Safety/Efficacy:** Not well-established. Dosing is highly variable and depends on institutional protocols, age, and renal status.
* **Typical Starting Range:** 500–1,000 mg/day divided with meals, adjusted based on serum phosphorus and ionized calcium levels. Refer to specialized pediatric nephrology guidelines/protocols.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia develops, reduce or interrupt the dose.
* **Renal Impairment:** Dosing is specifically for patients with renal failure; however, monitor the total daily elemental calcium intake closely to avoid excessive calcium loading.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Nephrolithiasis (calcium-containing stones).
## Adverse Effects
* **Common:** Hypercalcemia (most common), nausea, vomiting, constipation, and abdominal pain.
* **Serious:** Metastatic calcification (vascular or soft tissue calcification) if calcium-phosphorus product is excessively high.
## Key Drug Interactions
* **Quinolones and Tetracyclines:** Calcium significantly decreases absorption. Administer calcium acetate at least 2 hours apart from these antibiotics.
* **Levothyroxine:** Calcium interferes with absorption. Separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium reduces oral bisphosphonate absorption; separate by at least 2 hours.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
## Monitoring
* **Serum Phosphorus:** Monitor periodically (e.g., monthly).
* **Serum Calcium:** Monitor weekly/bi-weekly during initiation and dose titration; monthly thereafter.
* **Calcium-Phosphorus Product:** Keep <55 mg²/dL² to minimize the risk of metastatic calcification.
## Clinical Pearls
* **Timing:** Must be taken **with meals** to be effective as a phosphate binder.
* **Elemental Calcium:** 667 mg of calcium acetate contains 169 mg of elemental calcium.
* **Hypercalcemia Risk:** Risk is higher in patients with adynamic bone disease or those also taking Vitamin D analogs (calcitriol).
* **Calcium Intake:** Assess total dietary and supplemental calcium intake to prevent hypercalcemia.
***
**Educational Disclaimer:** This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and patient-specific factors with clinical literature and current guidelines before prescribing or administering medication.
