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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 less dependent on gastric pH for ionization, making it more effective in patients with hypochlorhydria or those taking gastric acid suppressants.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 667 mg to 1,334 mg (1 to 2 capsules/tablets) orally with each meal.
* **Dose Titration:** Titrate based on serum phosphorus levels to achieve target ranges (typically < 5.5 mg/dL).
* **Maximum Dose:** Generally 2,668 mg per meal; avoid exceeding 12–15 grams total daily to prevent hypercalcemia.
## Pediatric Dosing
* **Safety/Efficacy:** Not well-established. Dosing is highly variable and institutional-protocol dependent. Use only under the guidance of a pediatric nephrologist.
* **General approach:** Start at 8–10 mg/kg/dose per meal (elemental calcium equivalent) and adjust based on serum phosphorus and ionized calcium levels.
## Dose Adjustments
* **Renal Impairment:** Required; monitor calcium-phosphorus product to avoid metastatic calcification.
* **Hypercalcemia:** Reduce dose or discontinue if serum corrected calcium exceeds local targets (usually > 10.2–10.5 mg/dL).
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to calcium salts.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, abdominal pain.
* **Serious:** Metastatic soft tissue calcification (associated with high calcium-phosphorus product), vascular calcification.
## Key Drug Interactions
* **Quinolones/Tetracyclines:** Calcium significantly reduces absorption; administer 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Space by at least 4 hours.
* **Bisphosphonates:** Reduces absorption; space doses significantly.
## Monitoring
* **Serum Phosphorus:** Weekly or bi-weekly during initiation/titration.
* **Serum Calcium:** Monitor frequently; target corrected calcium < 10.2 mg/dL.
* **Calcium-Phosphorus (Ca x P) Product:** Maintain < 55 mg²/dL² to reduce risk of vascular calcification.
## Clinical Pearls
* **Timing is critical:** Must be taken *with* meals to bind dietary phosphorus; effectiveness is significantly reduced if taken on an empty stomach.
* **Calcium Overload:** If hypercalcemia develops, consider switching to a non-calcium-based phosphate binder (e.g., sevelamer or lanthanum carbonate).
* **Patient Education:** Ensure the patient understands this is a phosphate binder, not a calcium supplement for osteoporosis.
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**Disclaimer:** This information is for educational purposes only. Clinical practice guidelines and institutional protocols vary. Always verify specific dosing, safety, and contraindications via official prescribing information or your local pharmacy department prior to administration.
