Please check your internet connection and try again.
# Calcium acetate
## Overview
Calcium acetate is a phosphate-binding agent used to prevent hyperphosphatemia. It is more soluble than calcium carbonate, allowing for more efficient phosphate binding in the gastrointestinal tract.
## Primary Indications
Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
Initiate with 2 capsules (667 mg each) or 1334 mg with each meal. Titrate upwards to control serum phosphate levels. Most patients require 3–4 capsules per meal. Do not exceed 12 capsules (8 g) daily without close clinical monitoring.
## Pediatric Dosing
Safety and efficacy have not been established. Dosing in children is often extrapolated from adult guidelines or determined by local pediatric nephrology protocols based on serum phosphate and calcium levels.
## Dose Adjustments
* **Renal Impairment:** Required for hemodialysis or peritoneal dialysis patients. Monitor serum calcium for the development of hypercalcemia.
* **Hypercalcemia:** If serum calcium levels rise above the upper limit of normal, reduce the dose or discontinue temporarily.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Hypercalciuria or severe renal calculi.
## Adverse Effects
* **Common:** Nausea, vomiting, constipation, and hypercalcemia.
* **Serious:** Soft-tissue calcification (if calcium-phosphate product exceeds 55 mg²/dL²), severe hypercalcemia, and metabolic alkalosis.
## Key Drug Interactions
* **Tetracycline and Fluoroquinolone antibiotics:** Calcium reduces absorption. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Calcium interferes with absorption. Separate administration by at least 4 hours.
* **Bisphosphonates:** Calcium reduces absorption. Take bisphosphonates at least 2 hours apart.
* **Iron Supplements:** Calcium can inhibit iron absorption. Separate doses.
## Monitoring
* **Serum Phosphate:** Monitor at least once every 1–2 weeks during dose titration.
* **Serum Calcium:** Monitor initially and regularly to prevent hypercalcemia.
* **Calcium-Phosphate Product:** Aim for a target product of <55 mg²/dL².
## Clinical Pearls
* Must be taken with meals to bind dietary phosphate effectively. If a dose is missed, omit it and return to the regular schedule with the next meal.
* Calcium acetate provides a higher amount of elemental calcium relative to volume than some other binders; monitor for hypercalcemia frequently when initiating or escalating doses.
* Avoid concomitant use of other calcium-containing supplements (e.g., calcium carbonate, over-the-counter antacids) to prevent excessive calcium intake.
***
*Disclaimer: This information is for educational purposes only. Always verify prescribing information, contraindications, and dosing protocols through institutional guidelines or current pharmacopeia references (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*
