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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used primarily to manage hyperphosphatemia in patients with end-stage renal disease (ESRD). It provides a high calcium-to-acetate ratio, which is more effective at binding dietary phosphate than calcium carbonate.
## 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) administered orally with each meal.
* **Titration:** Adjust dosage to maintain serum phosphorus levels within target clinical ranges (typically <5.5 mg/dL).
* **Maximum:** Doses exceeding 12–15 tablets/day have not been studied extensively; titration should be guided by serum calcium and phosphorus levels.
## Pediatric Dosing
* **Safety and Efficacy:** Not established. Use should be guided by institutional protocols or pediatric nephrology specialists. Dosing is typically weight-based and highly individualized to avoid hypercalcemia.
## Dose Adjustments
* **Hypercalcemia:** If serum calcium exceeds 10.5 mg/dL, reduce the dose or temporarily discontinue.
* **Renal Impairment:** Required for all patients on therapy (due to phosphate-binding mechanism). No specific renal dosing adjustments exist as it is not systemically cleared via the kidneys in the traditional sense.
## Contraindications
* Hypersensitivity to calcium acetate.
* Hypercalcemia.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Metastatic calcification (due to elevated calcium-phosphate product).
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Calcium significantly decreases absorption. Separate administration by at least 2 hours.
* **Levothyroxine:** Calcium interferes with absorption. Administer at least 4 hours apart.
* **Bisphosphonates:** Calcium reduces absorption. Space doses.
* **Thiazide Diuretics:** May induce hypercalcemia by decreasing urinary calcium excretion.
## Monitoring
* **Serum Phosphorus:** Monitor weekly during initiation and dose titration; then periodically.
* **Serum Calcium:** Monitor weekly during initiation and titration.
* **Calcium-Phosphate Product:** Maintain <55 mg²/dL² to avoid metastatic calcification.
## Clinical Pearls
* **Best Efficacy:** Must be taken **with meals** to effectively bind dietary phosphate. Taking it on an empty stomach renders it ineffective for phosphate control.
* **Comparison:** Calcium acetate is often preferred over calcium carbonate in dialysis patients because it is more soluble at higher pH levels and carries a lower risk of metabolic alkalosis.
* **Caution:** Patients should be warned against using OTC calcium supplements, as this may lead to severe hypercalcemia.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice varies by institution and patient-specific factors. Always verify current, full prescribing information and local clinical protocols before administering any medication.
