Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with end-stage renal disease (ESRD). It provides a higher calcium content per gram than other calcium salts, effectively binding dietary phosphate in the GI tract to decrease systemic absorption.
## Primary Indications
* Hyperphosphatemia in patients with chronic kidney disease (CKD) on dialysis.
## Adult Dosing
* **Initial Dose:** 2 capsules or 1334 mg (two 667 mg tablets/capsules) orally with each meal.
* **Titration:** Adjust based on serum phosphorus levels.
* **Maximum:** Generally 3 or 4 tablets per meal; however, doses should be titrated to the lowest effective dose to prevent hypercalcemia.
## Pediatric Dosing
* **Safety/Efficacy:** Established in children for hyperphosphatemia.
* **Dosing:** Often weight-based, typically 50–100 mg/kg/day divided with meals. Dosing is highly variable and must be managed by a pediatric nephrologist based on local hospital protocols and target phosphorus ranges.
## Dose Adjustments
* **Renal Impairment:** Required; monitor calcium-phosphorus product to avoid calcification.
* **Hypercalcemia:** Reduce or discontinue dose if serum calcium exceeds 10.5 mg/dL.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, constipation, vomiting.
* **Serious:** Metastatic soft-tissue calcification (if calcium-phosphorus product >55 mg²/dL²), severe constipation (impaction).
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Calcium significantly decreases absorption. Separate administration by at least 2 hours before or 6 hours after.
* **Levothyroxine:** Separate by 4 hours to prevent chelation.
* **Bisphosphonates:** Separate by at least 2 hours.
* **Iron:** Calcium can inhibit iron absorption; space apart.
## Monitoring
* **Serum Phosphorus:** Titrate dose to maintain target levels (e.g., KDOQI guidelines).
* **Serum Calcium:** Monitor weekly during initiation/titration, then monthly.
* **Calcium-Phosphorus Product:** Keep <55 mg²/dL² to minimize calciphylaxis risk.
## Clinical Pearls
* **Administration:** Must be taken **with meals** to effectively bind dietary phosphate. If a meal is missed, the dose should be skipped.
* **Hypercalcemia Risk:** Calcium-based binders carry a higher risk of hypercalcemia compared to sevelamer or lanthanum. Avoid use in patients already prone to high calcium or those with adynamic bone disease.
* **Compliance:** Significant pill burden often impacts long-term adherence.
***
**Educational Disclaimer:** This information is for educational purposes only. Clinical practice varies by institution; always verify current prescribing information, laboratory values, and institutional guidelines before prescribing or administering medication.
