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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to manage hyperphosphatemia in patients with end-stage renal disease (ESRD). It has a higher calcium-binding capacity than calcium carbonate and is less dependent on gastric pH for dissolution. ## Primary Indications * Reduction of serum phosphorus in patients with end-stage renal disease (ESRD). ## Adult Dosing * **Initial Dose:** 667 mg to 1,334 mg (1–2 capsules/tablets) orally with each meal. * **Titration:** Adjust based on serum phosphate levels. * **Maximum:** Doses exceeding 12 tablets/day are rarely required; evaluate adherence and dietary intake before exceeding this. ## Pediatric Dosing * **Safety/Efficacy:** Not well-established in pediatric patients. Use is generally off-label and requires institutional protocol or nephrology specialist guidance. * **Dosing:** Often extrapolated from adult data, typically started at 10–20 mg/kg of elemental calcium per dose with meals, titrating to phosphorus goals. ## Dose Adjustments * **Renal Impairment:** Required for all patients on the drug; monitor hypercalcemia risk closely. * **Hypercalcemia:** If serum calcium exceeds the upper limit of normal, reduce the dose or switch to a non-calcium-based phosphate binder (e.g., sevelamer). ## Contraindications * Hypercalcemia. * Hypophosphatemia. * Known hypersensitivity to calcium acetate. ## Adverse Effects * **Common:** Hypercalcemia, nausea, constipation, abdominal pain. * **Serious:** Soft tissue calcification (dignified by prolonged hypercalcemia and high calcium-phosphorus product). ## Key Drug Interactions * **Tetracyclines/Fluoroquinolones:** Calcium decreases absorption; space dose at least 2–4 hours before or 6 hours after calcium acetate. * **Levothyroxine:** Space by at least 4 hours. * **Iron Supplements:** Concurrent intake reduces bioavailability; separate administration by at least 2 hours. ## Monitoring * **Serum Phosphorus:** Every 2–4 weeks during titration. * **Serum Calcium:** Weekly during initiation, then monthly. * **Calcium-Phosphorus Product:** Keep <55 mg²/dL² to minimize metastatic calcification risk. ## Clinical Pearls * **Administration:** Must be taken with meals to effectively bind dietary phosphorus. * **Calcification Risk:** Avoid use in patients with severe hypercalcemia or if the calcium-phosphorus product is persistently >70 mg²/dL². * **Adherence:** High pill burden is a common cause of treatment failure; assess compliance before increasing dosage. *** *Disclaimer: This information is for educational purposes only. Clinical practice varies by institution and patient-specific factors. Always verify current prescribing information, institutional protocols, and patient charts before prescribing or administering medication.*