Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a calcium salt used primarily as a phosphate binder. It provides 25% elemental calcium by weight (higher than calcium carbonate/citrate), making it highly effective at binding dietary phosphate in the gastrointestinal tract to form insoluble calcium phosphate.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 1,334 mg (two 667 mg capsules/tablets) orally with each meal.
* **Titration:** Adjust based on serum phosphate levels to maintain target range (typically 3.5–5.5 mg/dL).
* **Maximum Dose:** Generally 2,668 mg (four 667 mg tablets) per meal. Excessive intake may lead to hypercalcemia.
## Pediatric Dosing
Safety and efficacy have not been fully established in pediatric populations. Dosing is highly variable and depends on institutional protocols; if used, it is typically weight-based and titrated strictly to phosphorus targets under nephrology supervision.
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia develops, dosage must be reduced or temporarily discontinued.
* **Renal Impairment:** This drug is explicitly for patients with renal failure; however, monitor the calcium-phosphorus product to avoid metastatic calcification.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Metastatic soft-tissue calcification (if calcium-phosphorus product consistently exceeds 55–70 mg²/dL²).
## Key Drug Interactions
* **Quinolones/Tetracyclines:** Calcium significantly decreases absorption. Separate administration by at least 2–4 hours.
* **Bisphosphonates:** Calcium reduces bisphosphonate absorption; separate by at least 2 hours.
* **Levothyroxine:** Calcium binds levothyroxine; separate doses by at least 4 hours.
* **Calcium Channel Blockers:** May antagonize the effects of CCBs due to calcium's effect on cellular membrane potential.
## Monitoring
* **Serum Phosphorus:** Every 1–2 weeks during initial titration, then monthly/quarterly.
* **Serum Calcium:** Weekly during initiation, then monthly.
* **Calcium-Phosphorus Product:** Monitor regularly; keeping the product <55 mg²/dL² is generally recommended to minimize calcification risk.
## Clinical Pearls
* **Administration:** Must be taken with meals to bind dietary phosphorus. If the patient skips a meal, the dose should be skipped.
* **Elemental Calcium:** Because it provides significant amounts of calcium, avoid concomitant use of other calcium supplements or vitamin D analogues without clinical necessity, as this increases the risk of hypercalcemia.
* **Patient Education:** Emphasize that this is a "binder," not a calcium supplement for bone health; it is intended to clear phosphate via stool.
***
**Disclaimer:** This information is for educational purposes only. Clinical practice guidelines vary by institution and patient-specific factors. Always verify current prescribing information, institutional protocols, and patient safety profile before prescribing or administering medication.
