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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to reduce serum phosphorus in patients with end-stage renal disease (ESRD). It provides higher calcium content per gram compared to other calcium salts (e.g., calcium carbonate). ## Primary Indications * Reduction of serum phosphorus in patients with end-stage renal disease. ## Adult Dosing * **Initial Dose:** 1,334 mg (2 capsules/tablets) with each meal. * **Titration:** Increase dose gradually to achieve optimal serum phosphorus levels (target <5.5 mg/dL). * **Max Dose:** Generally capped at dose required to normalize phosphorus without inducing hypercalcemia; often limited by patient tolerance and calcium levels. Monitor closely if exceeding 12–15 grams daily. ## Pediatric Dosing * **Safety/Efficacy:** Not established; lacks robust pediatric clinical trial data. * **Clinical Practice:** If used, dosing is generally based on serum phosphorus levels and dietary intake, initiated at lower doses (e.g., 8–10 mg/kg/dose with meals). **Strict nephrology consultation is required.** ## Dose Adjustments * **Hypercalcemia:** If serum calcium exceeds the upper limit of normal or if calcium-phosphorus product exceeds 55 mg²/dL², reduce dose or discontinue therapy. * **Renal Impairment:** Dose is intended specifically for ESRD. No specific adjustment required for dialysis patients other than titration to response. ## Contraindications * Hypercalcemia. * Hypophosphatemia. ## Adverse Effects * **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain. * **Serious:** Metastatic calcification (seen primarily with chronically elevated calcium-phosphorus product). ## Key Drug Interactions * **Fluoroquinolones/Tetracyclines:** Calcium significantly decreases absorption. Administer antibiotics 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. Separate by at least 2 hours. ## Monitoring * **Serum Phosphorus:** Weekly during initial titration, then monthly to quarterly. * **Serum Calcium:** Weekly during titration; monitor for clinical symptoms of hypercalcemia (confusion, fatigue, constipation, arrhythmias). * **Calcium-Phosphorus Product:** Keep <55 mg²/dL² to minimize risk of vascular calcification. ## Clinical Pearls * **Timing:** Must be taken with meals to bind dietary phosphate effectively. * **Efficacy:** Approximately 25% of the weight of calcium acetate is elemental calcium. * **Choice of Agent:** Consider patients with hypercalcemia; if the calcium-phosphorus product is already high, non-calcium-based binders (e.g., sevelamer, lanthanum) may be preferred. * **Administration:** Capsules and tablets must be swallowed whole; do not crush or chew. *** *Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Dosing may vary based on institutional protocols and individual patient variables. Always verify current prescribing information, package inserts, and local guidelines before administration.*