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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used primarily in patients with end-stage renal disease (ESRD). It is highly soluble and provides a higher amount of elemental calcium per milligram compared to calcium carbonate, allowing for effective phosphate binding with lower total calcium load.
## Primary Indications
Reduction of serum phosphorus in patients with hyperphosphatemia associated with chronic kidney disease (CKD).
## Adult Dosing
* **Initial Dose:** 667 mg to 1,334 mg (1 to 2 capsules/tablets) orally with each meal.
* **Titration:** Adjust based on serum phosphorus levels.
* **Maximum:** Dosing is often titrated to maintain serum phosphorus < 5.5 mg/dL; exceeding 3,000 mg/day of elemental calcium intake (from all sources) increases the risk of hypercalcemia.
## Pediatric Dosing
Safety and efficacy have not been established in pediatric patients. Use is typically limited to specialist-directed, off-label protocols monitoring serum calcium and phosphorus closely.
## Dose Adjustments
* **Hypercalcemia:** If serum calcium levels rise, the dose should be reduced or temporarily discontinued.
* **Renal Impairment:** Standard for CKD stage 5/ESRD; no hepatic adjustment required.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation.
* **Serious:** Potential for accelerated vascular/soft tissue calcification if calcium-phosphorus product (Ca × P) is persistently > 55–60 mg²/dL².
## Key Drug Interactions
* **Tetracyclines/Fluoroquinolones:** Calcium binds these agents, significantly reducing absorption. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Bisphosphonates:** Reduces absorption; space doses by at least 2 hours.
* **Levothyroxine:** Calcium interferes with absorption; space by at least 4 hours.
## Monitoring
* **Serum Phosphorus:** Every 2–4 weeks during initiation/titration.
* **Serum Calcium:** Weekly during initial titration, then periodically.
* **Ca × P Product:** Ensure the product remains within target ranges (typically < 55) to minimize calciphylaxis risk.
## Clinical Pearls
* **Administration:** Must be taken with meals to ensure the drug binds dietary phosphorus in the gut.
* **Element Comparison:** 667 mg of calcium acetate provides approximately 169 mg of elemental calcium.
* **Risk Profile:** Always assess the patient's total calcium intake from other sources (e.g., active vitamin D analogs, calcium-containing dialysate) before increasing the dose.
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*Disclaimer: This information is for educational purposes only. Always verify dosages, contraindications, and drug interactions against institutional protocols and the most current prescribing information (package insert) before prescribing or administering medication.*
