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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 is more efficient per milligram of elemental calcium than calcium carbonate and carries a lower risk of hypercalcemia compared to calcium carbonate if used appropriately.
## Primary Indications
* Management of hyperphosphatemia 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. Most patients require 2,000 mg to 3,000 mg of elemental calcium per day.
* **Maximum:** Doses exceeding 3,000 mg of elemental calcium (approx. 12,000 mg of calcium acetate) daily are generally discouraged due to the risk of hypercalcemia.
## Pediatric Dosing
* No standardized dosing exists. Dosing is highly variable and depends on clinical protocols, degree of hyperphosphatemia, and dietary intake. Use in children should be under the supervision of a pediatric nephrologist.
## Dose Adjustments
* **Renal Impairment:** Required for all indications. Adjust dosing based on serum calcium and phosphate levels.
* **Hypercalcemia:** If serum calcium increases above the normal range, reduce the dose or temporarily discontinue until levels normalize.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to calcium acetate or excipients.
## Adverse Effects
* **Common:** Hypercalcemia, constipation, nausea, vomiting, abdominal pain.
* **Serious:** Metastatic soft tissue calcification (with prolonged elevated Calcium-Phosphorus product).
## Key Drug Interactions
* **Tetracycline/Quinolone antibiotics:** Calcium significantly reduces absorption. Separate administration by at least 2 to 4 hours.
* **Bisphosphonates:** Calcium reduces absorption; separate by at least 2 hours.
* **Levothyroxine:** Reduces absorption; separate by at least 4 hours.
* **Iron salts:** Calcium inhibits iron absorption; administer at least 2 hours apart.
## Monitoring
* **Serum Calcium:** Weekly during initial titration, then periodically.
* **Serum Phosphate:** Monitor regularly to assess efficacy of dose.
* **Calcium-Phosphorus (Ca x P) Product:** Maintain <55 mg²/dL² to reduce the risk of extraskeletal calcification.
## Clinical Pearls
* **Administration:** Must be taken **with meals** to effectively bind dietary phosphate. Taking it without food provides no clinical benefit for phosphate control.
* **Elemental Calcium Content:** 667 mg of calcium acetate provides approximately 169 mg (approx. 25%) of elemental calcium.
* **Hypercalcemia Caution:** Monitor for signs of hypercalcemia including weakness, confusion, cardiac arrhythmias, and excessive thirst.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical guidelines and protocols vary; always verify current prescribing information, laboratory values, and institutional practices before administration. Consult a licensed pharmacist or physician for specific clinical decisions.
