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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with end-stage renal disease (ESRD). It is more effective at binding dietary phosphate per weight of calcium than calcium carbonate because of higher solubility across the physiological pH range of the GI tract. ## 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 or tablets) with each meal. * **Titration:** Adjust based on serum phosphorus levels. Titrate to achieve target serum phosphorus (typically 3.5–5.5 mg/dL). * **Maximum Dose:** Generally considered to be 3–4 grams of elemental calcium per day, though clinical practice often limits total daily doses to avoid hypercalcemia. ## Pediatric Dosing * **Dosage:** Not well established in pediatric guidelines. Use is rare and typically requires nephrology consultation. Dosing is highly individualized based on serum phosphate and total daily elemental calcium intake. ## Dose Adjustments * **Renal Impairment:** Indicated specifically for ESRD. No dose reduction required for renal function, but monitor serum calcium closely to prevent hypercalcemia. * **Hypercalcemia:** If serum calcium levels rise, decrease or discontinue the dosage. ## Contraindications * Hypercalcemia. * Hypophosphatemia. * Known hypersensitivity to calcium acetate. ## Adverse Effects * **Common:** Hypercalcemia (often asymptomatic, monitor for fatigue, constipation, nausea, or confusion), constipation, nausea, vomiting, and abdominal pain. * **Serious:** Metastatic calcification (seen in patients with chronic hypercalcemia and/or high calcium-phosphorus product). ## Key Drug Interactions * **Quinolones/Tetracyclines:** Calcium significantly decreases absorption. Separate administration by at least 2–4 hours. * **Levothyroxine:** Calcium interferes with absorption. Separate administration by at least 4 hours. * **Bisphosphonates:** Calcium reduces absorption. Take at different times. * **Calcium Channel Blockers:** Large doses of calcium might antagonize the effects of CCBs. ## Monitoring * **Serum Phosphorus:** Monitor periodically to confirm efficacy. * **Serum Calcium:** Monitor weekly during initiation and dose titration; monitor monthly or quarterly once stable. * **Calcium-Phosphorus Product:** Keep <55 mg²/dL² to minimize the risk of metastatic calcification. ## Clinical Pearls * **Administration:** Must be taken with meals to effectively bind dietary phosphate. Any dose taken without food has negligible efficacy as a phosphate binder. * **Elemental Calcium Content:** 667 mg of calcium acetate contains 169 mg (approximately 25%) of elemental calcium. * **Hypercalcemia Risk:** Monitor for symptoms of hypercalcemia (anorexia, nausea, vomiting, dizziness, confusion). * **Patient Education:** Emphasize that this is not a calcium supplement; it is a phosphate binder and must be taken with the first bite of a meal. *** *Disclaimer: This information is for educational purposes only. Clinical practice protocols vary by institution. Always verify dosages, contraindications, and drug interactions against the most current package insert or institutional drug formulary before prescribing or administering.*