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 higher elemental calcium per gram compared to calcium carbonate, making it highly efficient at binding dietary phosphate in the gastrointestinal tract to form insoluble calcium phosphate for fecal excretion.
## Primary Indications
Hyperphosphatemia in patients with end-stage renal disease (ESRD) or chronic kidney disease (CKD) on dialysis.
## Adult Dosing
* **Initial Dose:** 667 mg (typically 1–2 capsules/tablets) orally with each meal.
* **Titration:** Adjust based on serum phosphate levels to maintain target ranges (usually <5.5 mg/dL).
* **Maximum Dose:** Generally not to exceed 3 tablets per meal; clinical protocols vary, but doses exceeding 9–12 tablets daily increase the risk of hypercalcemia.
## Pediatric Dosing
* **Dosing:** Not well-established by the FDA for pediatrics. Dosing is highly protocol-dependent.
* **Common Practice:** Extrapolated from adult studies, often titrated to phosphate levels, starting at 667 mg per meal, divided based on weight or nutritional intake. Consult institutional pediatric nephrology guidelines before prescribing.
## Dose Adjustments
* **Renal Impairment:** Required for phosphate binding; however, monitor closely for hypercalcemia as renal clearance of calcium decreases.
* **Hepatic Impairment:** No specific adjustments required.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Nausea, constipation, abdominal pain, diarrhea.
* **Serious:** Hypercalcemia (manifesting as confusion, arrhythmias, or severe constipation), metastatic calcification (e.g., vascular calcification).
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Calcium significantly reduces absorption. Administer antibiotics at least 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Separate administration by at least 4 hours to avoid bioavailability reduction.
* **Bisphosphonates:** Separate by at least 2 hours.
* **Vitamin D:** Concurrent use increases the risk of hypercalcemia; monitor serum calcium levels closely.
## Monitoring
* **Serum Phosphate:** Monitor at least monthly or per dialysis protocol.
* **Serum Calcium:** Monitor weekly during titration; ensure serum calcium-phosphate (Ca x P) product remains <55 mg²/dL² to minimize calcification risk.
* **Signs/Symptoms:** Monitor for clinical signs of hypercalcemia.
## Clinical Pearls
* **Timing:** Must be taken *with* meals to successfully bind dietary phosphorus. Taking the dose without food provides no phosphate-binding benefit.
* **Elemental Calcium:** 667 mg of calcium acetate contains approximately 169 mg of elemental calcium.
* **Hypercalcemia Risk:** Calcium-based binders are more likely to cause hypercalcemia than non-calcium binders (e.g., sevelamer); consider switching if hypercalcemia develops.
***
**Disclaimer:** This information is for educational purposes only. Clinical protocols, dosing guidelines, and manufacturer labeling are subject to change. Always verify current prescribing information, institutional protocols, and patient-specific factors before administering this medication.
