Please check your internet connection and try again.
# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to manage hyperphosphatemia in patients with end-stage renal disease (ESRD). It works by binding with dietary phosphate in the gastrointestinal tract to form insoluble calcium phosphate, which is then excreted in feces.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD) on hemodialysis.
## Adult Dosing
* **Initial Dose:** 1,334 mg (2 capsules or 1 tablet) taken orally with each meal.
* **Titration:** Adjust based on serum phosphorus levels.
* **Maximum Dose:** Generally 2,668 mg (4 capsules/tablets) per meal. Higher doses increase risk of hypercalcemia.
## Pediatric Dosing
* **Safety/Efficacy:** Well-established pediatric dosing is limited. Use is typically off-label and guided by nephrology protocol. Dosing is highly individualized based on phosphate levels and dietary intake. Consult local institutional pediatric nephrology guidelines.
## Dose Adjustments
* **Renal Impairment:** Required; used specifically for ESRD.
* **Hypercalcemia:** If serum calcium levels exceed the institution-specific upper limit, reduce or discontinue dose.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Nausea, constipation, diarrhea, dyspepsia.
* **Serious:** Hypercalcemia, hypercalcemia-related cardiac arrhythmias, metastatic soft tissue calcification.
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Calcium significantly decreases absorption. Separate administration by at least 2 hours before or 6 hours after.
* **Levothyroxine:** Calcium interferes with absorption. Separate by at least 4 hours.
* **Bisphosphonates:** Calcium reduces oral absorption.
* **Calcium Supplements:** Avoid concomitant use with other calcium-containing products to prevent severe hypercalcemia.
## Monitoring
* **Serum Phosphorus:** Monitor at least monthly during titration.
* **Serum Calcium:** Monitor frequency (weekly initially, then monthly).
* **Calcium-Phosphorus Product:** Target values vary (typically < 55 mg²/dL²); assess to evaluate risk of vascular calcification.
## Clinical Pearls
* **Administration:** Must be taken **with meals** to effectively bind dietary phosphorus. Taking without food significantly reduces efficacy.
* **Efficiency:** Calcium acetate binds twice as much phosphate per gram of calcium compared to calcium carbonate, requiring fewer tablets for efficacy.
* **Hypercalcemia Risk:** Monitor for signs of hypercalcemia (nausea, vomiting, confusion, weakness). Avoid excessive use of vitamin D analogs or high-calcium dialysate if hypercalcemia develops.
***
*Disclaimer: This information is for educational purposes only. Clinical protocols may vary by institution. Always verify dosing, contraindications, and drug interactions via current prescribing information (package insert) or institutional clinical decision support tools before prescribing or administering medication.*
