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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 highly soluble and provides approximately 25% elemental calcium by weight.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 1,334 mg (2 capsules or 1 tablet) taken orally with each meal.
* **Titration:** Adjust based on serum phosphate levels to maintain target range (typically 3.5–5.5 mg/dL).
* **Maximum Dose:** Generally 10–12 grams daily; however, titration should be guided by serum calcium levels to avoid hypercalcemia.
## Pediatric Dosing
* **Safety/Efficacy:** Not well-established in pediatric populations.
* **Dosing:** If used off-label, dosing is often extrapolated from adult guidelines (e.g., 667–1,334 mg per meal); however, expert consultation with a pediatric nephrologist is essential.
## Dose Adjustments
* **Renal Impairment:** Dose is specifically for patients with renal failure.
* **Hypercalcemia:** If corrected serum calcium exceeds 10.5 mg/dL, reduce dose or discontinue therapy.
* **Hepatic Impairment:** No specific adjustments provided.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to any component of the formulation.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, abdominal pain.
* **Serious:** Metastatic calcification (due to elevated calcium-phosphorus product >55 mg²/dL²), severe hypercalcemia.
## Key Drug Interactions
* **Tetracyclines/Fluoroquinolones:** Calcium binds these medications, significantly reducing absorption. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Levothyroxine:** Calcium interferes with absorption. Separate administration by at least 4 hours.
* **Oral Bisphosphonates:** Calcium reduces absorption; separate doses.
## Monitoring
* **Serum Phosphorus:** Monitor at least once monthly during titration.
* **Serum Calcium:** Monitor weekly during initial titration, then monthly.
* **Calcium-Phosphorus Product:** Keep <55 mg²/dL².
## Clinical Pearls
* **Administration:** Must be taken with meals to effectively bind dietary phosphorus.
* **Product Selection:** Calcium acetate is often preferred over calcium carbonate in renal patients because it binds twice the amount of phosphate per weight and causes less hypercalcemia.
* **Patient Education:** Advise patients to avoid calcium-containing antacids and vitamin D supplements unless specifically instructed, as this increases the risk of hypercalcemia.
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**Disclaimer:** This information is for educational purposes and does not substitute for professional medical judgment. Consult the manufacturer's official prescribing information and your institution's specific clinical protocols before prescribing or administering any medication.
