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# Calcium Acetate
## Overview
Calcium acetate is a calcium salt used primarily as a phosphate binder. It provides higher elemental calcium content per weight compared to other calcium salts, making it effective for lowering serum phosphorus levels in patients with chronic kidney disease (CKD).
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD) or chronic kidney disease (CKD).
## Adult Dosing
* **Initial Dose:** 667 mg to 1,334 mg (1 to 2 capsules/tablets) orally with each meal.
* **Titration:** Adjust based on serum phosphate levels.
* **Maximum:** Generally titrated to maintain serum phosphorus < 5.5 mg/dL; caution is advised to avoid hypercalcemia.
## Pediatric Dosing
* **Dosing:** Not well-established. Dosing is off-label and varies by local institutional protocol.
* **Guideline:** Typically 10 to 30 mg/kg/day of elemental calcium, divided with meals. Consult a pediatric nephrologist for specific titration.
## Dose Adjustments
* **Renal Impairment:** No specific adjustment required for CKD, as this is the target population; however, monitor closely for hypercalcemia.
* **Hypercalcemia:** Reduce dose or discontinue if serum calcium levels exceed the upper limit of normal or if the calcium-phosphorus product exceeds 55 mg²/dL².
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to calcium acetate or excipients.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, and abdominal pain.
* **Serious:** Metastatic calcification (associated with high calcium-phosphorus product), soft tissue calcification.
## Key Drug Interactions
* **Fluoroquinolones/Tetracyclines:** Formation of insoluble chelates significantly reduces antibiotic absorption. Separate administration by at least 2 to 4 hours.
* **Levothyroxine:** Calcium salts can bind to thyroid hormones; space by at least 4 hours.
* **Bisphosphonates:** Calcium reduces bisphosphonate absorption; space doses accordingly.
## Monitoring
* **Serum Phosphorus:** Monitor every 1–3 weeks during dose titration, then periodically.
* **Serum Calcium:** Monitor monthly, especially when starting or titrating.
* **Calcium-Phosphorus Product:** Keep < 55 mg²/dL² to minimize the risk of vascular and soft tissue calcification.
## Clinical Pearls
* **Administration:** Must be taken with meals to maximize phosphate-binding capacity.
* **Calcium Content:** 667 mg of calcium acetate contains approximately 169 mg (8.45 mEq) of elemental calcium.
* **Switching:** If hypercalcemia develops, consider switching to a non-calcium-based phosphate binder (e.g., sevelamer, lanthanum).
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*Disclaimer: This information is for educational purposes only. Drug dosing, contraindications, and interactions should be verified against current institutional protocols and the official manufacturer's prescribing information (package insert) before clinical use.*
