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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 efficient at binding dietary phosphorus in the gastrointestinal tract to form insoluble calcium phosphate, which is then excreted in feces.
## Primary Indications
* Management of hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Initial Dose:** 667 mg orally with each meal.
* **Titration:** Adjust based on serum phosphate levels.
* **Maintenance:** Typically 1,334 mg (two 667 mg tablets) per meal.
* **Maximum:** Doses exceeding 12 capsules/tablets per day are generally not recommended due to the risk of hypercalcemia.
## Pediatric Dosing
* **Dosing:** Not well-established. Use is clinical judgment-based, often guided by institutional protocols.
* **Guidance:** Pediatric nephrology specialists should determine dosage based on serum phosphorus and calcium levels, often starting at lower conservative intervals (e.g., 300–667 mg per meal).
## Dose Adjustments
* **Hypercalcemia:** If hypercalcemia develops, reduce the dose or temporarily discontinue.
* **Concomitant Therapy:** If using with vitamin D, monitor calcium levels closely as vitamin D increases calcium absorption.
## Contraindications
* Hypercalcemia.
* Hypophosphatemia.
* Known hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia, nausea, constipation, and vomiting.
* **Serious:** Metastatic calcification (if calcium-phosphorus product is excessively high), severe hypercalcemia (confusion, arrhythmias, nephrolithiasis).
## Key Drug Interactions
* **Tetracycline/Quinolone Antibiotics:** Calcium binds these drugs, 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.
* **Bisphosphonates:** Reduces absorption of bisphosphonates; separate doses by at least 2 hours.
## Monitoring
* **Serum Phosphorus:** Monitor weekly/monthly during titration, then periodically.
* **Serum Calcium:** Monitor closely to avoid hypercalcemia.
* **Calcium-Phosphorus Product:** Keep the product below 55 mg²/dL² to minimize the risk of vascular and soft tissue calcification.
## Clinical Pearls
* **Administration:** Must be taken **with meals** to be effective as a phosphate binder.
* **Comparison:** Calcium acetate is approximately 25% calcium by weight, compared to calcium carbonate which is 40%. It is generally considered as effective, if not more, at lower elemental calcium loads, theoretically posing a lower risk of severe hypercalcemia.
* **Nutritional Support:** Ensure the patient is not over-supplementing with calcium-containing multivitamins or antacids.
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*Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific contraindications before prescribing or administering medication.*
