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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used primarily in patients with end-stage renal disease (ESRD). It is more effective than calcium carbonate at a lower elemental calcium dose due to higher solubility across varying pH levels.
## Primary Indications
* Reduction of serum phosphorus in patients with end-stage renal disease (ESRD) on hemodialysis or peritoneal dialysis.
## Adult Dosing
* **Initial Dose:** 667 mg to 1,334 mg (1 to 2 tablets/capsules) orally with each meal.
* **Titration:** Adjust based on serum phosphate levels.
* **Maximum:** Generally limited by hypercalcemia; doses exceeding 10–12 tablets per day significantly increase the risk of hypercalcemic events.
## Pediatric Dosing
* **Not universally established.** Use is off-label and requires nephrology consultation.
* **Typical initiation:** Start with low doses (e.g., 300–667 mg) taken with each meal, titrated strictly to serum phosphate and calcium levels to avoid iatrogenic hypercalcemia and stunted bone growth.
## Dose Adjustments
* **Renal Impairment:** Required; specifically designed for patients with ESRD.
* **Hypercalcemia:** If serum calcium levels exceed 10.5–11.0 mg/dL, withhold medication or reduce the dose.
* **Concomitant therapy:** If using Vitamin D analogues, monitor for excessive calcium-phosphorus product (Ca × P > 55 mg²/dL²).
## Contraindications
* Hypercalcemia.
* Hypophosphatemia (risk of worsening).
## Adverse Effects
* **Common:** Nausea, constipation, hypercalcemia.
* **Serious:** Metastatic calcification (vascular or soft tissue) if Ca × P product is consistently elevated.
## Key Drug Interactions
* **Fluoroquinolones (e.g., ciprofloxacin, levofloxacin):** Calcium binds to these medications, significantly reducing antibiotic absorption. Administer at least 2 hours before or 6 hours after calcium acetate.
* **Tetracyclines/Doxycycline:** Reduces absorption; space by 2–4 hours.
* **Levothyroxine:** Reduces absorption; space by at least 4 hours.
* **Bisphosphonates:** Reduces absorption; space by at least 2 hours.
## Monitoring
* **Serum Phosphorus:** Every 2–4 weeks during initiation/titration, then regularly.
* **Serum Calcium:** Weekly during initiation, then monthly as determined by clinical status.
* **Ca × P Product:** Calculated routinely to prevent calciphylaxis.
## Clinical Pearls
* **Timing is critical:** Must be taken with meals to effectively bind dietary phosphate. If a dose is missed, it should generally be skipped rather than doubled.
* **Solubility:** Calcium acetate provides ~25% elemental calcium by weight (compared to 40% in calcium carbonate), but its superior dissolution makes it a more potent binder.
* **Hypercalcemia Risk:** Patients often take concomitant Vitamin D analogues and high-calcium dialysate, which cumulative with calcium acetate therapy heightens the risk of hypercalcemia.
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*Disclaimer: This information is for educational purposes and is not a substitute for professional medical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administration.*
