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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to reduce serum phosphorus levels in patients with end-stage renal disease (ESRD). It is more efficient than calcium carbonate as a phosphate binder due to higher solubility across the physiological pH range of the gastrointestinal tract.
## Primary Indications
Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
Initiate with 1,334 mg (two 667 mg capsules/tablets) orally with each meal. Titrate the dose based on serum phosphorus levels to achieve target ranges (typically 3.5–5.5 mg/dL). Most patients require 2,000–4,000 mg per day. Maximum safe limits depend on hypercalcemia risk; doses exceeding 6 capsules (4,000 mg) per meal are rarely recommended without strict monitoring.
## Pediatric Dosing
Safety and efficacy have not been established in pediatric patients. Use is off-label and requires institutional protocol or expert consultation. Dosing is typically weight-based and titrated cautiously to avoid hypercalcemia.
## Dose Adjustments
For patients developing hypercalcemia (serum calcium > 10.5 mg/dL), hold or reduce the dose. Reduce dose if serum calcium-phosphorus product exceeds 55 mg²/dL². No specific renal adjustment is required, as the drug is intended for patients with renal failure.
## Contraindications
* Hypercalcemia
* Hypophosphatemia
* Known hypersensitivity to calcium salts
## Adverse Effects
* **Common:** Hypercalcemia, nausea, vomiting, constipation, abdominal pain.
* **Serious:** Metastatic calcification (if calcium-phosphorus product is chronically elevated).
## Key Drug Interactions
* **Quinolones/Tetracyclines:** Calcium significantly decreases absorption. Separate administration by at least 2 hours.
* **Levothyroxine:** Space by at least 4 hours to prevent chelation.
* **Bisphosphonates:** Calcium reduces absorption; space doses.
* **Digoxin:** Hypercalcemia may increase risk of digoxin toxicity.
## Monitoring
* **Serum Phosphorus:** Monitor every 2–4 weeks initially, then periodically once stable.
* **Serum Calcium:** Monitor weekly during dose titration, then monthly.
* **Calcium-Phosphorus Product:** Ensure the product of serum calcium (mg/dL) and phosphorus (mg/dL) remains below 55.
## Clinical Pearls
* Must be taken with meals to effectively bind dietary phosphate. Taking it without food provides minimal phosphate-binding benefit.
* Switching from calcium carbonate: 1,334 mg of calcium acetate is roughly equivalent in binding capacity to 1,500 mg of calcium carbonate.
* Monitor for signs of hypercalcemia (e.g., fatigue, muscle weakness, mental status changes).
* Encourage adherence to a low-phosphorus diet as primary therapy.
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*Disclaimer: This information is for educational purposes only. Always verify current prescribing information, institutional guidelines, and drug-specific interactions using reliable clinical resources (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*
