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Product Name
:
CALCIUM GLUCONATE
Chemical Name
:
Calcium Gluconate
Therapeutic Category
:
Fluids and Electrolytes
Pharmacologic Category
:
Calcium Salt- Electrolyte Supplement, Parenteral
Pharmaceutical Form
:
Ampoule
Composition
:
Calcium Gluconate 10mg/100ml
Monitoring Parameters
Dosing
 
Dosing: Adult
Dietary Reference Intake for Calcium:
Adults, Female/Male: RDA:
19-50 years: 1000 mg/day
≥51 years, females: 1200 mg/day
51-70 years, males: 1000 mg/day
Female: Pregnancy/Lactating: RDA: Same as for Adults, Female/Male
Dosage note: Calcium chloride has 3 times more elemental calcium than calcium gluconate. Calcium chloride is 27% elemental calcium; calcium gluconate is 9% elemental calcium. One gram of calcium chloride is equal to 270 mg of elemental calcium; 1 gram of calcium gluconate is equal to 90 mg of elemental calcium. The following dosages are expressed in terms of the calcium gluconate salt based on a solution concentration of 100 mg/mL (10%) containing 0.465 mEq (9.3 mg)/mL elemental calcium:
Hypocalcemia:
I.V.: 2-15 g/24 hours as a continuous infusion or in divided doses
Hypocalcemia secondary to citrated blood infusion: I.V.: 500 mg to 1 g per 500 mL of citrated blood (infused into another vein). Single doses up to 2 g have also been recommended.
Note: Routine administration of calcium, in the absence of signs/symptoms of hypocalcemia, is generally not recommended. A number of recommendations have been published seeking to address potential hypocalcemia during massive transfusion of citrated blood; however, many practitioners recommend replacement only as guided by clinical evidence of hypocalcemia and/or serial monitoring of ionized calcium.
Hypocalcemic tetany: I.V.: 1-3 g/dose may be administered until therapeutic response occurs
Magnesium intoxication or cardiac arrest in the presence of hyperkalemia or hypocalcemia: I.V.: 500-800 mg/dose (maximum: 3 g/dose)
Maintenance electrolyte requirements for TPN: I.V.: Daily requirements: 1.7-3.4 g/1000 kcal/24 hours
Calcium channel blocker overdose (unlabeled use): I.V. infusion: 10% solution: 0.6-1.2 mL/kg/hour or I.V. 0.2-0.5 ml/kg every 15-20 minutes for 4 doses (maximum: 2-3 g/dose). In life-threatening situations, 1 g has been given every 1-10 minutes until clinical effect is achieved (case reports of resistant hypotension reported use of 12-18 g total).
Dosing: Pediatric
Dietary Reference Intake for Calcium:
0-6 months: Adequate intake: 200 mg/day
7-12 months: Adequate intake: 260 mg/day
1-3 years: RDA: 700 mg/day
4-8 years: RDA: 1000 mg/day
9-18 years: RDA: 1300 mg/day
Dosage note: Calcium chloride has 3 times more elemental calcium than calcium gluconate. Calcium chloride is 27% elemental calcium; calcium gluconate is (9% elemental calcium). One gram of calcium chloride is equal to 270 mg of elemental calcium; 1 gram of calcium gluconate is equal to 90 mg of elemental calcium. The following dosages are expressed in terms of the calcium gluconate salt based on a solution concentration of 100 mg/mL (10%) containing 0.465 mEq (9.3 mg)/mL elemental calcium:
Hypocalcemia:
I.V.: Infants and Children: 200-500 mg/kg/day as a continuous infusion or in 4 divided doses (maximum: 2-3 g/dose)
Hypocalcemia secondary to citrated blood infusion: I.V.: Infants and Children: Give 98 mg (0.45 mEq elemental calcium) for each 100 mL citrated blood infused.
Note: Routine administration of calcium, in the absence of signs/symptoms of hypocalcemia, is generally not recommended. A number of recommendations have been published seeking to address potential hypocalcemia during massive transfusion of citrated blood; however, many practitioners recommend replacement only as guided by clinical evidence of hypocalcemia and/or serial monitoring of ionized calcium.
Hypocalcemic tetany: I.V.: Infants and Children: 100-200 mg/kg/dose over 5-10 minutes; may repeat every 6-8 hours or follow with an infusion of 500 mg/kg/day
Magnesium intoxication or cardiac arrest in the presence of hyperkalemia or hypocalcemia: I.V.: Infants and Children: 60-100 mg/kg/dose (maximum: 3 g/dose)
Dosing: Geriatric
Dietary Reference Intake for Calcium: RDA:
Females: Refer to adult dosing.
Males ≤70 years: Refer to adult dosing.
Males >70 years: 1200 mg/day
All other indications: Refer to adult dosing.
Dosing: Renal Impairment
Clcr <25 mL/minute: Dosage adjustments may be necessary depending on the serum calcium levels.
Use
 
Treatment and prevention of hypocalcemia; treatment of tetany, cardiac disturbances of hyperkalemia, cardiac resuscitation when epinephrine fails to improve myocardial contractions, hypocalcemia; calcium supplementation; hydrofluoric acid (HF) burns
Use - Unlabeled/Investigational
Calcium channel blocker overdose
Adverse Reactions
 
Frequency not defined.
I.V.:
Cardiovascular: Arrhythmia, bradycardia, cardiac arrest, hypotension, vasodilation, and syncope may occur following rapid I.V. injection
Central nervous system: Sense of oppression
Gastrointestinal: Chalky taste
Local: Abscess and necrosis following I.M. administration
Neuromuscular & skeletal: Tingling sensation
Miscellaneous: Heat waves
Postmarketing and/or case reports: Calcinosis cutis
Contraindications
 
Hypersensitivity to calcium gluconate or any component of the formulation; ventricular fibrillation during cardiac resuscitation; digitalis toxicity or suspected digoxin toxicity; hypercalcemia
Warnings / Precautions Drug
 
Concerns related to adverse effects:
• Cardiac arrest: May produce cardiac arrest.
• Gastrointestinal effects: Constipation, bloating, and gas are common with oral calcium supplements (especially carbonate salt).
Disease-related concerns:
• Acidosis: Use with caution in patients with respiratory acidosis, renal impairment, or respiratory failure; acidifying effect of calcium chloride may potentiate acidosis.
• Hyperphosphatemia: Use with caution in patients with severe hyperphosphatemia.
• Kidney stones (calcium-containing): Use caution when administering calcium supplements to patients with a history of kidney stones.
• Renal impairment: Use with caution in patients with renal failure to avoid hypercalcemia; frequent monitoring of serum calcium and phosphorus is necessary.
Concurrent drug therapy issues:
• Digitalis: Use with caution in digitalized patients; hypercalcemia may precipitate cardiac arrhythmias.
• Minerals/other oral drugs: Calcium administration interferes with absorption of some minerals and drugs; use with caution.
• Vitamin D: It is recommended to concomitantly administer vitamin D for optimal calcium absorption.
Dosage form specific issues:
• Absorption: Taking oral calcium (≤500 mg) with food improves absorption.
• Aluminum: Solutions may contain aluminum; toxic levels may occur following prolonged administration in premature neonates or patients with renal impairment.
• I.V. administration: For I.V. use only; do not inject SubQ or I.M. Avoid too rapid I.V. administration and avoid extravasation.
Interactions
 
Bisphosphonate Derivatives: Calcium Salts may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral calcium supplements within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Risk D: Consider therapy modification
Calcium Acetate: Calcium Salts may enhance the adverse/toxic effect of Calcium Acetate. Risk X: Avoid combination
Calcium Channel Blockers: Calcium Salts may diminish the therapeutic effect of Calcium Channel Blockers. Risk C: Monitor therapy
CefTRIAXone: Calcium Salts (Intravenous) may enhance the adverse/toxic effect of CefTRIAXone. Ceftriaxone binds to calcium forming an insoluble precipitate. Management: Use of ceftriaxone with calcium-containing solutions within 48 hours of one another is contraindicated in neonates (28 days of age or younger). In older patients, flush lines with compatible fluid between administration. Risk D: Consider therapy modification
DOBUTamine: Calcium Salts may diminish the therapeutic effect of DOBUTamine. Risk C: Monitor therapy
Eltrombopag: Calcium Salts may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., calcium-containing products) by at least 4 hours. Risk D: Consider therapy modification
Estramustine: Calcium Salts may decrease the absorption of Estramustine. Risk D: Consider therapy modification
Phosphate Supplements: Calcium Salts may decrease the absorption of Phosphate Supplements. Exceptions: Potassium Phosphate. Risk D: Consider therapy modification
Quinolone Antibiotics: Calcium Salts may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Exceptions: Moxifloxacin; Moxifloxacin (Systemic). Risk D: Consider therapy modification
Tetracycline Derivatives: Calcium Salts may decrease the serum concentration of Tetracycline Derivatives. Management: If coadministration of oral calcium with oral tetracyclines can not be avoided, consider separating administration of each agent by several hours. Risk D: Consider therapy modification
Thiazide Diuretics: May decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. Risk C: Monitor therapy
Thyroid Products: Calcium Salts may diminish the therapeutic effect of Thyroid Products. Management: Separate the doses of the thyroid product and the oral calcium supplement by at least 4 hours. Risk D: Consider therapy modification
Trientine: May decrease the serum concentration of Calcium Salts. Calcium Salts may decrease the serum concentration of Trientine. Risk D: Consider therapy modification
Vitamin D Analogs: Calcium Salts may enhance the adverse/toxic effect of Vitamin D Analogs. Risk C: Monitor therapy
Pregnancy
 
C
Pregnancy Implications
Reproduction studies have not been completed.
Lactation
 
Enters breast milk
Breast-Feeding Considerations
Endogenous calcium is excreted in breast milk.
Mechanism of Action
 
As dietary supplement, used to prevent or treat negative calcium balance; in osteoporosis, it helps to prevent or decrease the rate of bone loss. The calcium in calcium salts moderates nerve and muscle performance and allows normal cardiac function.
Pharmacodynamics / Kinetics
 
Distribution: Primarily in bones and teeth; crosses placenta; enters breast milk
Protein binding: Primarily albumin
Excretion: Primarily feces (as unabsorbed calcium); urine (20%)
 
   
 
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