Medication Guide App

Calcium Salts

Class: Replacement Preparations
VA Class: TN420
CAS Number: 543-90-8
Brands: Alka-Mints, Calcet, Calci-Chew, Calci-Mix, Calphosan, Caltrate, Caltrate + Vitamin D, Chooz, Citracal, Citracal + D, Healthy Woman, Liqui-Cal, Os-Cal, Os-Cal +D, PhosLo, Posture, Posture-D, Titralac, Tums, Viactiv

Warning(s)

  • Pharmacy Bulk Packages
  • Pharmacy bulk packages are for preparation of IV mixtures only.g

  • Not for direct IV infusion.g

Introduction

Calcium salts are used as a source of calcium, an essential nutrient cation.b

Uses for Calcium Salts

Dietary Requirements (oral therapy)

For maintaining an adequate intake of calcium to support the development and preservation of bone mass at a level sufficient to prevent fractures associated with osteopenia or osteoporosis in later life and of other calcified tissues (e.g., teeth).112 126 129

Although calcium can have beneficial effects on BP, 101 102 no current rationale to supplement calcium intake solely for BP reduction.114 120 121

Adequate intakes of calcium can be accomplished through changes in food consumption behaviors, consumption of nutrient-fortified foodstuffs, use of dietary supplements, or a combination of these.112

Use fortified foodstuffs to increase or maintain intakes without major changes in food habits and use supplements in certain individuals who are at increased risk.112 In the US and Canada, calcium principally is obtained from dairy products (almost 75% of total intake).112 Other principal sources include fruits and vegetables (about 9%) and grain products (about 5%).112 In addition, many healthy individuals take dietary supplements containing calcium.112

For specific information on currently recommended Adequate Intakes (AIs) of calcium for various life-stage and gender groups, see Dosage under Dosage and Administration.b

Supplemental Therapy for Pregnant, Postmenopausal, or Nursing Women (oral therapy)

Calcium salts are used as supplemental therapy for pregnant, postmenopausal, or nursing women.b

In general, any calcium salt may be used for chronic replacement therapy.b

Phosphate salts of calcium are efficacious in pregnant, nursing, or osteoporotic patients who usually require both calcium and phosphorus supplements, but they should not be used in hypocalcemic-hyperphosphatemic states (e.g., hypoparathyroidism, renal failure).b

Hypocalcemia (parenteral and oral therapy)

Calcium salts are used as a source of calcium cation for the treatment or prevention of calcium depletion when dietary measures are inadequate.b Conditions associated with calcium deficiency include hypoparathyroidism, achlorhydria, chronic diarrhea, vitamin D deficiency, steatorrhea, sprue, pregnancy and lactation, menopause, pancreatitis, renal failure, alkalosis, and hyperphosphatemia.b

IV calcium chloride is considered the calcium salt of choice to prevent hypocalcemia during transfusions with citrated blood.b In addition to being irritating, however, the chloride salt is acidifying and generally should not be used when acidosis coincides with hypocalcemia (e.g., renal failure).b

The calcium glycerophosphate and calcium lactate fixed-combination injection is used IM to increase serum calcium concentrations.142

Administration of certain drugs (e.g., some diuretics, anticonvulsants) may sometimes result in hypocalcemia, which may warrant calcium replacement therapy.b

Calcium is administered in long-term electrolyte replacement regimens.b

Use of calcium salts should not preclude the use of other measures intended to correct the underlying cause of calcium depletion.b

Vitamin D analogs may be administered concomitantly with oral calcium salts for the treatment of chronic hypocalcemia, especially when caused by vitamin D deficiency.b

Calcium salts may be used orally for the treatment of hypocalcemia secondary to the administration of anticonvulsant drugs.b

Hypocalcemic Tetany (IV therapy)

IV calcium gluconate is considered the salt of choice for the treatment of acute hypocalcemia.b

Calcium salts are used to treat acute hypocalcemic tetany secondary to renal failure, hypoparathyroidism, premature delivery, and/or maternal diabetes mellitus in infants, and poisoning with magnesium, oxalic acid, radiophosphorus, carbon tetrachloride, fluoride, phosphate, strontium, or radium.b

Hypoparathyroidism, Chronic (oral therapy)

Calcium salts may be used for treatment of chronic hypoparathyroidism.b

Latent Tetany (oral therapy)

Calcium salts may be used for the treatment of latent tetany.b

Osteoporosis Prevention (oral therapy)

For women whose dietary intake of calcium is limited, supplementation with oral calcium salts is recommended for the prevention of primary osteoporosis.100 126

Daily calcium requirement is about 1 g in premenopausal women and in women receiving estrogen therapy and about 1.5 g in postmenopausal women who are not receiving supplemental estrogen therapy.100 126

While not as effective as a regimen of estrogens and exercise, the addition of calcium to a regimen of exercise appears be more effective than exercise alone in preventing or slowing bone loss in postmenopausal women considered at risk for osteoporotic fracture because of low bone density, and generally appears to be better tolerated than the estrogen-exercise regimen.111 126

Intake of elemental calcium of 1–1.5 g daily, beginning well before the menopause, is believed by some clinicians to reduce the incidence of osteoporosis in postmenopausal women; increased calcium intake may also prevent or diminish age-related bone loss in men.100 126

Osteoporosis Treatment (oral therapy)

Calcium salts may be used for treatment of osteoporosis.b

Osteomalacia (oral therapy)

Calcium salts may be used for treatment of osteomalacia.b

Anticonvulsant-induced Hypocalcemia (oral therapy)

Calcium salts may be used for treatment of rickets, latent tetany, and hypocalcemia secondary to the administration of anticonvulsant drugs.b

Rickets (oral therapy)

Calcium salts may be used for treatment of rickets.b

Corticosteroid-induced Osteoporosis (oral therapy)

Corticosteroid-induced osteoporosis results in part from decreased GI absorption of calcium and increased urinary calcium excretion; attempts at normalizing calcium balance may limit the extent of bone loss during systemic corticosteroid therapy.119

Maintain an adequate calcium intake of about 1.5 g of elemental calcium daily in adults receiving chronic systemic corticosteroid therapy.119

Hyperphosphatemia in Chronic Renal Failure (oral therapy)

Calcium acetate and calcium carbonate are considered the salts of choice for chronic renal failure.113 126

In addition to providing a source of calcium, calcium acetate or carbonate sequesters phosphate in the intestine by forming insoluble phosphates that are excreted fecally, thus reducing serum phosphate concentrations and secondary hyperparathyroidism.b

Calcium carbonate partially corrects metabolic acidosis which may occur in chronic renal failure.b

Because of the risk of aluminum accumulation and resultant neurotoxic and osteomalacic effects, most clinicians no longer use aluminum hydroxide to inhibit phosphorus absorption; instead calcium acetate or carbonate and/or non-calcium-, non-aluminum-, non-magnesium-containing phosphate binders (e.g., lanthanum carbonate, sevelamer hydrochloride) currently are used.127 130 131 132

When taken with meals, calcium acetate or carbonate can contribute to controlling hyperphosphatemia in chronic renal failure by binding to and inhibiting absorption of phosphates in the GI tract.113 127

Exercise caution in patients undergoing chronic hemodialysis to prevent hypophosphatemia.b

Patients with end-stage renal failure may develop hypercalcemia when calcium is administered with meals; do not give calcium supplementation concomitantly when calcium salts are used to control hyperphosphatemia in such patients.113

Progressive hypercalcemia secondary to overdose of calcium salts can occur and may require emergency treatment measures.113

Chronic hypercalcemia also may lead to vascular and other soft-tissue calcification;113 126 periodic (e.g., twice weekly) monitoring of calcium concentrations is recommended during the initial dose adjustment.113 One manufacturer recommends that the serum calcium times phosphate (Ca × P) product should not exceed 66.113 Radiographic evaluation of a suspected anatomical region for early soft-tissue calcification may be useful.113

Hyperkalemia with Secondary Cardiotoxicity (IV therapy)

Calcium salts are used with ECG monitoring to antagonize the cardiotoxicity of hyperkalemia when the ECG shows broad QRS complexes or absent P waves.134 b

Administer parenteral calcium salts cautiously, if at all, to patients receiving cardiac glycosides (especially during cardiac resuscitation or for the treatment of hyperkalemia) or if digoxin toxicity is suspected.134 b (See Digoxin under Drug Interactions.)

CPR (IV therapy)

Calcium has been administered IV or into the ventricular cavity during cardiac resuscitation when epinephrine or isoproterenol had failed to improve weak or ineffective myocardial contraction.b j However, because of the theoretical potential for detrimental effects resulting from high concentrations of calcium and the lack of demonstrated benefit, the guidelines on CPR and emergency cardiovascular care (ECC) currently state that calcium should not be used routinely to support circulation in the setting of cardiac arrest in ACLS in adults and pediatric advanced life support (PALS) in children, except when hyperkalemia, ionized hypocalcemia (e.g., after multiple blood transfusions), or calcium-channel blocking agent toxicity is present.109 134 b

Guidelines no longer include recommendations for the use of calcium in the acute phase of CPR in neonates.109 134 b

Calcium chloride is the calcium salt of choice for cardiac resuscitation, when calcium is indicated.134 b In addition to being irritating, however, the chloride salt is acidifying and generally should not be used when acidosis coincides with hypocalcemia (e.g., renal failure).b

Aminoglycoside Neuromuscular Blockade (IV therapy)

Calcium salts are used to antagonize neuromuscular blockade resulting from the use of aminoglycoside antibiotics (e.g., gentamicin, kanamycin, neomycin) with or without agents possessing neuromuscular blocking properties (e.g., gallamine triethiodide).b

Magnesium Intoxication (IV therapy)

Calcium gluconate may be used in the treatment of magnesium sulfate overdosage.c

Calcium gluconate is considered treatment of choice for magnesium toxicity in pregnant women with eclampsia.134 b

Myasthenia Gravis (oral therapy)

Calcium salts are used as adjunctive treatment of myasthenia gravis.b

In general, any oral calcium salt may be used for chronic replacement therapy.b

Medullary Thyroid Carcinoma (IV therapy)

Calcium infusions (“calcium challenge”) are used in medullary thyroid carcinoma.b

Acid Indigestion (oral therapy)

Calcium carbonate or phosphate may be used for self-medication for the relief of acid indigestion, heartburn, and sour stomach.d

Colic, Renal, Biliary, Intestinal, or Lead (IV and IM therapy)

Calcium salts have been used IM or IV as adjunctive therapy to reduce spasms in renal, biliary, intestinal, or lead colic.b

Zollinger-Ellison Syndrome, Diagnosis (IV therapy)

Calcium infusions (“calcium challenge”) are used to diagnose the Zollinger-Ellison syndrome.b

Eaton-Lambert Syndrome (oral therapy)

Calcium salts are used as adjunctive treatment of the Eaton-Lambert syndrome.b

In general, any oral calcium salt may be used for chronic replacement therapy.b

Insect Bites and Other Sensitivity Reactions (IV therapy)

Calcium salts have been used IV as adjuncts to relieve muscle cramps in the treatment of insect bites or stings (e.g., black widow spider) or to decrease capillary permeability in sensitivity reactions characterized by urticaria or angioedema and in allergic conditions, including nonthrombocytopenic purpura, dermatitis herpetiformis, drug-induced pruritus, hay fever, and asthma.b

Preeclampsia (oral therapy)

Although some evidence suggested a beneficial effect of calcium supplementation on preeclampsia,117 118 125 a large, well-designed study did not confirm a beneficial effect of calcium supplementation in preventing preeclampsia during pregnancy.114 117 However, these findings do not obviate adequate dietary calcium intake during pregnancy nor do they address whether adequate or increased calcium intake can affect blood pressure favorably in pregnant women.105 118 125

β-Adrenergic or Calcium-channel Blocking Agent Overdosage (IV therapy)

Some experts state that calcium salts may be considered in the treatment of bradycardia or shock associated with calcium-channel blocking agent-induced toxicity.134 b

These experts state that there is insufficient evidence to recommend for or against the use of calcium in β-adrenergic blocking agent toxicity, but that calcium salts may be considered in the treatment of bradycardia or shock.134 b

Diuresis (oral therapy)

Calcium chloride, an acid-forming salt, has been used to promote diuresis, however, because it is irritating and loses effectiveness after a few days, it is rarely used for this effect.b

Calcium Salts Dosage and Administration

Administration

Administer calcium orally (as acetate, carbonate, citrate, gluconate, lactate, or phosphate salt) or IV (as chloride or gluconate salt).134 b j

The fixed combination of calcium glycerophosphate and calcium lactate is injected IM.142

In extreme cardiac emergencies, calcium chloride has been administered intracardially into the ventricular cavity.b j

For ACLS during CPR in pediatric patients, calcium chloride administration via central venous catheter is preferred because of the risk of sclerosis or infiltration with a peripheral venous line.134 b

For ACLS during CPR in pediatric patients, calcium chloride also may be administered by intraosseous injection; onset of action and systemic concentrations are comparable to those achieved with central venous administration.134 b

Oral Administration

Administer acetate, carbonate, citrate, gluconate, lactate, and phosphate salts of calcium orally.b

Administer most oral calcium supplements 1–1.5 hours after meals or with a demulcent (e.g., milk).112 b However, calcium carbonate powder generally should be administered with meals, since mixing the powder with food for administration is recommended.b

Calcium salts used to bind dietary phosphate in patients with end-stage renal disease should be administered with meals (e.g., 10–15 minutes before, or during, the meal).130

IV Administration

For solution and drug compatibility information, see Compatibility under Stability.

Calcium chloride or gluconate may be administered IV.b j

Calcium gluconate usually is administered IV as a 10% solution and calcium chloride as a 2–10% solution.b j

When injected IV, administer calcium salts slowly through a small needle into a large vein to avoid too rapid an increase in serum calcium and extravasation of calcium solution into the surrounding tissue with resultant necrosis.b

Following IV injections, the patient should remain recumbent for a short time.b

Close monitoring of serum calcium concentrations is essential during IV administration of calcium.b

Children: Calcium salts should not be administered through scalp veins; oral administration of calcium supplements or calcium-rich foods should replace IV calcium therapy as soon as possible.b

Dilution

Usually, administer IV undiluted.a b c

Parenteral calcium salts also may be administered in a compatible large-volume IV infusion fluid.b (See Solution Compatibility under Compatibility.)

Pharmacy bulk packages are for preparing IV admixtures only.g

Rate of Administration

Administer IV calcium injections slowly at a rate not exceeding 0.7–1.8 mEq/minute.b

Stop the injection if the patient complains of discomfort.b

Pharmacy bulk packages must not be infused IV directly.g

Administer pediatric dose for CPR by slow IV injection over 10–20 seconds.b

IM or Sub-Q Injection

Calcium chloride should not be injected IM or into subcutaneous or perivascular tissue, since severe necrosis and sloughing may occur.b

Although other calcium salts may cause mild to severe local reactions, they generally are less irritating than calcium chloride.b (See Cautions.)

Although some manufacturers previously stated that calcium gluconate could be injected IM when IV administration was not possible,b manufacturers of calcium gluconate currently state that the drug should not be injected IM or into subcutaneous tissue because of the potential for severe local reactions.140 141

The fixed-combination of calcium glycerophosphate and calcium lactate is injected IM.142

Intracardiac Injection

Limit intracardiac injection to personnel well trained in the technique and generally use only during open cardiac massage or when other routes of administration are persistently inaccessible.109

Inject into the left ventricular chamber.109

Follow intracardiac administration by external cardiac massage to ensure entry of the drug into the coronary circulation.

Administration Risks

Hazards include coronary artery laceration, cardiac tamponade, pneumothorax, and the need to interrupt external chest compressions and ventilation during the period of administration.109

Dosage

Dosage of the oral calcium supplements usually is expressed in g or mg of elemental calcium and depends on the requirements of the individual patient.b

Dosage of parenteral calcium replacements usually is expressed as mEq of calcium and depends on individual patient requirements.b

One mEq of elemental calcium is equivalent to 20 mg.b

The calcium content of the various calcium salts is approximately:b

Calcium Salt

Calcium Content

calcium acetate

253 mg (12.7 mEq) per g

calcium carbonate

400 mg (20 mEq) per g

calcium chloride

270 mg (13.5 mEq) per g

calcium citrate

211 mg (10.6 mEq) per g

calcium gluceptate

82 mg (4.1 mEq) per g

calcium gluconate

90 mg (4.5 mEq) per g

calcium glycerophosphate

191 mg (9.6 mEq) per g

calcium lactate

130 mg (6.5 mEq) per g

calcium phosphate dibasic anhydrous

290 mg (14.5 mEq) per g

calcium phosphate dibasic dihydrate

230 mg (11.5 mEq) per g

calcium phosphate tribasic

400 mg (20 mEq) per g

Oral calcium supplements usually are administered in 3 or 4 divided doses daily.b

Optimum calcium absorption may require supplemental vitamin D in individuals with inadequate vitamin D intake, those with impaired renal activation of the vitamin, or those not receiving adequate exposure to sunlight.112 116

Pediatric Patients

Dietary Requirements
Oral

Because hypocalcemia is relatively common in neonates, special evaluation of calcium requirements may be needed for some neonates.112

Adequate Intake (AI) of elemental calcium currently recommended by the National Academy of Sciences (NAS) in healthy children:112

Infants <6 Months of Age:

210 mg daily when the source is human milk (i.e., for breast-fed infants); 315 mg daily for infants receiving cow milk-based formula.112

Infants 6–12 Months of Age:

270 mg daily when the source is human milk and solid foods; 335 mg daily for infants receiving cow milk-based formula.112

Children 1–3 Years of Age:

500 mg daily.b

Children 4–8 Years of Age:

800 mg daily.b

Children 9–18 Years of Age:

1.3 g daily.112

Infants fed with various specialty formulas, including soy protein-based and protein hydrolysate formulas, should receive an additional 20% increase in calcium intake compared with infants receiving cow milk-based formulas due to lower calcium bioavailability associated with various specialty formulas.112

Give special consideration for different calcium requirements in children with chronic illnesses such as juvenile rheumatologic conditions, renal disease, liver failure, and certain endocrine disorders, including type 1 (insulin-dependent) diabetes mellitus.112

Hypocalcemia

Calcium gluconate usually is administered IV as a 10% solution and calcium chloride as a 2–10% solution.b j

Calcium replacement requirements can be estimated by clinical condition and/or serum calcium determinations.b

Prevention
Oral

Neonates: Usually, 50–150 mg/kg of elemental calcium daily; do not exceed 1 g daily.b

Children: Usually, 45–65 mg/kg of elemental calcium daily.b

Treatment When Prompt Elevation of Serum Calcium Is Required
IV

Infants: <0.93 mEq of calcium; may be repeated every 1–3 days depending on the patient’s response.140 141 b

Children: Usually, initial dose of 0.93–2.3 mEq of calcium; may be repeated every 1–3 days depending on the patient’s response.140 141 b

Alternatively, one manufacturer recommends a pediatric IV calcium dose of 0.272 mEq/kg, up to a maximum total daily dosage of 1.36–13.6 mEq, in the treatment of hypocalcemic disorders.138

Hypocalcemic Tetany
IV

Neonates: May be treated with divided doses of calcium totaling about 2.4 mEq/kg daily.b

Children: Usually, calcium dose of 0.5–0.7 mEq/kg administered IV 3 or 4 times daily or until tetany is controlled.b

Exchange Transfusions of Citrated Blood
IV

Neonates: 0.45 mEq of calcium concurrently with each 100 mL of citrated blood.b

CPR

In critically ill children, calcium chloride may provide greater bioavailability of calcium than calcium gluconate.134 b Administer appropriate dose by slow IV or intraosseous injection.134 b

IV

Children, per PALS guidelines: 0.272 mEq/kg of calcium 128 134 as calcium chloride (0.2 mL/kg of 10% calcium chloride); this dose of 10% calcium chloride will provide 20 mg/kg of the salt and 5.4 mg/kg of elemental calcium.128 134

Calcium-channel Blocking Agent Overdosage
IV

For cardiovascular emergencies in pediatric patients: 0.272 mEq/kg of calcium as 10% calcium chloride (0.2 mL/kg) may be given over 5–10 minutes; if a beneficial effect is observed, an IV calcium infusion of 0.27–0.68 mEq/kg per hour using calcium chloride may be given.134 b Monitor ionized calcium concentrations to prevent hypercalcemia.134 b

Adults

Dietary Requirements
Oral

Calcium replacement requirements can be estimated by clinical condition and/or serum calcium determinations.b

Prophylactic administration of calcium supplements may be necessary in some patients in order to maintain serum calcium >9 mg/dL.b

The AI of elemental calcium for healthy adults are:

Adults 19–50 Years of Age:

1 g daily.112

Adults ≥ 51 Years of Age:

1.2 g daily.112

Pregnant or Lactating Women:

Generally, the usual AI of calcium appropriate for their age.112

Hypocalcemia

Calcium gluconate usually is administered IV as a 10% solution and calcium chloride as a 2–10% solution.b j

Calcium replacement requirements can be estimated by clinical condition and/or serum calcium determinations.b

Prevention
Oral

Usually, about 1 g of elemental calcium daily.b

Treatment
Oral

Usually, 1–2 g or more of elemental calcium daily.b

IM

Usually, 0.8 mEq of calcium as the calcium glycerophosphate and calcium lactate fixed-combination preparation 1–4 times weekly or as directed by a clinician.142

Treatment When Prompt Elevation of Serum Calcium Is Required

Calcium gluconate usually is administered IV as a 10% solution and calcium chloride as a 2–10% solution.134 b j

IV

Usual initial dose of 2.3–14 mEq of calcium; doses may be repeated every 1–3 days depending on the patient’s response.136 137 138 139 140 141 b

Acute, symptomatic hypocalcemia: 4.65–9.3 mEq of calcium as 10% calcium gluconate (10–20 mL) over 10 minutes, followed by IV infusion of 27–36 mEq of calcium (58–77 mL of 10% calcium gluconate in 0.5–1 L of 5% dextrose injection).134 b Alternatively, 6.8 mEq of calcium as 10% calcium chloride (5 mL) over 10 minutes, followed by IV infusion of 50 mEq of calcium (36.6 mL of 10% calcium chloride) over 6–12 hours.134 b Measure serum calcium concentrations every 4–6 hours and maintain total serum calcium concentrations at 7–9 mg/dL.134 b

Hypocalcemic Tetany

Calcium gluconate usually is administered IV as a 10% solution and calcium chloride as a 2–10% solution.134 b j

IV

4.5–16 mEq doses of calcium, administered until therapeutic response occurs.b

Exchange Transfusions of Citrated Blood
IV

About 1.35 mEq of calcium concurrently with each 100 mL of citrated blood.b

CPR
IV

Per ACLS guidelines, 0.109–0.218 mEq/kg of calcium as calcium chloride; may repeat dose as necessary.109 134 b

Alternatively, 7–14 mEq of calcium as calcium chloride has been given.b

Intracardiac Injection

Usually, 2.7–5.4 mEq of calcium as calcium chloride into the ventricular cavity during cardiac resuscitation.b j

Hyperkalemia with Secondary Cardiotoxicity
IV

Usually, 2.25–14 mEq of calcium while monitoring the ECG; may repeat dosage after 1–2 minutes if necessary.b

Alternatively, for hyperkalemia associated with severe potassium elevation (>7 mEq/L with toxic ECG changes), 6.8–13.6 mEq of calcium as 10% calcium chloride (5–10 mL) has been administered over 2–5 minutes to reduce the effects of potassium at the myocardial cell membrane (e.g., reduce the risk of ventricular fibrillation).134 b

Hyperphosphatemia in Chronic Renal Failure
Oral

Usual initial dose of 1.334 g of calcium acetate (338 mg of calcium) with each meal;113 increase dosage gradually according to serum phosphate concentrations, provided hypercalcemia does not occur.113

Manufacturer states that most patients require about 2–2.67 g (about 500–680 mg of calcium) with each meal.113 However, some experts recommend limiting dosage of calcium provided by phosphate binders to ≤1.5 g daily and limiting total calcium intake (including dietary calcium) to ≤2 g daily; dialysis patients who remain hyperphosphatemic despite such therapy should receive a calcium-containing phosphate binder in combination with a non-calcium-, non-aluminum-, non-magnesium-containing phosphate binder.130

Monitor serum calcium concentrations twice weekly during initiation of therapy and subsequent dosage adjustment; also monitor serum phosphorus concentrations periodically.113

If hypercalcemia occurs, reduce dosage or withhold the salt.113 If severe hypercalcemia occurs, specific measures (e.g., hemodialysis) for the management of overdosage may be necessary.113

Zollinger-Ellison Syndrome, Diagnosis
IV

Usually, 0.25 mEq/kg of calcium per hour for a 3-hour period; serum gastrin concentrations are determined 30 minutes before the infusion, at the start of the infusion, and at 30-minute intervals thereafter for 4 hours.b

In most patients with Zollinger-Ellison syndrome, preinfusion serum gastrin concentrations increase by more than 50% or by greater than 500 pg/mL during the infusion.b

Magnesium Intoxication
IV

Initially, 7 mEq of calcium; adjust subsequent doses according to patient response.b

Alternatively, 6.8–13.6 mEq of calcium as 10% calcium chloride (5–10 mL) has been administered and repeated as necessary.134 b

Medullary Thyroid Carcinoma, Diagnosis
IV

Usually, about 7 mEq of calcium over 5–10 minutes; in patients with medullary thyroid carcinoma, plasma calcitonin concentrations are elevated above normal basal concentrations.b

Osteoporosis
Primary Prevention in Women
Oral

Usually, 1–1.5 g daily of elemental calcium; 1 g daily in premenopausal women and 1.5 g daily in postmenopausal women not receiving estrogen replacement.100 126

Corticosteroid-induced Osteoporosis

To limit the extent of corticosteroid-induced osteoporosis, adults receiving chronic systemic corticosteroid therapy should maintain an adequate calcium intake.119

Oral

About 1.5 g of elemental calcium daily.119

Special Populations

Hepatic Impairment

No specific dosage recommendations for hepatic impairment.a b c

Renal Impairment

No specific dosage recommendations for renal impairment.a b c

Geriatric Patients

No specific geriatric dosage recommendations.a

Cautions for Calcium Salts

Contraindications

  • Ventricular fibrillation.b

  • Hypercalcemia.b

  • Hypophosphatemia.b

  • Renal calculi.b

  • IV administration contraindicated when serum calcium concentrations are above normal.b

Warnings/Precautions

Warnings

Use calcium salts cautiously, if at all, in sarcoidosis,b renal or cardiac disease,b or patients receiving cardiac glycosides (see Digoxin under Interactions).b

Because it is acidifying, use calcium chloride cautiously in cor pulmonale,b respiratory acidosis,b renal disease,b or respiratory failure.b

Non-lipid-soluble drugs (e.g., calcium) may injure the airway; avoid endotracheal administration.134

Calcium Monitoring

Frequently perform determinations of serum calcium concentrations.b

Maintain serum calcium concentrations at 9–10.4 mg/dL (4.5–5.2 mEq/L).b Some clinicians prefer to maintain serum calcium at slightly lower concentrations.b

Usually, do not allow serum calcium concentrations to exceed 12 mg/dL.b

Determinations of urine calcium are generally unreliable and hypercalciuria can occur in the presence of hypocalcemia.b Forcing fluids may produce increased urine volume and thus prevent the formation of renal stones in patients with hypercalciuria.b

For treatment of acute, symptomatic hypocalcemia, measure serum calcium concentrations every 4–6 hours.134 Total serum calcium concentrations should be maintained at 7–9 mg/dL 134

For ACLS during CPR, measure ionized calcium concentrations because total calcium concentration does not correlate well with ionized concentration in critically ill patients.134 b

Citrated Blood Transfusion

Administration of calcium in patients who have received transfusions of citrated blood may result in higher than normal total serum calcium concentrations.b In these patients, however, most of the excess calcium is bound to citrate and is inactive; therefore, serious toxicity usually does not result.b

Discontinuing calcium when hypercalcemia occurs usually is sufficient to return serum calcium concentrations to normal.b

Local Effects

Calcium salts are irritating to tissue when administered by IM or sub-Q injection and cause mild to severe local reactions including burning, necrosis and sloughing of tissue, cellulitis, and soft tissue calcification; venous irritation may occur with IV administration.b (See IV Administration and also see IM or Sub-Q Injection, under Dosage and Administration.)

IV Injection Effects

Extravasation of calcium solution into surrounding tissues during IV injection can cause necrosis.b

Patients may complain of tingling sensations, a sense of oppression or heat waves, and a calcium or chalky taste following IV administration of calcium salts.b

Cardiovascular Effects

Rapid IV injection of calcium salts may cause vasodilation, decreased BP, bradycardia, cardiac arrhythmias, syncope, and cardiac arrest.b

Inadvertent injection of calcium into the myocardium during attempted intracardiac injection into the ventricular cavity can result in lacerated coronary arteries, cardiac tamponade or pneumothorax, and intractable ventricular fibrillation may result.b

GI Effects

Orally administered calcium salts may be irritating to the GI tract.b

Calcium salts are constipating.b

Calcium chloride, by any route of administration, produces more irritation than the other calcium salts and has been reported to cause GI hemorrhage when taken orally.b

Hypercalcemia

Hypercalcemia is rarely produced by administration of calcium alone, but may occur with large doses in patients with chronic renal failure.b

Avoid overtreatment of hypocalcemia since hypercalcemia may be more dangerous than hypocalcemia.b

Mild hypercalcemia may be asymptomatic or manifest as constipation, anorexia, nausea, and vomiting, with mental changes such as confusion, delirium, stupor, and coma becoming evident as the degree of hypercalcemia increases.113

Mild hypercalcemia usually is readily controlled by reducing calcium intake (e.g., decreasing the dose of or avoiding supplemental calcium); more severe hypercalcemia may require specific management (e.g., hemodialysis).113

Dialysis patients with chronic renal failure receiving calcium salts may require adjustments in calcium concentrations in the dialysate to reduce the risk of hypercalcemia.113 126

Long-term effects of chronic calcium administration (e.g., for hyperphosphatemia in chronic renal failure) on progression of vascular or soft-tissue calcification is unknown.113 127

Renal Calculi

High dietary intake of calcium has long been suspected as contributing to the risk of renal calculi, and restriction of calcium intake (i.e., low-calcium diets) had long been considered a reasonable measure in an attempt to prevent calculi formation in patients with idiopathic hypocalciuria.122 123 124

Recent evidence indicates that high dietary intake of calcium actually decreases the risk of symptomatic renal calculi, while intake of supplemental calcium may increase the risk of symptomatic stones.122 123 124

General Precautions

Use of Fixed Combination

When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.

Specific Populations

Pregnancy

Category C.c i

Lactation

Manufacturers state that it is not known whether calcium salts are distributed into milk,a c and to observe caution with parenteral therapy.c

Calcium is an important component of human milk in women not receiving supplemental calcium salts,112 and maternal calcium supplementation does not substantially affect milk calcium concentrations since the principal source is from maternal bone resorption.112

Pediatric Use

Give calcium cautiously to children by IV route.PDH

Geriatric Use

Calcium absorption (after oral administration) may be decreased in geriatric patients.PDH

Common Adverse Effects

Constipation, nausea, vein irritation.PDH

Interactions for Calcium Salts

Consider the possibility that other drug interactions reported with antacids could occur.k

Specific Drugs and Laboratory Tests

Drug or Test

Interaction

Comments

Bisphosphonates, oral (e.g., alendronate, etidronate, ibandronate, risedronate)

Concomitant administration may result in reduced bisphosphonate absorption144 145 146 147 148 150

Administer calcium salts ≥30 minutes after alendronate or risedronate, ≥60 minutes after ibandronate, and not within 2 hours of etidronate administration144 145 146 147 148

Digoxin

Inotropic and toxic effects are synergistic and arrhythmias may occur (particularly when calcium is given IV)b

Avoid IV administration of calcium in patients receiving digoxin, particularly if digoxin toxicity is suspected; if necessary, calcium should be given slowly in small amounts134 b

Iron preparations, oral

Concomitant administration may result in reduced iron absorption149 150

Advise patients to take the drugs at different times, whenever possible149 150

Levothyroxine

Calcium carbonate may form insoluble chelate with levothyroxine, resulting in decreased levothyroxine absorption and increased serum thyrotropin concentrations143 150

Administer oral levothyroxine and calcium carbonate ≥4 hours apart143

Quinolones

Concomitant administration of calcium salts and some fluoroquinolones (e.g., ciprofloxacin) may reduce oral bioavailability of the fluoroquinolone151 152

Recommended timing of fluoroquinolone administration relative to the calcium dose may vary depending on the specific fluoroquinolone preparation used151 152

Test, corticosteroids (Glenn-Nelson technique)

Transient elevations of plasma 11-hydroxycorticosteroid concentrations with IV calcium, but concentrations return to control values after 1 hourb

Test, magnesium (serum and urine)

False-negative values as measured by the Titan yellow methodb

Tetracyclines

Calcium complexes tetracycline antibiotics rendering them inactiveb

Do not give the 2 drugs together orally nor should they be mixed for parenteral administrationb

Thiazide diuretics

Risk of hypercalcemiaPDH

Avoid concomitant usePDH

Calcium Salts Pharmacokinetics

Absorption

Oral bioavailability of calcium from nonfood sources and supplements depends on intestinal pH, the presence or absence of a meal, and the dose.112

Calcium is actively absorbed in the duodenum and proximal jejunum and, to a lesser extent, in the more distal segments of the small intestine.b

Degree of absorption depends on a number of factors; absorption from the intestine is never complete.b

Absorption requires a soluble, ionized form.b

An acidic intestinal pH is necessary for ionization of calcium; thus an alkaline pH impedes absorption.b 112

Vitamin D, in its activated forms, is required for calcium absorption and increases the capability of the absorptive mechanisms.b

Decreased absorption with hypocalcemia secondary to deficiency of either parathyroid hormone or vitamin D.b

IM or IV administered calcium salts are absorbed directly into the blood stream.b

Glucocorticoids and low serum concentrations of calcitonin may depress calcium absorption.b

Bioavailability

When a 250-mg dose of calcium is administered with a standardized breakfast, average oral bioavailability in adults ranges from 25–35% with various salts; under the same conditions, absorption from milk is about 29%.112

Extent of calcium absorption from supplements is greatest when taken in doses ≤500 mg.112

Food

Calcium absorption is decreased in the absence of a meal.112

Calcium absorption is retarded by certain anions (e.g., oxalates, phytates, sulfates) and by fatty acids which precipitate or complex calcium ions; however, an intestinal pH of 5–7 facilitates maximal dissolution and dissociation of these complexes.b

Calcium may be poorly absorbed from foods rich in oxalic acid (e.g., spinach, sweet potatoes, rhubarb, beans) or phytic acid (e.g., unleavened bread, raw beans, seeds, nuts, grains, soy isolates).112

Although soybeans contain high concentrations of phytic acid, calcium absorption is relatively high from this food.112

Plasma Concentrations

Following IV injection of calcium salts, serum calcium concentrations increase almost immediately and may return to previous values in 30 minutes to 2 hours.b

Normal total serum calcium concentrations range from 9–10.4 mg/dL (4.5–5.2 mEq/L), but only ionized calcium is physiologically active.b

Serum calcium concentrations are not necessarily accurate indications of total body calcium; total body calcium may be decreased in the presence of hypercalcemia, and hypocalcemia can occur even though total body calcium is increased.b

Of total serum calcium concentration, 50% is in the ionic form and 5% is complexed by phosphates, citrates, and other anions.b

Hyperproteinemia is associated with increased total serum calcium concentrations.b

Hypoproteinemia is associated with decreased total serum calcium concentrations.b

Acidosis results in increased concentrations of ionic calcium, while alkalosis promotes a decrease in the ionic serum calcium concentration.b

Special Populations

Fractional calcium absorption varies with age as follows:

Infancy: about 60%.112

Children, prepubertal: about 28%.112

Early puberty: about 34%.112

Young adults: about 25%, although it increases during the last 2 trimesters of pregnancy.112

Fractional absorption declines with aging, decreasing on average by 0.21% annually in postmenopausal women.112 Similar declines with aging in men.112

Absorption is decreased in certain disease states such as achlorhydria, renal osteodystrophy, steatorrhea, or uremia.b

Efficiency of intestinal calcium absorption may be increased when calcium intake is reduced and during pregnancy112 b but not lactation (maternal bone resorption is principal source)112 when calcium requirements are higher than normal.b

Distribution

CSF concentrations of calcium are about 50% of serum concentrations and tend to reflect ionized serum calcium concentrations.b

Calcium enters extracellular fluid and is incorporated rapidly into skeletal tissue.b Bone contains 99% of total calcium; 1% is distributed equally between the intracellular and extracellular fluids.b

Extent

Following absorption, calcium first enters the extracellular fluid and is then rapidly incorporated into skeletal tissue.b

Bone formation is not stimulated by calcium administration.b

Plasma Protein Binding

Approximately 45%; for a change in serum albumin of 1 g/dL, serum calcium concentration may change about 0.8 mg/dL (0.04 mEq/dL).b

Calcium crosses the placenta; reaches higher concentrations in fetal than maternal blood.b 112

Calcium is distributed into milk.b

Elimination

Elimination Route

Excreted mainly in the feces as unabsorbed calcium and that secreted via bile and pancreatic juice into the GI tract lumen.b

Most of the calcium filtered by renal glomeruli is reabsorbed in the ascending limb of the loop of Henle and proximal and distal convoluted tubules.b Only small amounts of the cation are excreted in urine.b

Parathyroid hormone, vitamin D, and thiazide diuretics decrease urinary excretion of calcium, whereas other diuretics, calcitonin, and growth hormone promote renal excretion of the cation.b

Urinary excretion decreases with reduction of ionic serum concentrations but is proportionately increased as serum ionized concentrations increase.b

In healthy adults on a regular diet, urinary excretion of calcium may be as high as 250–300 mg daily.b With low calcium diets, urinary excretion usually does not exceed 150 mg daily.b

Calcium also is excreted by the sweat glands.b

Special Populations

Urinary excretion of calcium decreases during pregnancy and in the early stages of renal failure.b

Urinary excretion decreases with aging, possibly because of age-related decreases in intestinal calcium absorption efficiency and an associated decrease in filtered calcium load.112

Endogenous fecal calcium excretion does not change appreciably with aging.112

Stability

Storage

Oral

Capsules

25°C (may be exposed to 15–30°C).i

Solution

Tight container at 15–30°C.f

Tablets

Cool, dry place at 15–30°C.e

Parenteral

Injection

15–30°C; do not freeze.a c j

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Interaction of calcium and phosphate in parenteral nutrition solutions is a complex phenomenon; various factors have been identified as playing a role in solubility or precipitation of a given combination.135 Calcium salts are conditionally compatible with phosphate in parenteral nutrition solutions; incompatibility dependent on a solubility and concentration phenomenon and not entirely predictable.135 Precipitation may occur during compounding or at some time after compounding is completed.135 Consult specialized references for specific stability and compatibility information.

Calcium Chloride

Parenteral
Solution CompatibilityHID

Incompatible

Fat emulsion 10%, IV

Drug Compatibility
Admixture CompatibilityHID

Compatible

Amikacin sulfate

Ascorbic acid injection

Chloramphenicol sodium succinate

Dopamine HCl

Hydrocortisone sodium succinate

Isoproterenol HCl

Lidocaine HCl

Norepinephrine bitartrate

Penicillin G potassium

Penicillin G sodium

Pentobarbital sodium

Phenobarbital sodium

Verapamil HCl

Incompatible

Amphotericin B

Ceftriaxone sodium

Magnesium sulfate

Variable

Dobutamine HCl

Sodium bicarbonate

Y-site CompatibilityHID

Compatible

Amiodarone HCl

Ceftaroline fosamil

Dobutamine HCl

Doxapram HCl

Epinephrine HCl

Esmolol HCl

Hydroxyethyl starch 130/0.4 in sodium chloride 0.9%

Micafungin sodium

Milrinone lactate

Morphine sulfate

Paclitaxel

Sodium nitroprusside

Incompatible

Amphotericin B cholesteryl sulfate complex

Propofol

Sodium bicarbonate

Calcium Gluconate

Parenteral
Solution CompatibilityHID

Compatible

Alcohol 5%, dextrose 5%

Amino acids 4%, dextrose 25%

Dextrose 5% in Ringer’s injection, lactated

Dextrose 5% in sodium chloride 0.9%

Dextrose 5% in water

Dextrose 10% in sodium chloride 0.18%

Dextrose 10 or 20% in water

Fructose 10% in water

Invert sugar 10% in Electrolyte #1 or #2

Polysal M with dextrose 5%

Ringer’s injection, lactated

Sodium chloride 0.9%

Sodium lactate (1/6) M

Incompatible

Fat emulsion 10%, IV

Drug Compatibility
Admixture CompatibilityHID

Compatible

Amikacin sulfate

Aminophylline

Ascorbic acid injection

Chloramphenicol sodium succinate

Furosemide

Heparin sodium

Hydrocortisone sodium succinate

Lidocaine HCl

Norepinephrine bitartrate

Penicillin G potassium

Penicillin G sodium

Phenobarbital sodium

Potassium chloride

Prochlorperazine edisylate

Tobramycin sulfate

Vancomycin HCl

Verapamil HCl

Incompatible

Amphotericin B

Ceftriaxone sodium

Dobutamine HCl

Methylprednisolone sodium succinate

Variable

Magnesium sulfate

Y-Site CompatibilityHID

Compatible

Aldesleukin

Allopurinol sodium

Amifostine

Amiodarone HCl

Aztreonam

Bivalirudin

Cefazolin sodium

Ceftaroline fosamil

Ciprofloxacin

Cisatracurium besylate

Cladribine

Dexmedetomidine HCl

Dobutamine HCl

Docetaxel

Doripenem

Doxapram HCl

Doxorubicin HCl liposome injection

Enalaprilat

Epinephrine HCl

Etoposide phosphate

Famotidine

Fenoldopam mesylate

Filgrastim

Gemcitabine HCl

Granisetron HCl

Heparin sodium with hydrocortisone sodium succinate

Hetastarch in lactated electrolyte injection (Hextend)

Hydroxyethyl starch 130/0.4 in sodium chloride 0.9%

Labetalol HCl

Linezolid

Melphalan HCl

Micafungin sodium

Midazolam HCl

Milrinone lactate

Nicardipine HCl

Oxaliplatin

Piperacillin sodium–tazobactam sodium

Potassium chloride

Prochlorperazine edisylate

Propofol

Remifentanil HCl

Sargramostim

Tacrolimus

Telavancin HCl

Teniposide

Thiotepa

Vinorelbine tartrate

Incompatible

Amphotericin B cholesteryl sulfate complex

Fluconazole

Indomethacin sodium trihydrate

Pemetrexed disodium

Variable

Ampicillin sodium

Meropenem

Actions

  • Calcium is essential for maintenance of the functional integrity of nervous, muscular, and skeletal systems and cell-membrane and capillary permeability.b

  • Calcium is an important activator in many enzymatic reactions and essential to a number of physiologic processes including transmission of nerve impulses; contraction of cardiac, smooth, and skeletal muscles; renal function; respiration; and blood coagulation.b

  • Calcium plays regulatory roles in the release and storage of neurotransmitters and hormones, in the uptake and binding of amino acids, and in cyanocobalamin (vitamin B12) absorption and gastrin secretion.b

  • Calcium accounts for 1–2% of adult body weight, and more than 99% of total body calcium is found in bone and teeth.112

  • Calcium is present in blood, extracellular fluid, muscle, and other tissues where it has roles in mediating vascular contraction and vasodilation, muscle contraction, nerve transmission, and glandular secretion.112

  • Skeleton serves as a reservoir for calcium in addition to serving as a structural support for the body.112

  • Conditions associated with reduced concentrations of circulating estrogen alter calcium homeostasis.112

  • Reduced estrogen concentrations are associated with reduced calcium absorption efficiency and increased bone turnover rates.112

Advice to Patients

  • Advise patients of the importance of dosage compliance, adherence to instructions about diet, and avoidance of concomitant use of antacids or other preparations containing clinically important concentrations of calcium.113 127 i PDH

  • Advise patients of importance of taking calcium with meals or milk for maximum absorption.112 b

  • Advise patients that daily supplemental intake >2 g is unlikely to provide additional benefit.h

  • Advise patients of potential manifestations of hypercalcemia.113

  • Warn patients not to use bone meal or dolomite as a source of calcium; they may contain lead.PDH

  • Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.a b

  • Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a

  • Importance of informing patients of other important precautionary information.a b j (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Calcium Acetate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Calcium Acetate Powder

Oral

Capsules

667 mg (169 mg calcium; 8.45 mEq of Ca++)*

Calcium Acetate Capsules

PhosLo GelCaps

Fresenius

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Calcium Carbonate, Precipitated

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Calcium Carbonate, Precipitated Powder

Oral

Capsules

1.25 g (500 mg calcium)

Calcium Carbonate, Precipitated Calci-Mix

Watson

Capsules, liquid-filled

600 mg (240 mg of calcium)

Liqui-Cal Softgels

Advanced Nutritional Technology

Suspension

1.25 g (500 mg calcium) per 5 mL*

Calcium Carbonate Suspension

Tablets

650 mg (260 mg calcium)*

Calcium Carbonate Tablets

1.25 g (500 mg calcium)*

Calcium Carbonate Tablets

Os-Cal 500

GlaxoSmithKline

Tablets, chewable

420 mg (168 mg calcium)

Titralac

3M

500 mg (200 mg calcium)

Chooz

Insight

Tums

GlaxoSmithKline

750 mg (300 mg calcium)

Tums E-X 750

GlaxoSmithKline

850 mg (340 mg calcium)

Alka-Mints

Bayer

1 g (400 mg calcium)

Tums Ultra 1000

GlaxoSmithKline

1.25 g (500 mg calcium)*

Calcium Carbonate Chewable Tablets

Calci-Chew

Watson

Os-Cal 500

GlaxoSmithKline

Tablets, film-coated

1.5 g (600 mg calcium)*

Calcium Carbonate Tablets

Caltrate 600

Wyeth

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Calcium Carbonate, Precipitated, Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Pieces, chewable

1.25 g (500 mg calcium) with Cholecalciferol 100 units and Phytonadione 40 mcg

Viactiv Soft Calcium Chews

McNeil

Tablets

Calcium Carbonate 240 mg with Calcium Gluconate 240 mg, Calcium Lactate 240 mg (152.8 mg calcium), and Cholecalciferol 100 units

Calcet

Mission

1.25 g (500 mg calcium) with Cholecalciferol 200 units*

Calcium Carbonate, Precipitated, and Cholecalciferol Tablets

Os-Cal 500+D

GlaxoSmithKline

1.5 g (600 mg calcium) with Cholecalciferol 125 units*

Calcium Carbonate, Precipitated, and Cholecalciferol Tablets

1.5 g (600 mg calcium) with Cholecalciferol 280 units*

Calcium Carbonate, Precipitated, and Cholecalciferol Tablets

Healthy Woman (scored)

Personal Products

Tablets, film-coated

1.5 g (600 mg calcium) with Cholecalciferol 400 units

Caltrate 600 + Vitamin D

Wyeth

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Calcium Chloride

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Calcium Chloride Powder

Parenteral

Injection

10% (1.36–1.4 mEq of Ca++ and Cl- per mL)*

Calcium Chloride Injection

Calcium Citrate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

950 mg (200 mg calcium)

Citracal

Bayer

Calcium Citrate Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets

1.5 g (315 mg calcium) with Cholecalciferol 250 units

Citracal + D Caplets

Bayer

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Calcium Gluceptate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Calcium Gluceptate Powder

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Calcium Gluconate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Calcium Gluconate Powder

Oral

Tablets

500 mg (45 mg calcium)*

Calcium Gluconate Tablets

650 mg (58.5 mg calcium)*

Calcium Gluconate Tablets

1 g (90 mg calcium)*

Calcium Gluconate Tablets

Parenteral

Injection

10% (0.45–0.48 mEq of Ca++ per mL provided by calcium gluconate and other calcium salt stabilizers)*

Calcium Gluconate Injection

Injection, for preparation of IV admixtures

10% (0.45–0.48 mEq of Ca++ per mL provided by calcium gluconate and calcium saccharate or other calcium salts stabilizers) pharmacy bulk package*

Calcium Gluconate Injection Pharmacy Bulk Package

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Calcium Glycerophosphate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Calcium Glycerophosphate Powder

Calcium Glycerophosphate and Calcium Lactate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

Injection

0.08 mEq of Ca++ (provided by calcium glycerophosphate 5 mg and calcium lactate 5 mg) per mL

Calphosan

Glenwood

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Calcium Lactate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Calcium Lactate Powder

Oral

Tablets

325 mg (42.25 mg calcium)*

Calcium Lactate Tablets

650 mg (84.5 mg calcium)*

Calcium Lactate Tablets

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Calcium Phosphate Dibasic

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Calcium Phosphate Dibasic Powder

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Calcium Phosphate Tribasic

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Calcium Phosphate Tribasic Powder

Oral

Tablets, film-coated

1.5652 g (600 mg calcium)

Posture (scored)

Inverness

Calcium Phosphate Tribasic Combinations

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Tablets, film-coated

1.5652 g (600 mg calcium) with Cholecalciferol 125 units

Posture-D (scored)

Inverness

Calcium salts are also commercially available in combination with vitamins, minerals, electrolytes, and antacids.

AHFS DI Essentials. © Copyright, 2004-2014, Selected Revisions June 18, 2013. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

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145. Proctor & Gamble Pharmaceuticals. Didronel (etidronate disodium) tablets prescribing information. Cincinnati, OH; 2007 Oct.

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147. Proctor & Gamble Pharmaceuticals. Actonel (risedronate sodium) tablets prescribing information. Cincinnati, OH; 2008 Apr.

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d. Food and Drug Administration. Antacid products for over-the-counter (OTC) human use. [21 FR Part 331] Fed Regist. 1990; 55:19859.

e. Rugby Laboratories, Inc. Calcium gluconate supplement patient information. Duluth, GA; 2004 Mar.

f. Rugby Laboratories, Inc. Calcionate (calcium glubionate) syrup patient information. Duluth, GA; undated.

g. American Pharmaceutical Partners, Inc. Calcium gluconate injection USP pharmacy bulk package prescribing information. Schaumburg, IL; 2002 May.

h. GlaxoSmithKline. Os-Cal 500 calcium supplement patient information. Research Triangle Park, NC; undated.

i. Nabi Biopharmaceuticals. Phos Lo (calcium acetate) Gel Caps prescribing information. Boca Raton, FL; 2003 Aug.

j. American Regent Laboratories, Inc. Calcium chloride injection, USP 10% prescribing information. Shirley, NY; 2000 Feb.

k. AHFS Drug Information 2008. McEvoy, GK, ed. Antacids. Bethesda, MD: American Society of Health-System Pharmacists; 2008; 2960-5

PDH. Schilling McCann JA, Publisher. Pharmacists drug handbook. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins and American Society of Health-System Pharmacists; 2003.

HID. Trissel LA. Handbook on injectable drugs. 17h ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013:176-89.

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