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Calcium Glubionate

Pronunciation

(KAL see um gloo BYE oh nate)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Syrup, Oral:

Calcionate: 1.8 g/5 mL (473 mL) [fruit flavor]

Brand Names: U.S.

  • Calcionate [OTC]

Pharmacologic Category

  • Calcium Salt

Pharmacology

As dietary supplement, used to prevent or treat negative calcium balance. The calcium in calcium salts moderates nerve and muscle performance and allows normal cardiac function.

Absorption

Minimal unless chronic, high doses; absorption predominantly in the duodenum and dependent on calcitriol and vitamin D; mean absorption of calcium intake varies with age (infants 60%, prepubertal children 28%, pubertal children 34%, adults 25%); during pregnancy, calcium absorption doubles; calcium is absorbed in soluble, ionized form; solubility of calcium is increased in an acid environment (IOM 2011); decreased absorption occurs in patients with achlorhydria, renal osteodystrophy, steatorrhea, or uremia

Distribution

Primarily in bones, teeth (IOM 2011)

Excretion

Primarily feces (75%; as unabsorbed calcium); urine (22%) (IOM 2011)

Protein Binding

~40%, primarily to albumin (Wills 1971)

Use: Labeled Indications

Dietary supplement

Dosing: Adult

Dosage is in terms of elemental calcium

Dietary Reference Intake for Calcium: Oral:

Adults, Females/Males: RDA:

19 to 50 years: 1000 mg daily

≥51 years, females: 1200 mg daily

51 to 70 years, males: 1000 mg daily

Females: Pregnancy/Lactating: RDA: Requirements are the same as in nonpregnant or nonlactating females

Dietary supplement: Oral: Note: Each 5 mL contains elemental calcium 115 mg: 15 mL 3 times daily or 15 mL 4 times daily (pregnancy/lactating)

Dosing: Geriatric

Dietary Reference Intake for Calcium: RDA: Oral:

Females: Refer to adult dosing.

Males ≤70 years: Refer to adult dosing.

Males >70 years: 1200 mg/day

Dietary supplement: Refer to adult dosing.

Dosing: Pediatric

Dosage is in terms of elemental calcium

Dietary Reference Intake for Calcium: Oral:

1 to 6 months: Adequate intake: 200 mg daily

7 to 12 months: Adequate intake: 260 mg daily

1 to 3 years: RDA: 700 mg daily

4 to 8 years: RDA: 1000 mg daily

9 to 18 years: RDA: 1300 mg daily

Females: Pregnancy/Lactating: RDA: Requirements are the same as in nonpregnant or nonlactating females

Dietary supplement: Oral: Note: Each 5 mL contains elemental calcium 115 mg

Infants <12 months: 5 mL 5 times daily; may mix with juice or formula

Children <4 years: 10 mL 3 times daily

Children ≥4 years and Adolescents: Refer to adult dosing.

Administration

Take with a full glass of water or juice, 1-3 hours after meals and other medications, and 1-2 hours before any approved iron supplements.

Dietary Considerations

Should be taken before meals to enhance absorption. May decrease iron absorption so should be administered 1-2 hours before or after iron supplementation. Limit intake of bran, foods high in oxalates, or whole grain cereals which may decrease calcium absorption.

Storage

Store at room temperature.

Drug Interactions

Alpha-Lipoic Acid: Calcium Salts may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Calcium Salts. Consider therapy modification

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. Consider therapy modification

Calcium Acetate: Calcium Salts may enhance the adverse/toxic effect of Calcium Acetate. Avoid combination

Calcium Channel Blockers: Calcium Salts may diminish the therapeutic effect of Calcium Channel Blockers. Monitor therapy

Cardiac Glycosides: Calcium Salts may enhance the arrhythmogenic effect of Cardiac Glycosides. Monitor therapy

Deferiprone: Calcium Salts may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Consider therapy modification

DOBUTamine: Calcium Salts may diminish the therapeutic effect of DOBUTamine. Monitor therapy

Dolutegravir: Calcium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral calcium. Alternatively, dolutegravir and oral calcium can be taken together with food. Consider therapy modification

Eltrombopag: Calcium Salts may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any calcium-containing product. Consider therapy modification

Estramustine: Calcium Salts may decrease the absorption of Estramustine. Consider therapy modification

Multivitamins/Fluoride (with ADE): May increase the serum concentration of Calcium Salts. Calcium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). More specifically, calcium salts may impair the absorption of fluoride. Management: Avoid eating or drinking dairy products or consuming vitamins or supplements with calcium salts one hour before or after of the administration of fluoride. Consider therapy modification

Multivitamins/Minerals (with ADEK, Folate, Iron): May increase the serum concentration of Calcium Salts. Monitor therapy

Phosphate Supplements: Calcium Salts may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate and calcium administration. Administering oral phosphate supplements as far apart from the administration of an oral calcium salt as possible may be able to minimize the significance of the interaction. Exceptions: Sodium Glycerophosphate Pentahydrate. Consider therapy modification

Quinolone Antibiotics: Calcium Salts may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Exceptions: LevoFLOXacin (Oral Inhalation); Moxifloxacin (Systemic). Consider therapy modification

Strontium Ranelate: Calcium Salts may decrease the serum concentration of Strontium Ranelate. Management: Separate administration of strontium ranelate and oral calcium salts by at least 2 hours in order to minimize this interaction. 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. Consider therapy modification

Thiazide and Thiazide-Like Diuretics: May decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. 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. Consider therapy modification

Trientine: Calcium Salts may decrease the serum concentration of Trientine. Trientine may decrease the serum concentration of Calcium Salts. Consider therapy modification

Vitamin D Analogs: Calcium Salts may enhance the adverse/toxic effect of Vitamin D Analogs. Monitor therapy

Test Interactions

Decreased magnesium

Adverse Reactions

Frequency not defined. Symptoms reported with hypercalcemia.

Endocrine & metabolic: Increased thirst

Gastrointestinal: Abdominal pain, anorexia, constipation, nausea, vomiting, xerostomia

Renal: Polyuria

Warnings/Precautions

Concerns related to adverse effects:

• Gastrointestinal effects: Constipation, bloating, and gas are common with calcium supplements (especially carbonate salt).

Disease-related concerns:

• Achlorhydria: Calcium absorption is impaired in achlorhydria; common in elderly, use an alternate salt (eg, citrate) and administer with food.

• Hypoparathyroid disease: Hypercalcemia and hypercalciuria are most likely to occur in hypoparathyroid patients receiving high doses of vitamin D.

• Kidney stones (calcium-containing): Use caution when administering calcium supplements to patients with a history of kidney stones.

Concurrent drug therapy issues:

• 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.

Other warnings/precautions:

• Absorption: Taking calcium (≤500 mg) with food improves absorption.

• Appropriate product selection: Multiple salt forms of calcium exist; close attention must be paid to the salt form when ordering and administering calcium; incorrect selection or substitution of one salt for another without proper dosage adjustment may result in serious over or under dosing.

Pregnancy Considerations

Calcium crosses the placenta. Intestinal absorption of calcium increases during pregnancy. The amount of calcium reaching the fetus is determined by maternal physiological changes. Calcium requirements are the same in pregnant and nonpregnant females (IOM, 2011).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience abdominal pain or flatulence. Have patient report immediately to prescriber severe constipation, severe nausea, severe vomiting, or confusion (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.

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