calcium gluconate (Rx, OTC)

Brand and Other Names:Gluconate, Ca
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 100mg/mL (10%)

tablet

  • 50mg
  • 500mg
  • 650mg

capsule

  • 500mg
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Calcium Supplementation

19-50 years old: 1000 mg/day PO divided q8-12hr, preferably 1-2 hours after meals

>50 years old: 1200 mg/day PO divided q8-12hr, preferably 1-2 hours after meals

Pregnant or breastfeeding patient: 1000/day PO divided q8-12hr, preferably 1-2 hours after meals

Dosing considerations

  • Dietary reference intakes are expressed as elemental calcium

Hypocalcemia

Treatment of conditions arising from calcium deficiency (eg, hypocalcemic tetany, hypoparathyroidism)

Mild (ionized calcium 1-1.2 mmol/L)

  • Management of non-life-threatening symptoms
  • PO: 1-3 g/day in divided doses; oral repletion may be considered and administered on outpatient basis
  • IV: 1-2 g over 2 hours

Severe (ionized calcium <1 mmol/L)

  • Without seizure or tetany: 0.5 mg/kg/hr IV; may be increased to 2 mg/kg/hr; not to exceed 3-4 g IV over 4 hours
  • Hypocalcemic tetany: 100-300 mg elemental calcium (~3 g calcium gluconate) IV over 5-10 minutes, followed by continuous IV infusion at 0.5 mg/kg/hr (may be increased to 2 mg/kg/hr)
  • Monitor serum calcium q4-6hr to maintain serum calcium levels

Cardiac Arrest (Off-label)

Management of cardiac arrest only in presence of hyperkalemia, hypocalcemia, or hypermagnesemia (routine use for cardiac arrest not recommended, because it yields no improvement in survival)

1.5-3 g IV over 2-5 minutes

Hydrofluoric Acid Burn (Off-label)

Topical: Use 2.5% gel, placing in glove to apply to hand; if gel unavailable, prepare with 10% calcium gluconate solution in 3 times volume of KY gel

Subcutaneous: 10% calcium gluconate, no more than 0.5 mL/cm² of skin; do not use in digits

If topical and/or subcutaneous do not work, consider intra-arterial

Intra-arterial calcium infusion for moderate to severe burns: Infuse 10 mL 10% calcium gluconate mixed with 40-50 mL D5W over 4 hours, repeating as needed (need to indicate with high-pressure pump)

Calcium Channel Blocker Overdose (Off-label)

60-120 mg/kg/hr IV or 60 mg/kg IV over 5 minutes every 10-20 minutes PRN up to 3-4 doses; not to exceed 3-4 g/dose

Hyperkalemia (Off-label)

1.5-3 g IV infused over 2-5 minutes

Hypermagnesemia (Off-label)

1.5-3 g IV infused over 2-5 minutes

Dosage Forms & Strengths

injectable solution

  • 100mg/mL (10%)

tablet

  • 50mg
  • 500mg
  • 650mg
more...

Calcium Supplementation

0-6 months old: 210 mg/day PO divided q8-12hr, preferably 1-2 hours after meals

7-12 months old: 270 mg/day PO divided q8-12hr, preferably 1-2 hours after meals

1-3 years old: 500 mg/day PO divided q8-12hr, preferably 1-2 hours after meals

4-8 years old: 800 mg/day PO divided q8-12hr, preferably 1-2 hours after meals

9-18 years old: 1300 mg/day PO divided q8-12hr, preferably 1-2 hours after meals

Dosing considerations

  • Dietary reference intakes are expressed as elemental calcium

Hypocalcemia

Treatment of conditions arising from calcium deficiency (eg, hypocalcemic tetany, hypoparathyroidism)

Mild

  • Neonates: 500-1500 mg/kg/day PO divided q4-6hr 
  • Infants/children: 500-725 mg/kg/day PO divided q6-8hr

Severe

  • Neonates: 200-800 mg/kg/day IV by continuous infusion or divided q6hr as intermittent infusions 
  • Infants/children: 200-500 mg/kg/day IV by continuous infusion or divided q6hr as intermittent infusions

Hypocalcemic tetany

  • 100-200 mg/kg IV over 10 minutes; may be repeated after 6 hours, or initiate continuous infusion not to exceed 500 mg/kg/day
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Interactions

Interaction Checker

and calcium gluconate

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            Adverse Effects

            Frequency Not Defined

            Bradycardia

            Hypotension

            Headache

            Constipation

            Diarrhea

            Flatulence

            Nausea

            Vomiting

            Hypomagnesemia

            Hypophosphatemia

            Extravasation necrosis

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            Warnings

            Contraindications

            Hypersensitivity

            IM/SC administration

            Ventricular fibrillation during CPR

            Hypercalcemia

            Digoxin poisonings

            Sarcoidosis

            Cautions

            Hepatic or renal impairment, cardiovascular disease, acidosis, history of renal calculi

            Cardiac arrest may occur

            Constipation, bloating, and gas may occur with oral administration

            Use caution in patients with severe hyperphosphatemia

            Adult and Pediatric Advanced Life Support programs no longer recommend routine calcium for CPR

            Rapid IV infusion associated with hypotension, bradycardia, syncope, cardiac arrest, cardiac arrhythmias, sense of oppression or heat waves, tingling sensation, vasodilation

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Calcium enters human milk; use with caution

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Bone mineral component; cofoactor in enzymatic reactions, essential for neurotransmission, muscle contraction, and many signal transduction pathways

            Absorption

            Oral absorption requires vitamin D; absorption is increased with acidic condition; therefore, administer 1-2 hr after meals

            Distribution

            Protein bound: ~45% (primarily to albumin)

            Elimination

            Excretion: Feces as unabsorbed calcium salt (80%), urine (20%)

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            Administration

            1 g calcium gluconate salt contains 93 mg elemental calcium

            Injectable 10% solution 10% contains 100 mg/mL (ie, elemental calcium 0.465 mEq/ mL or 9.3 mg/mL)

            IV Compatibilities

            Additive: Aminophylline, dopamine, heparin, hydrocortisone, lidocaine, norepinephrine, potassium chloride, sodium bicarbonate, vancomycin, verapamil, vitamins B and C

            Y-site: Cefazolin, dobutamine, epinephrine, heparin, potassium chloride, vitamins B and C

            Not specific: Erythromycin

            IV Incompatibilities

            Additive: Amphotericin B, dobutamine

            Y-site: Ampicillin, sodium bicarbonate

            Not specific: Clindamycin, tetracycline

            IV Preparation

            May be given diluted or undiluted

            Solution may be diluted in NS, D5W (mix in up to 1000 mL), or 2/3-1/3

            Store at room temperature

            Do not mix in same bag or line with carbonates, phosphates, sulfates, and tartrates, because of precipitation

            IV Administration

            May administer IV push at rate of 50-100 mg/min (0.5-1 mL/min); rapid IV administration may produce arrhythmias, hypotension, myocardial infarction, or vasodilation

            For intermittent IV infusion, maximum rate is 200 mg/min (2 mL/min)

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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