calcium gluconate (Rx, OTC)

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)

Immediately irrigate skin with tap water; lavage should occur immediately at hydrofluoric acid burn site for 15-30 min

After irrigation, apply calcium gluconate 2.5-5% gel to the affected area q30min initially, then q4hr afterwards for ~3-4 days

If gel is unavailable, calcium gluconate gel can be made with a water-soluble lubricant (eg, K-Y Jelly), added to calcium gluconate solution or calcium gluconate powder (75 mL water-soluble lubricant plus 25 mL of 10% calcium gluconate or 100 mL of water-soluble lubricant plus 2.5 g of calcium gluconate) (Mckee 2014)

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

If topical and/or SC 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

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

Contraindicated (1)

• ceftriaxone

  ceftriaxone, calcium gluconate. Other (see comment). Contraindicated. Comment: Do not use ANY calcium containing solutions (including Ringer or Harmann) in combination with IV ceftriaxone; risk of potentially fatal particulate precipitation in lungs, kidneys. Separate by at least 48 hrs.

Serious - Use Alternative (7)

• baloxavir marboxil

  calcium gluconate will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

• demeclocycline

  calcium gluconate, demeclocycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

• doxycycline

  calcium gluconate, doxycycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

• eltrombopag

  calcium gluconate decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

• minocycline

  calcium gluconate, minocycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

• oxytetracycline

  calcium gluconate, oxytetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

• tetracycline

  calcium gluconate, tetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

Monitor Closely (53)

• acebutolol

  calcium gluconate decreases effects of acebutolol by unspecified interaction mechanism. Use Caution/Monitor.

• alendronate

  calcium gluconate decreases levels of alendronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• amlodipine

  calcium gluconate decreases effects of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor.

• atenolol

  calcium gluconate decreases effects of atenolol by unspecified interaction mechanism. Use Caution/Monitor.

• betaxolol

  calcium gluconate decreases effects of betaxolol by unspecified interaction mechanism. Use Caution/Monitor.

• bisoprolol

  calcium gluconate decreases effects of bisoprolol by unspecified interaction mechanism. Use Caution/Monitor.

• carvedilol

  calcium gluconate decreases effects of carvedilol by unspecified interaction mechanism. Use Caution/Monitor.

• celiprolol

  calcium gluconate decreases effects of celiprolol by unspecified interaction mechanism. Use Caution/Monitor.

• ciprofloxacin

  calcium gluconate decreases effects of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Ciprofloxacin should be administered 2 hr before or 6 hr after calcium salts.

• clevidipine

  calcium gluconate decreases effects of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor.

• deferiprone

  calcium gluconate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

• delafloxacin

  calcium gluconate will decrease the level or effect of delafloxacin by cation binding in GI tract. Modify Therapy/Monitor Closely. Oral delafloxacin form chelates with alkaline earth and transition metal cations. Administer oral delafloxacin at least 2 hr before or 6 hr after these agents.

• digoxin

  calcium gluconate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• diltiazem

  calcium gluconate decreases effects of diltiazem by pharmacodynamic antagonism. Use Caution/Monitor.

• esmolol

  calcium gluconate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.

• estramustine

  calcium gluconate decreases levels of estramustine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Patients should take estramustine with water at least 1h before or 2h after meals.

• etidronate

  calcium gluconate decreases levels of etidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• felodipine

  calcium gluconate decreases effects of felodipine by pharmacodynamic antagonism. Use Caution/Monitor.

• fleroxacin

  calcium gluconate, fleroxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• gemifloxacin

  calcium gluconate, gemifloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• ibandronate

  calcium gluconate decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• isradipine

  calcium gluconate decreases effects of isradipine by pharmacodynamic antagonism. Use Caution/Monitor.

• labetalol

  calcium gluconate decreases effects of labetalol by unspecified interaction mechanism. Use Caution/Monitor.

• levofloxacin

  calcium gluconate, levofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• levothyroxine

  calcium gluconate decreases levels of levothyroxine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• metoprolol

  calcium gluconate decreases effects of metoprolol by unspecified interaction mechanism. Use Caution/Monitor.

• moxifloxacin

  calcium gluconate, moxifloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• nadolol

  calcium gluconate decreases effects of nadolol by unspecified interaction mechanism. Use Caution/Monitor.

• nebivolol

  calcium gluconate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

• nicardipine

  calcium gluconate decreases effects of nicardipine by pharmacodynamic antagonism. Use Caution/Monitor.

• nifedipine

  calcium gluconate decreases effects of nifedipine by pharmacodynamic antagonism. Use Caution/Monitor.

• nisoldipine

  calcium gluconate decreases effects of nisoldipine by pharmacodynamic antagonism. Use Caution/Monitor.

• ofloxacin

  calcium gluconate, ofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• omadacycline

  calcium gluconate will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• pamidronate

  calcium gluconate decreases levels of pamidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• penbutolol

  calcium gluconate decreases effects of penbutolol by unspecified interaction mechanism. Use Caution/Monitor.

• pindolol

  calcium gluconate decreases effects of pindolol by unspecified interaction mechanism. Use Caution/Monitor.

• potassium phosphates, IV

  calcium gluconate decreases effects of potassium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Calcium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

• propranolol

  calcium gluconate decreases effects of propranolol by unspecified interaction mechanism. Use Caution/Monitor.

• rilpivirine

  calcium gluconate decreases levels of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of antacids with rilpivirine may cause significant decreases in rilpivirine plasma concentrations because of increased gastric pH. If antacids must be administered, they should given at least 2 hr before or at least 4 hr after rilpivirine.

• risedronate

  calcium gluconate decreases levels of risedronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• sarecycline

  calcium gluconate will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• sodium phosphates, IV

  calcium gluconate decreases effects of sodium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Calcium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of calcium gluconate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of calcium gluconate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sotalol

  calcium gluconate decreases effects of sotalol by unspecified interaction mechanism. Use Caution/Monitor.

• squill

  calcium gluconate increases toxicity of squill by unspecified interaction mechanism. Use Caution/Monitor.

• strontium ranelate

  calcium gluconate decreases levels of strontium ranelate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Applies to oral form of calcium. Separate by 2 hr.

• tiludronate

  calcium gluconate decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• timolol

  calcium gluconate decreases effects of timolol by unspecified interaction mechanism. Use Caution/Monitor.

• verapamil

  calcium gluconate decreases effects of verapamil by pharmacodynamic antagonism. Use Caution/Monitor.

• vitamin D

  vitamin D, calcium gluconate. Other (see comment). Use Caution/Monitor. Comment: The concurrent use of vitamin D with calcium salts is generally beneficial; in some patients this combination may result in hypercalcemia.

• zoledronic acid

  calcium gluconate decreases levels of zoledronic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

Minor (50)

• amikacin

  amikacin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• amiloride

  amiloride decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• bendroflumethiazide

  bendroflumethiazide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• budesonide

  budesonide decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• bumetanide

  bumetanide decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• caffeine

  caffeine decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• calcitriol topical

  calcitriol topical increases levels of calcium gluconate by pharmacodynamic synergism. Minor/Significance Unknown. Topical calcitriol may lead to hypercalcemia.

• carbonyl iron

  calcium gluconate decreases levels of carbonyl iron by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  carbonyl iron increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• chlorothiazide

  chlorothiazide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• chlorthalidone

  chlorthalidone increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• cortisone

  cortisone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• cyclopenthiazide

  cyclopenthiazide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• deflazacort

  deflazacort decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• dexamethasone

  dexamethasone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• drospirenone

  drospirenone decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• ethacrynic acid

  ethacrynic acid decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• ferric maltol

  ferric maltol increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  calcium gluconate decreases levels of ferric maltol by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• ferrous fumarate

  calcium gluconate decreases levels of ferrous fumarate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  ferrous fumarate increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• ferrous gluconate

  ferrous gluconate increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  calcium gluconate decreases levels of ferrous gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• ferrous sulfate

  ferrous sulfate increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• fludrocortisone

  fludrocortisone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• furosemide

  furosemide decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• gentamicin

  gentamicin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• hydrochlorothiazide

  hydrochlorothiazide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• hydrocortisone

  hydrocortisone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• indapamide

  indapamide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• iron dextran complex

  calcium gluconate decreases levels of iron dextran complex by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  iron dextran complex increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• iron sucrose

  calcium gluconate decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  iron sucrose increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• isoniazid

  isoniazid decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• isotretinoin

  isotretinoin increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• lily of the valley

  calcium gluconate increases effects of lily of the valley by unspecified interaction mechanism. Minor/Significance Unknown.

• manganese

  calcium gluconate, manganese. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hours.

• methyclothiazide

  methyclothiazide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• methylprednisolone

  methylprednisolone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• metolazone

  metolazone increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• neomycin PO

  neomycin PO decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• paromomycin

  paromomycin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• polysaccharide iron

  calcium gluconate decreases levels of polysaccharide iron by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  polysaccharide iron increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• prednisolone

  prednisolone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• prednisone

  prednisone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• rose hips

  calcium gluconate decreases levels of rose hips by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  rose hips increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• shark cartilage

  calcium gluconate, shark cartilage. pharmacodynamic synergism. Minor/Significance Unknown. May lead to hypercalcemia (theoretical).

• sodium polystyrene sulfonate

  sodium polystyrene sulfonate increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

• spironolactone

  spironolactone decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• streptomycin

  streptomycin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• teriparatide

  teriparatide increases levels of calcium gluconate by pharmacodynamic synergism. Minor/Significance Unknown.

• tobramycin

  tobramycin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• torsemide

  torsemide decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• triamcinolone acetonide injectable suspension

  triamcinolone acetonide injectable suspension decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• triamterene

  triamterene decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• acebutolol

  Monitor Closely (1)calcium gluconate decreases effects of acebutolol by unspecified interaction mechanism. Use Caution/Monitor.

• alendronate

  Monitor Closely (1)calcium gluconate decreases levels of alendronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• amikacin

  Minor (1)amikacin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• amiloride

  Minor (1)amiloride decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• amlodipine

  Monitor Closely (1)calcium gluconate decreases effects of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor.

• atenolol

  Monitor Closely (1)calcium gluconate decreases effects of atenolol by unspecified interaction mechanism. Use Caution/Monitor.

• baloxavir marboxil

  Serious - Use Alternative (1)calcium gluconate will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

• bendroflumethiazide

  Minor (1)bendroflumethiazide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• betaxolol

  Monitor Closely (1)calcium gluconate decreases effects of betaxolol by unspecified interaction mechanism. Use Caution/Monitor.

• bisoprolol

  Monitor Closely (1)calcium gluconate decreases effects of bisoprolol by unspecified interaction mechanism. Use Caution/Monitor.

• budesonide

  Minor (1)budesonide decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• bumetanide

  Minor (1)bumetanide decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• caffeine

  Minor (1)caffeine decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• calcitriol topical

  Minor (1)calcitriol topical increases levels of calcium gluconate by pharmacodynamic synergism. Minor/Significance Unknown. Topical calcitriol may lead to hypercalcemia.

• carbonyl iron

  Minor (2)calcium gluconate decreases levels of carbonyl iron by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  carbonyl iron increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• carvedilol

  Monitor Closely (1)calcium gluconate decreases effects of carvedilol by unspecified interaction mechanism. Use Caution/Monitor.

• ceftriaxone

  Contraindicated (1)ceftriaxone, calcium gluconate. Other (see comment). Contraindicated. Comment: Do not use ANY calcium containing solutions (including Ringer or Harmann) in combination with IV ceftriaxone; risk of potentially fatal particulate precipitation in lungs, kidneys. Separate by at least 48 hrs.

• celiprolol

  Monitor Closely (1)calcium gluconate decreases effects of celiprolol by unspecified interaction mechanism. Use Caution/Monitor.

• chlorothiazide

  Minor (1)chlorothiazide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• chlorthalidone

  Minor (1)chlorthalidone increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• ciprofloxacin

  Monitor Closely (1)calcium gluconate decreases effects of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Ciprofloxacin should be administered 2 hr before or 6 hr after calcium salts.

• clevidipine

  Monitor Closely (1)calcium gluconate decreases effects of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor.

• cortisone

  Minor (1)cortisone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• cyclopenthiazide

  Minor (1)cyclopenthiazide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• deferiprone

  Monitor Closely (1)calcium gluconate decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

• deflazacort

  Minor (1)deflazacort decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• delafloxacin

  Monitor Closely (1)calcium gluconate will decrease the level or effect of delafloxacin by cation binding in GI tract. Modify Therapy/Monitor Closely. Oral delafloxacin form chelates with alkaline earth and transition metal cations. Administer oral delafloxacin at least 2 hr before or 6 hr after these agents.

• demeclocycline

  Serious - Use Alternative (1)calcium gluconate, demeclocycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

• dexamethasone

  Minor (1)dexamethasone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• digoxin

  Monitor Closely (1)calcium gluconate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

• diltiazem

  Monitor Closely (1)calcium gluconate decreases effects of diltiazem by pharmacodynamic antagonism. Use Caution/Monitor.

• doxycycline

  Serious - Use Alternative (1)calcium gluconate, doxycycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

• drospirenone

  Minor (1)drospirenone decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• eltrombopag

  Serious - Use Alternative (1)calcium gluconate decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

• esmolol

  Monitor Closely (1)calcium gluconate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.

• estramustine

  Monitor Closely (1)calcium gluconate decreases levels of estramustine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Patients should take estramustine with water at least 1h before or 2h after meals.

• ethacrynic acid

  Minor (1)ethacrynic acid decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• etidronate

  Monitor Closely (1)calcium gluconate decreases levels of etidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• felodipine

  Monitor Closely (1)calcium gluconate decreases effects of felodipine by pharmacodynamic antagonism. Use Caution/Monitor.

• ferric maltol

  Minor (2)ferric maltol increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  calcium gluconate decreases levels of ferric maltol by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• ferrous fumarate

  Minor (2)calcium gluconate decreases levels of ferrous fumarate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  ferrous fumarate increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• ferrous gluconate

  Minor (2)ferrous gluconate increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  calcium gluconate decreases levels of ferrous gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• ferrous sulfate

  Minor (1)ferrous sulfate increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• fleroxacin

  Monitor Closely (1)calcium gluconate, fleroxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• fludrocortisone

  Minor (1)fludrocortisone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• furosemide

  Minor (1)furosemide decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• gemifloxacin

  Monitor Closely (1)calcium gluconate, gemifloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• gentamicin

  Minor (1)gentamicin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• hydrochlorothiazide

  Minor (1)hydrochlorothiazide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• hydrocortisone

  Minor (1)hydrocortisone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• ibandronate

  Monitor Closely (1)calcium gluconate decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• indapamide

  Minor (1)indapamide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• iron dextran complex

  Minor (2)calcium gluconate decreases levels of iron dextran complex by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  iron dextran complex increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• iron sucrose

  Minor (2)calcium gluconate decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  iron sucrose increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• isoniazid

  Minor (1)isoniazid decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• isotretinoin

  Minor (1)isotretinoin increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• isradipine

  Monitor Closely (1)calcium gluconate decreases effects of isradipine by pharmacodynamic antagonism. Use Caution/Monitor.

• labetalol

  Monitor Closely (1)calcium gluconate decreases effects of labetalol by unspecified interaction mechanism. Use Caution/Monitor.

• levofloxacin

  Monitor Closely (1)calcium gluconate, levofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• levothyroxine

  Monitor Closely (1)calcium gluconate decreases levels of levothyroxine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• lily of the valley

  Minor (1)calcium gluconate increases effects of lily of the valley by unspecified interaction mechanism. Minor/Significance Unknown.

• manganese

  Minor (1)calcium gluconate, manganese. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hours.

• methyclothiazide

  Minor (1)methyclothiazide increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• methylprednisolone

  Minor (1)methylprednisolone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• metolazone

  Minor (1)metolazone increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

• metoprolol

  Monitor Closely (1)calcium gluconate decreases effects of metoprolol by unspecified interaction mechanism. Use Caution/Monitor.

• minocycline

  Serious - Use Alternative (1)calcium gluconate, minocycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

• moxifloxacin

  Monitor Closely (1)calcium gluconate, moxifloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• nadolol

  Monitor Closely (1)calcium gluconate decreases effects of nadolol by unspecified interaction mechanism. Use Caution/Monitor.

• nebivolol

  Monitor Closely (1)calcium gluconate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

• neomycin PO

  Minor (1)neomycin PO decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• nicardipine

  Monitor Closely (1)calcium gluconate decreases effects of nicardipine by pharmacodynamic antagonism. Use Caution/Monitor.

• nifedipine

  Monitor Closely (1)calcium gluconate decreases effects of nifedipine by pharmacodynamic antagonism. Use Caution/Monitor.

• nisoldipine

  Monitor Closely (1)calcium gluconate decreases effects of nisoldipine by pharmacodynamic antagonism. Use Caution/Monitor.

• ofloxacin

  Monitor Closely (1)calcium gluconate, ofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• omadacycline

  Monitor Closely (1)calcium gluconate will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• oxytetracycline

  Serious - Use Alternative (1)calcium gluconate, oxytetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

• pamidronate

  Monitor Closely (1)calcium gluconate decreases levels of pamidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• paromomycin

  Minor (1)paromomycin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• penbutolol

  Monitor Closely (1)calcium gluconate decreases effects of penbutolol by unspecified interaction mechanism. Use Caution/Monitor.

• pindolol

  Monitor Closely (1)calcium gluconate decreases effects of pindolol by unspecified interaction mechanism. Use Caution/Monitor.

• polysaccharide iron

  Minor (2)calcium gluconate decreases levels of polysaccharide iron by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  polysaccharide iron increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• potassium phosphates, IV

  Monitor Closely (1)calcium gluconate decreases effects of potassium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Calcium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

• prednisolone

  Minor (1)prednisolone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• prednisone

  Minor (1)prednisone decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• propranolol

  Monitor Closely (1)calcium gluconate decreases effects of propranolol by unspecified interaction mechanism. Use Caution/Monitor.

• rilpivirine

  Monitor Closely (1)calcium gluconate decreases levels of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of antacids with rilpivirine may cause significant decreases in rilpivirine plasma concentrations because of increased gastric pH. If antacids must be administered, they should given at least 2 hr before or at least 4 hr after rilpivirine.

• risedronate

  Monitor Closely (1)calcium gluconate decreases levels of risedronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• rose hips

  Minor (2)calcium gluconate decreases levels of rose hips by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
  
  rose hips increases levels of calcium gluconate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• sarecycline

  Monitor Closely (1)calcium gluconate will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

• shark cartilage

  Minor (1)calcium gluconate, shark cartilage. pharmacodynamic synergism. Minor/Significance Unknown. May lead to hypercalcemia (theoretical).

• sodium phosphates, IV

  Monitor Closely (1)calcium gluconate decreases effects of sodium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Calcium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

• sodium polystyrene sulfonate

  Minor (1)sodium polystyrene sulfonate increases levels of calcium gluconate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of calcium gluconate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of calcium gluconate by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sotalol

  Monitor Closely (1)calcium gluconate decreases effects of sotalol by unspecified interaction mechanism. Use Caution/Monitor.

• spironolactone

  Minor (1)spironolactone decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• squill

  Monitor Closely (1)calcium gluconate increases toxicity of squill by unspecified interaction mechanism. Use Caution/Monitor.

• streptomycin

  Minor (1)streptomycin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• strontium ranelate

  Monitor Closely (1)calcium gluconate decreases levels of strontium ranelate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Applies to oral form of calcium. Separate by 2 hr.

• teriparatide

  Minor (1)teriparatide increases levels of calcium gluconate by pharmacodynamic synergism. Minor/Significance Unknown.

• tetracycline

  Serious - Use Alternative (1)calcium gluconate, tetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

• tiludronate

  Monitor Closely (1)calcium gluconate decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

• timolol

  Monitor Closely (1)calcium gluconate decreases effects of timolol by unspecified interaction mechanism. Use Caution/Monitor.

• tobramycin

  Minor (1)tobramycin decreases levels of calcium gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• torsemide

  Minor (1)torsemide decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• triamcinolone acetonide injectable suspension

  Minor (1)triamcinolone acetonide injectable suspension decreases levels of calcium gluconate by increasing elimination. Minor/Significance Unknown.

• triamterene

  Minor (1)triamterene decreases levels of calcium gluconate by increasing renal clearance. Minor/Significance Unknown.

• verapamil

  Monitor Closely (1)calcium gluconate decreases effects of verapamil by pharmacodynamic antagonism. Use Caution/Monitor.

• vitamin D

  Monitor Closely (1)vitamin D, calcium gluconate. Other (see comment). Use Caution/Monitor. Comment: The concurrent use of vitamin D with calcium salts is generally beneficial; in some patients this combination may result in hypercalcemia.

• zoledronic acid

  Monitor Closely (1)calcium gluconate decreases levels of zoledronic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.