Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 100mg/mL (10%)
tablet
- 50mg
- 500mg
- 650mg
capsule
- 500mg
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
Dosage Forms & Strengths
injectable solution
- 100mg/mL (10%)
tablet
- 50mg
- 500mg
- 650mg
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Adverse Effects
Frequency Not Defined
Bradycardia
Hypotension
Headache
Constipation
Diarrhea
Flatulence
Nausea
Vomiting
Hypomagnesemia
Hypophosphatemia
Extravasation necrosis
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
Calcium gluconate injection contains aluminum, up to 100 mcg per liter
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
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.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%)
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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Patient Handout
Formulary
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