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

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
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Interactions

Interaction Checker

and calcium gluconate

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            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.

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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

            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

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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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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            calcium gluconate intravenous
            -
            100 mg/mL (10%) vial

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

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            Patient Education
            calcium gluconate oral

            CALCIUM SUPPLEMENTS - ORAL

            USES: This medication is used to prevent or treat low blood calcium levels in people who do not get enough calcium from their diets. It may be used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased activity of the parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). It may also be used in certain patients to make sure they are getting enough calcium (e.g., women who are pregnant, nursing, or postmenopausal, people taking certain medications such as phenytoin, phenobarbital, or prednisone).Calcium plays a very important role in the body. It is necessary for normal functioning of nerves, cells, muscle, and bone. If there is not enough calcium in the blood, then the body will take calcium from bones, thereby weakening bones. Having the right amount of calcium is important for building and keeping strong bones.

            HOW TO USE: Take this medication by mouth with food. If your product contains calcium citrate, then it may be taken with or without food. Follow all directions on the product package, or take as directed by your doctor. For best absorption, if your daily dose is more than 600 milligrams, then divide your dose and space it throughout the day. If you have any questions, ask your doctor or pharmacist.If you are using the chewable product, chew it well before swallowing.If you are using the effervescent tablet, allow the tablet to fully dissolve in a glass of water before drinking it. Do not chew or swallow the tablet whole.If you are using the liquid product or powder, measure the medication with a dose-measuring spoon or device to make sure you get the correct dose. Do not use a household spoon. If the liquid product is a suspension, shake the bottle well before each dose.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.If your doctor has recommended that you follow a special diet, it is very important to follow the diet to get the most benefit from this medication and to prevent serious side effects. Do not take other supplements/vitamins unless ordered by your doctor.If you think you may have a serious medical problem, seek immediate medical attention.

            SIDE EFFECTS: Constipation and upset stomach may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: nausea/vomiting, loss of appetite, unusual weight loss, mental/mood changes, bone/muscle pain, headache, increased thirst/urination, weakness, unusual tiredness.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

            PRECAUTIONS: Before taking calcium, tell your doctor or pharmacist if you have any allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This product should not be used if you have certain medical conditions. Before using this product, consult your doctor or pharmacist if you have: high calcium levels (hypercalcemia).If you have any of the following health problems, consult your doctor or pharmacist before using this product: kidney disease, kidney stones, little or no stomach acid (achlorhydria), heart disease, disease of the pancreas, a certain lung disease (sarcoidosis), difficulty absorbing nutrition from food (malabsorption syndrome).Some sugar-free formulations of calcium may contain aspartame. If you have phenylketonuria (PKU) or any other condition that requires you to restrict your intake of aspartame (or phenylalanine), consult your doctor or pharmacist about using this drug safely.Tell your doctor if you are pregnant before using this medication.This medication passes into breast milk. Consult your doctor before breast-feeding.

            DRUG INTERACTIONS: If you are taking this product under your doctor's direction, your doctor or pharmacist may already be aware of possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor or pharmacist first.Before using this product, tell your doctor or pharmacist if you use any of the following products: digoxin, cellulose sodium phosphate, certain phosphate binders (e.g., calcium acetate).Calcium can decrease the absorption of other drugs such as bisphosphonates (for example, alendronate), tetracycline antibiotics (such as doxycycline, minocycline), estramustine, levothyroxine, and quinolone antibiotics (such as ciprofloxacin, levofloxacin). Separate your doses of these medications as far as possible from your doses of calcium. Ask your doctor or pharmacist about how long you should wait between doses and for help finding a dosing schedule that will work with all your medications.Check the labels on all your prescription and nonprescription/herbal products (e.g., antacids, vitamins) because they may contain calcium. Ask your pharmacist about using those products safely.This document does not contain all possible interactions. Before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist.

            OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: nausea/vomiting, loss of appetite, mental/mood changes, headache, weakness, tiredness.

            NOTES: Foods rich in calcium include: dairy products (e.g., milk, yogurt, cheese, ice cream), dark-green leafy vegetables (e.g., broccoli, spinach, bok choy), and calcium-fortified foods (e.g., orange juice).Vitamin D helps with the absorption of calcium. Foods rich in vitamin D include: fortified dairy products, eggs, sardines, cod liver oil, chicken livers, and fatty fish. Vitamin D is also made by the body as a result of exposure to the sun.Keep all regular medical and laboratory appointments. If your doctor has directed you to take this medication, laboratory and/or medical tests (e.g., calcium levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

            MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

            STORAGE: Store at room temperature away from light and moisture. See packaging for the exact temperature range. If you have any questions about storage, ask your pharmacist. Do not store in the bathroom. Keep all medicines away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

            Information last revised August 2021. Copyright(c) 2021 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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            Formulary

            FormularyPatient Discounts

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            • View the formulary and any restrictions for each plan.
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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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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.