Calcium gluconate: Difference between revisions

Calcium gluconate
	Adult Indications & Dosage
	Pediatric Indications & Dosage
	Contraindications
	Warnings & Precautions
	Adverse Reactions
	Drug Interactions
	Use in Specific Populations
	Administration & Monitoring
	Overdosage
	Pharmacology
	Clinical Studies
	How Supplied
	Images
	Patient Counseling Information
	Precautions with Alcohol
	Brand Names
	Look-Alike Names

VisualWikitext

Latest revision as of 18:31, 18 August 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Disclaimer

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Overview

Calcium gluconate is a mineral supplement that is FDA approved for the treatment of hypocalcemic tetany, hypocalcemia, black widow spider bites to relieve muscle cramping, rickets, osteomalacia, lead colic and magnesium sulfate overdosage, non thrombocytopnic pupura, exudative dermatoses, pruritus, hyperkalemia. Common adverse reactions include tingling sensations, a sense of oppression or heat waves and a calcium or chalky taste, vasodilation, hypotension, bradycardia, cardiac arrhythmias, syncope and cardiac arrest.

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Indications

Calcium Gluconate Injection, USP is used to treat conditions arising from calcium deficiencies such as hypocalcemic tetany, hypocalcemia related to hypoparathyroidism and hypocalcemia due to rapid growth of pregnancy.

It is also used in the treatment of black widow spider bites to relieve muscle cramping and as an adjunct in the treatment of rickets, osteomalacia, lead colic and magnesium sulfate overdosage.

Calcium gluconate has also been employed to decrease capillary permeability in allergic conditions, non thrombocytopnic pupura and exudative dermatoses such as dermatitis herpetiformis and for pruritus of eruptions caused by certain drugs. In hyperkalemia, calcium gluconate may aid in antagonizing the cardiac toxicity, provided the patient is not receiving digitalis therapy.

Dosage

The dose is dependent on the requirements of the individual patient. Intravenous calcium gluconate injection must be administered slowly.

Adults-500 mg to 2 g (5 to 20 mL)

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Calcium Gluconate in adult patients.

Non–Guideline-Supported Use

Indications

Allergic condition

Cardiac arrest, due to hyperkalemia

Cardiac arrest, due to hypermagnesemia

Chemical burn, Hydrofluoric acid

Dermatitis, exudative

Gastrinoma

Hypocalcemia

Insulinoma

Non-thrombocytopenic purpura

Osteomalacia

Tetany, due to hypocalcemia

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Indications

Calcium Gluconate Injection, USP is used to treat conditions arising from calcium deficiencies such as hypocalcemic tetany, hypocalcemia related to hypoparathyroidism and hypocalcemia due to rapid growth of pregnancy.

It is also used in the treatment of black widow spider bites to relieve muscle cramping and as an adjunct in the treatment of rickets, osteomalacia, lead colic and magnesium sulfate overdosage.

Calcium gluconate has also been employed to decrease capillary permeability in allergic conditions, non thrombocytopnic pupura and exudative dermatoses such as dermatitis herpetiformis and for pruritus of eruptions caused by certain drugs. In hyperkalemia, calcium gluconate may aid in antagonizing the cardiac toxicity, provided the patient is not receiving digitalis therapy.

Dosage

Pediatric Patients-200 to 500 mg (2 to 5 mL)

Infants-Not more than 200 mg (not more than 2 mL)

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Calcium Gluconate in pediatric patients.

Non–Guideline-Supported Use

Indications

Rickets

Allergic condition

Cardiac arrest, due to hyperkalemia

Cardiac arrest, due to hypermagnesemia

Dermatitis, exudative

Hypocalcemia

Non-thrombocytopenic purpura

Contraindications

Calcium salts are contraindicated in patients with ventricular fibrillation or hypercalcemia. Intravenous administration of calcium is contraindicated when serum calcium levels are above normal.

Warnings

For intravenous use only. Subcutaneous or intramuscular injection may cause severe necrosis and sloughing.

This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.

Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.

Adverse Reactions

Clinical Trials Experience

Patients may complain of tingling sensations, a sense of oppression or heat waves and a calcium or chalky taste following the intravenous administration of calcium gluconate.

Rapid intravenous injection of calcium salts may cause vasodilation, decreased blood pressure, bradycardia, cardiac arrhythmias, syncope and cardiac arrest. Use in digitalized patients may precipitate arrhythmias.

Local necrosis and abscess formation may occur with intramuscular injection.

Postmarketing Experience

There is limited information regarding Postmarketing Experience of Calcium Gluconate in the drug label.

Drug Interactions

The inotropic and toxic effects of cardiac glycosides and calcium are synergistic, and arrhythmias may occur if these drugs are given together (particularly when calcium is given together particularly when calcium is given intravenously). Intravenous administration of calcium should be avoided in patients receiving cardiac glycosides; if necessary, calcium should be given slowly in small amounts.

Calcium complexes tetracycline antibiotics rendering them inactive. The two drugs should not be given at the same time orally nor should they be mixed for parenteral administration.
Calcium gluconate injection has been reported to be incompatible with intravenous solutions containing various drugs. Published data are too varied and/or limited to permit generalizations, and specialized reference should be consulted for specific information.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): Teratogenic Effects: Pregnancy Category C- Animal reproduction studies have not been conducted with calcium gluconate. It is also not known whether calcium gluconate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Calcium gluconate should be given to a pregnant woman only if clearly needed.
Pregnancy Category (AUS):

Australian Drug Evaluation Committee (ADEC) Pregnancy Category

There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Calcium gluconate in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Calcium gluconate during labor and delivery.

Nursing Mothers

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when calcium gluconate is administered to a nursing woman.

Pediatric Use

There is no FDA guidance on the use of Calcium gluconate with respect to pediatric patients.

Geriatic Use

There is no FDA guidance on the use of Calcium gluconate with respect to geriatric patients.

Gender

There is no FDA guidance on the use of Calcium gluconate with respect to specific gender populations.

Race

There is no FDA guidance on the use of Calcium gluconate with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Calcium gluconate in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Calcium gluconate in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Calcium gluconate in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Calcium gluconate in patients who are immunocompromised.

Administration and Monitoring

Administration

Intravenous

Monitoring

There is limited information regarding Monitoring of Calcium gluconate in the drug label.

IV Compatibility

There is limited information regarding IV Compatibility of Calcium Gluconate in the drug label.

Overdosage

There is limited information regarding Chronic Overdose of Calcium Gluconate in the drug label.

Pharmacology

There is limited information regarding Calcium gluconate Pharmacology in the drug label.

Mechanism of Action

There is limited information regarding Calcium gluconate Mechanism of Action in the drug label.

Structure

Calcium Gluconate Injection, USP is a sterile, nonpyrogenic, supersaturated solution of calcium gluconate for intravenous use only.

Each mL contains: Calcium gluconate 94 mg; calcium saccharate (tetrahydrate) 4.5 mg; Water for Injection q.s. Hydrochloric acid and/or sodium hydroxide may have been added for pH adjustment (6.0-8.2)

Calcium saccharate provides 6% of the total calcium and stabilizes the supersaturated solution of calcium gluconate.

Each 10 mL of the injection provides 93 mg elemental calcium (Ca++) equivalent to 1 g of calcium gluconate.

The structural formula is:

This image is provided by the National Library of Medicine.

Pharmacodynamics

There is limited information regarding Pharmacodynamics of Calcium Gluconate in the drug label.

Pharmacokinetics

There is limited information regarding Pharmacokinetics of Calcium Gluconate in the drug label.

Nonclinical Toxicology

There is limited information regarding Nonclinical Toxicology of Calcium Gluconate in the drug label.

Clinical Studies

There is limited information regarding Clinical Studies of Calcium Gluconate in the drug label.

How Supplied

Storage

Store at 20o to 25o C (68o to 77o F). Do not permit to freeze.

Images

Drug Images

{{#ask: Page Name::Calcium gluconate |?Pill Name |?Drug Name |?Pill Ingred |?Pill Imprint |?Pill Dosage |?Pill Color |?Pill Shape |?Pill Size (mm) |?Pill Scoring |?NDC |?Drug Author |format=template |template=DrugPageImages |mainlabel=- |sort=Pill Name }}

Package and Label Display Panel

{{#ask: Label Page::Calcium gluconate |?Label Name |format=template |template=DrugLabelImages |mainlabel=- |sort=Label Page }}

Patient Counseling Information

There is limited information regarding Patient Counseling Information of Calcium Gluconate in the drug label.

Precautions with Alcohol

Alcohol-Calcium Gluconate interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

There is limited information regarding Calcium gluconate Brand Names in the drug label.

Look-Alike Drug Names

There is limited information regarding Calcium gluconate Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

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 * It is also used in the treatment of black widow spider bites to relieve [[muscle cramping]] and as an adjunct in the treatment of [[rickets]], [[osteomalacia]], [[lead colic]] and magnesium sulfate overdosage.
-* Calcium gluconate has also been employed to decrease capillary permeability in allergic conditions, non thrombocytopnic pupura and exudative dermatoses such as [[dermatitis herpetiformis]] and for [[pruritus]] of eruptions caused by certain drugs.  In [[hyperkalemia]], calcium gluconate may aid in antagonizing the cardiac toxicity, provided the patient is not receiving digitalis therapy.
+* Calcium gluconate has also been employed to decrease capillary permeability in allergic conditions, [[non thrombocytopnic pupura]] and exudative dermatoses such as [[dermatitis herpetiformis]] and for [[pruritus]] of eruptions caused by certain drugs.  In [[hyperkalemia]], calcium gluconate may aid in antagonizing the cardiac toxicity, provided the patient is not receiving digitalis therapy.
 ==Dosage==
@@ Line 23: / Line 27: @@
 * Adults-500 mg to 2 g (5 to 20 mL)
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+Allergic condition
-* Developed by:
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-* Strength of Evidence:
+Chemical burn, Hydrofluoric acid
-* Dosing Information
+[[Dermatitis]], exudative
-:* Dosage
+[[Gastrinoma]]
-=====Condition2=====
+[[Hypocalcemia]]
-There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in adult patients.
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-Allergic condition
-Cardiac arrest, due to [[hyperkalemia]]
-Cardiac arrest, due to [[hypermagnesemia]]
-Chemical burn, Hydrofluoric acid
-[[Dermatitis]], exudative
-[[Gastrinoma]]
-[[Hypocalcemia]]
-[[Insulinoma]]
 [[Non-thrombocytopenic purpura]]
 [[Osteomalacia]]
 Tetany, due to [[hypocalcemia]]
 |fdaLIADPed===Indications==
@@ Line 65: / Line 63: @@
 * Infants-Not more than 200 mg (not more than 2 mL)
-|offLabelPedGuideSupport======Condition1=====
+|offLabelPedGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of Calcium Gluconate in pediatric patients.
+|offLabelPedNoGuideSupport===Indications==
-* Developed by:
+* Rickets
-* Class of Recommendation:
+* Allergic condition
-* Strength of Evidence:
+* [[Cardiac arrest]], due to [[hyperkalemia]]
-* Dosing Information
+* [[Cardiac arrest]], due to [[hypermagnesemia]]
-:* Dosage
+* [[Dermatitis]], exudative
-=====Condition2=====
+* [[Hypocalcemia]]
-There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of {{PAGENAME}} in pediatric patients.
-<!--Non–Guideline-Supported Use (Pediatric)-->
-|offLabelPedNoGuideSupport===Indications==
-* Rickets
-* Allergic condition
-* [[Cardiac arrest]], due to [[hyperkalemia]]
-* [[Cardiac arrest]], due to [[hypermagnesemia]]
-* [[Dermatitis]], exudative
-* [[Hypocalcemia]]
 * [[Non-thrombocytopenic purpura]]
 |contraindications=Calcium salts are contraindicated in patients with [[ventricular fibrillation]] or [[hypercalcemia]].  Intravenous administration of calcium is contraindicated when serum calcium levels are above normal.
 |warnings=* For intravenous use only.  Subcutaneous or intramuscular injection may cause severe necrosis and sloughing.
-'''WARNING''': This product contains aluminum that may be toxic.  Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired.  Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.
+* This product contains aluminum that may be toxic.  Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired.  Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.
-Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity.  Tissue loading may occur at even lower rates of administration.
+* Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity.  Tissue loading may occur at even lower rates of administration.
 |clinicalTrials=* Patients may complain of tingling sensations, a sense of oppression or heat waves and a calcium or chalky taste following the intravenous administration of calcium gluconate.
 * Rapid intravenous injection of calcium salts may cause vasodilation, decreased blood pressure, [[bradycardia]], [[cardiac arrhythmias]], [[syncope]] and [[cardiac arrest]].  Use in digitalized patients may precipitate arrhythmias.
 * Local necrosis and abscess formation may occur with intramuscular injection.
-|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of {{PAGENAME}} in the drug label.
+|postmarketing=There is limited information regarding <i>Postmarketing Experience</i> of Calcium Gluconate in the drug label.
-=====Body as a Whole=====
-=====Cardiovascular=====
-=====Digestive=====
-=====Endocrine=====
-=====Hematologic and Lymphatic=====
-=====Metabolic and Nutritional=====
-=====Musculoskeletal=====
-=====Neurologic=====
-=====Respiratory=====
-=====Skin and Hypersensitivy Reactions=====
-=====Special Senses=====
-=====Urogenital=====
-=====Miscellaneous=====
-<!--Drug Interactions-->
 |drugInteractions=* The inotropic and toxic effects of cardiac glycosides and calcium are synergistic, and arrhythmias may occur if these drugs are given together (particularly when calcium is given together particularly when calcium is given intravenously).  Intravenous administration of calcium should be avoided in patients receiving cardiac glycosides; if necessary, calcium should be given slowly in small amounts.
 * Calcium complexes tetracycline antibiotics rendering them inactive.  The two drugs should not be given at the same time orally nor should they be mixed for parenteral administration.
 * Calcium gluconate injection has been reported to be incompatible with intravenous solutions containing various drugs.  Published data are too varied and/or limited to permit generalizations, and specialized reference should be consulted for specific information.
 |useInPregnancyFDA=Teratogenic Effects: Pregnancy Category C- Animal reproduction studies have not been conducted with calcium gluconate.  It is also not known whether calcium gluconate can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity.  Calcium gluconate should be given to a pregnant woman only if clearly needed.
 |useInPregnancyAUS=* '''Australian Drug Evaluation Committee (ADEC) Pregnancy Category'''
 There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of {{PAGENAME}} in women who are pregnant.
 |useInLaborDelivery=There is no FDA guidance on use of {{PAGENAME}} during labor and delivery.
 |useInNursing=It is not known whether this drug is excreted in human milk.  Because many drugs are excreted in human milk, caution should be exercised when calcium gluconate is administered to a nursing woman.
 |useInPed=There is no FDA guidance on the use of {{PAGENAME}} with respect to pediatric patients.
 |useInGeri=There is no FDA guidance on the use of {{PAGENAME}} with respect to geriatric patients.
@@ Line 175: / Line 110: @@
 |useInImmunocomp=There is no FDA guidance one the use of {{PAGENAME}} in patients who are immunocompromised.
-<!--Administration and Monitoring-->
-|administration=* Oral
-* Intravenous
+|administration=* Intravenous
 |monitoring=There is limited information regarding <i>Monitoring</i> of {{PAGENAME}} in the drug label.
-* Description
 <!--IV Compatibility-->
-|IVCompat=There is limited information regarding <i>IV Compatibility</i> of {{PAGENAME}} in the drug label.
+|IVCompat=There is limited information regarding <i>IV Compatibility</i> of Calcium Gluconate in the drug label.
+|overdose=There is limited information regarding <i>Chronic Overdose</i> of Calcium Gluconate in the drug label.
-<!--Overdosage-->
+|structure=Calcium Gluconate Injection, USP is a sterile, nonpyrogenic, supersaturated solution of calcium gluconate for intravenous use only.
-|overdose====Acute Overdose===
-====Signs and Symptoms====
-* Description
-====Management====
-* Description
-===Chronic Overdose===
-There is limited information regarding <i>Chronic Overdose</i> of {{PAGENAME}} in the drug label.
-<!--Pharmacology-->
-<!--Drug box 2-->
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-|mechAction=*
-<!--Structure-->
-|structure=*
-: [[File:{{PAGENAME}}01.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
-<!--Pharmacodynamics-->
-|PD=There is limited information regarding <i>Pharmacodynamics</i> of {{PAGENAME}} in the drug label.
-<!--Pharmacokinetics-->
-|PK=There is limited information regarding <i>Pharmacokinetics</i> of {{PAGENAME}} in the drug label.
-<!--Nonclinical Toxicology-->
-|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of {{PAGENAME}} in the drug label.
-<!--Clinical Studies-->
-|clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of {{PAGENAME}} in the drug label.
-<!--How Supplied-->
+Each mL contains: Calcium gluconate 94 mg; calcium saccharate (tetrahydrate) 4.5 mg; Water for Injection q.s. Hydrochloric acid and/or sodium hydroxide may have been added for pH adjustment (6.0-8.2)
-|howSupplied=*
-|packLabel=<!--Patient Counseling Information-->
-|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of {{PAGENAME}} in the drug label.
-<!--Precautions with Alcohol-->
+Calcium saccharate provides 6% of the total calcium and stabilizes the supersaturated solution of calcium gluconate.
-|alcohol=* Alcohol-{{PAGENAME}} interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
-<!--Brand Names-->
+Each 10 mL of the injection provides 93 mg elemental calcium (Ca++) equivalent to 1 g of calcium gluconate.
-|brandNames=* ®<ref>{{Cite web | title =  | url =  }}</ref>
-<!--Look-Alike Drug Names-->
+The structural formula is:
-|lookAlike=* A® — B®<ref name="www.ismp.org">{{Cite web  | last =  | first =  | title = http://www.ismp.org | url = http://www.ismp.org | publisher =  | date =  }}</ref>
-<!--Drug Shortage Status-->
+[[File:calcium gluconate structure.png|thumb|none|400px|This image is provided by the National Library of Medicine.]]
+|PD=There is limited information regarding <i>Pharmacodynamics</i> of Calcium Gluconate in the drug label.
+|PK=There is limited information regarding <i>Pharmacokinetics</i> of Calcium Gluconate in the drug label.
+|nonClinToxic=There is limited information regarding <i>Nonclinical Toxicology</i> of Calcium Gluconate in the drug label.
+|clinicalStudies=There is limited information regarding <i>Clinical Studies</i> of  Calcium Gluconate in the drug label.
+|howSupplied=[[File:calcium gluconate table.png|thumb|none|600px|This image is provided by the National Library of Medicine.]]
+|storage=* Store at 20o to 25o C (68o to 77o F). Do not permit to freeze.
+|fdaPatientInfo=There is limited information regarding <i>Patient Counseling Information</i> of  Calcium Gluconate in the drug label.
+|alcohol=* Alcohol-Calcium Gluconate interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
 |drugShortage=
 }}
@@ Line 262: / Line 161: @@
 <!--Category-->
+[[Category:Calcium compounds]]
+[[Category:Antidotes]]
 [[Category:Drug]]

Calcium gluconate: Difference between revisions

Latest revision as of 18:31, 18 August 2015

Disclaimer

Overview

Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

Indications

Dosage

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

Non–Guideline-Supported Use

Indications

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

Indications

Dosage

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

Non–Guideline-Supported Use

Indications

Contraindications

Warnings

Adverse Reactions

Clinical Trials Experience

Postmarketing Experience

Drug Interactions

Use in Specific Populations

Pregnancy

Labor and Delivery

Nursing Mothers

Pediatric Use

Geriatic Use

Gender

Race

Renal Impairment

Hepatic Impairment

Females of Reproductive Potential and Males

Immunocompromised Patients

Administration and Monitoring

Administration

Monitoring

IV Compatibility

Overdosage

Pharmacology

Mechanism of Action

Structure

Pharmacodynamics

Pharmacokinetics

Nonclinical Toxicology

Clinical Studies

How Supplied

Storage

Images

Drug Images

Package and Label Display Panel

Patient Counseling Information

Precautions with Alcohol

Brand Names

Look-Alike Drug Names

Drug Shortage Status

Price

References

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