save money it may Calcium Chloride Overview Side Effects Professional Interactions Pregnancy More User Reviews Support Group Q & A Pricing & Coupons Pronunciation (KAL see um KLOR ide) Dosage Forms Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Solution, Intravenous: Generic: 10% (10 mL) Solution, Intravenous [preservative free]: Generic: 10% (10 mL) Slideshow Treatment of Opioid-Induced Constipation: The Hard Facts Pharmacologic Category Calcium Salt Electrolyte Supplement, Parenteral Pharmacology Moderates nerve and muscle performance via action potential excitation threshold regulation Excretion Primarily feces (80% as insoluble calcium salts); urine (20%) Protein Binding ~40%, primarily to albumin (Wills, 1971) Use: Labeled Indications Treatment of hypocalcemia and conditions secondary to hypocalcemia (eg, tetany, seizures, arrhythmias); emergent treatment of severe hypermagnesemia Off Label Uses Calcium channel blocker overdose Data from a limited number of patients suggests the use of calcium may be beneficial for the treatment of hemodynamically unstable calcium channel blocker overdose refractory to other treatments [Perkins 1978] , [Ramoska 1993] . Clinical experience also suggests the utility of calcium chloride in the treatment of calcium channel blocker overdose [Kerns 2007] . Additional data may be necessary to further define the role of calcium chloride in the treatment of calcium channel blocker overdose. Based on the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care and the American Academy of Pediatrics (AAP) Committee on Drugs [AAP [Hegenbarth 2008]] , calcium chloride, although based on limited evidence, is an effective and recommended treatment in the setting of calcium channel blocker overdose. Beta-blocker overdose (shock refractory to other measures) Data from one human case report and an animal study suggest that calcium may be helpful in beta blocker overdose [Love 1996] , [Pertoldi 1998] . Clinical experience also suggests the utility of calcium chloride in the treatment of beta blocker overdose [Kerns 2007] . Additional data may be necessary to further define the role of calcium chloride in the treatment of beta-blocker overdose. Based on the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care and the American Academy of Pediatrics (AAP) Committee on Drugs [AAP [Hegenbarth 2008]] , calcium chloride, although based on limited evidence, is an effective and recommended treatment in the setting of beta-blocker overdose (refractory to glucagon and high-dose inotropes/vasopressors). Severe hyperkalemia Based on the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care , calcium chloride is an effective and recommended treatment to stabilize the myocardial cell membrane in patients with severe hyperkalemia (K+ >6.5 mEq/L with toxic ECG changes). Malignant arrhythmias (including cardiac arrest) associated with hypermagnesemia Based on the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care , calcium chloride is effective and recommended for the treatment of malignant arrhythmias (including cardiac arrest) in patients with hypermagnesemia. Contraindications Known or suspected digoxin toxicity; not recommended as routine treatment in cardiac arrest (includes asystole, ventricular fibrillation, pulseless ventricular tachycardia, or pulseless electrical activity) Dosing: Adult Note: One gram of calcium chloride salt is equal to 270 mg of elemental calcium. Dosages are expressed in terms of the calcium chloride salt based on a solution concentration of 100 mg/mL (10%) containing 1.4 mEq (27 mg)/mL elemental calcium. Hypocalcemia: IV: Acute, symptomatic: Manufacturer's labeling: 200 to 1,000 mg every 1 to 3 days Severe, symptomatic (eg, seizure, tetany): 1,000 mg over 10 minutes; repeat every 60 minutes until symptoms resolve (French 2012) Note: In general, IV calcium gluconate is preferred over IV calcium chloride in nonemergency settings due to the potential for more severe extravasation with calcium chloride. Cardiac arrest or cardiotoxicity in the presence of hyperkalemia, hypocalcemia, or hypermagnesemia: IV: 500 to 1,000 mg over 2 to 5 minutes; may repeat as necessary (AHA [Vanden Hoek, 2010]) Note: Routine use in cardiac arrest is not recommended due to the lack of improved survival (AHA [Neumar 2010]). Beta-blocker overdose (with shock refractory to other measures) (off-label use): Note: Optimal dose has not been established (DeWitt 2004): IV: Initial: 10% solution: 20 mg/kg over 5 to 10 minutes followed by an IV infusion (AHA [Vanden Hoek 2010]; Kerns 2007) IV infusion: 10% solution: 20 to 50 mg/kg/hour titrated to improved blood pressure, contractility; maintain ionized calcium at a goal of twice normal (AHA [Vanden Hoek 2010]; Kerns 2007). Calcium channel blocker overdose (off-label use): Note: Optimal dose has not been established (DeWitt, 2004). IV: Initial: 10% solution: 1,000 to 2,000 mg over 5 minutes; may repeat every 10 to 20 minutes with 3 to 4 additional doses or 1,000 mg every 2 to 3 minutes until clinical effect is achieved (DeWitt 2004); if favorable response obtained, consider IV infusion or 20 mg/kg over 5 to 10 minutes followed by a continuous IV infusion (Kerns 2007). IV infusion: 10% solution: 20 to 50 mg/kg/hour titrated to improved blood pressure and contractility; maintain ionized calcium at a goal of twice normal (Kerns 2007). Dosing: Geriatric Refer to adult dosing. Dosing: Pediatric Note: One gram of calcium chloride salt is equal to 270 mg of elemental calcium. Dosages are expressed in terms of the calcium chloride salt based on a solution concentration of 100 mg/mL (10%) containing 1.4 mEq (27 mg)/mL elemental calcium. Hypocalcemia: Acute, symptomatic: Manufacturer s recommendations: Children: IV: 2.7 to 5 mg/kg/dose every 4 to 6 hours Note: In general, IV calcium gluconate is preferred over IV calcium chloride in nonemergency settings due to the potential for more severe extravasation with calcium chloride. Cardiac arrest or cardiotoxicity in the presence of hyperkalemia, hypocalcemia, or hypermagnesemia: Infants and Children: IV, I.O.: 20 mg/kg (maximum: 2,000 mg/dose); may repeat as necessary (AHA [Kleinman, 2010]; Hegenbarth, 2008) Note: Routine use in cardiac arrest is not recommended due to the lack of improved survival (AHA [Kleinman, 2010]). Calcium channel blocker overdose (off-label use): Note: Optimal dose has not been established (DeWitt 2004): Infants and Children: IV, I.O.: Initial: 10 to 20 mg/kg (maximum: 2,000 mg/dose) over 10 to 15 minutes; may repeat every 10 to 15 minutes (AHA [Kleinman, 2010]; Arroyo 2009); if favorable response obtained, consider IV infusion IV infusion: 20 to 50 mg/kg/hour (Arroyo 2009) Dosing: Renal Impairment No initial dosage adjustment necessary; however, accumulation may occur with renal impairment and subsequent doses may require adjustment based on serum calcium concentrations. Dosing: Hepatic Impairment No initial dosage adjustment necessary; subsequent doses should be guided by serum calcium concentrations. Reconstitution IV: For intermittent IV infusion, dilute to a maximum concentration of 20 mg/mL. Administration For IV administration only. Not for IM or SubQ administration (severe necrosis and sloughing may occur). Avoid rapid administration (do not exceed 100 mg/minute except in emergency situations). For intermittent IV infusion, infuse diluted solution over 1 hour or no greater than 45-90 mg/kg/hour (0.6 to 1.2 mEq/kg/hour); administration via a central or deep vein is preferred; do not use scalp, small hand or foot veins for IV administration (severe necrosis and sloughing may occur). Monitor ECG if calcium is infused faster than 2.5 mEq/minute; stop the infusion if the patient complains of pain or discomfort. Warm solution to body temperature prior to administration. Do not infuse calcium chloride in the same IV line as phosphate-containing solutions. Vesicant; ensure proper needle or catheter placement prior to and during IV infusion. Avoid extravasation. Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave needle/cannula in place); gently aspirate extravasated solution (do NOT flush the line). Early/acute calcium extravasation: Initiate hyaluronidase antidote; remove needle/cannula; apply dry cold compresses; elevate extremity (Hurst 2004; Reynolds 2014). Hyaluronidase: Intradermal or SubQ: Inject a total of 1 to 1.7 mL (15 units/mL) as five separate 0.2 to 0.3 mL injections (using a 25-gauge needle) into area of extravasation at the leading edge in a clockwise manner (MacCara 1983; Reynolds 2014; Zenk 1981). May also inject hyaluronidase through the catheter that caused the infiltration (Reynolds 2014). Delayed calcium extravasation: Closely monitor site; most calcifications spontaneously resolve. However, if a severe manifestation of calcinosis cutis occurs, may initiate sodium thiosulfate antidote. Sodium thiosulfate: IV: 12.5 g over 30 minutes; may increase gradually to 25 g 3 times per week; monitor for non-anion gap acidosis, hypocalcemia, severe nausea (Reynolds 2014). Storage Store intact vials at 20 C to 25 C (68 F to 77 F); excursions permitted to 15 C to 30 C (59 F to 86 F). Do not refrigerate solutions; IV infusion solutions in D5W, LR, NS, or other appropriate solutions are stable for 24 hours at room temperature. Although calcium chloride is not routinely used in the preparation of parenteral nutrition, it is important to note that phosphate salts may precipitate when mixed with calcium salts. Solubility is improved in amino acid parenteral nutrition solutions. Check with a pharmacist to determine compatibility. Drug Interactions Bisphosphonate Derivatives: Calcium Salts may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral calcium supplements within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Consider therapy modification Calcium Acetate: Calcium Salts may enhance the adverse/toxic effect of Calcium Acetate. Avoid combination Calcium Channel Blockers: Calcium Salts may diminish the therapeutic effect of Calcium Channel Blockers. Monitor therapy Cardiac Glycosides: Calcium Salts may enhance the arrhythmogenic effect of Cardiac Glycosides. Monitor therapy CefTRIAXone: Calcium Salts (Intravenous) may enhance the adverse/toxic effect of CefTRIAXone. Ceftriaxone binds to calcium forming an insoluble precipitate. Management: Use of ceftriaxone with calcium-containing solutions within 48 hours of one another is contraindicated in neonates (28 days of age or younger). In older patients, flush lines with compatible fluid between administration. Consider therapy modification Deferiprone: Calcium Salts may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Consider therapy modification DOBUTamine: Calcium Salts may diminish the therapeutic effect of DOBUTamine. Monitor therapy Dolutegravir: Calcium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral calcium. Alternatively, dolutegravir and oral calcium can be taken together with food. Consider therapy modification Eltrombopag: Calcium Salts may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any calcium-containing product. Consider therapy modification Multivitamins/Fluoride (with ADE): May increase the serum concentration of Calcium Salts. Calcium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). More specifically, calcium salts may impair the absorption of fluoride. Management: Avoid eating or drinking dairy products or consuming vitamins or supplements with calcium salts one hour before or after of the administration of fluoride. Consider therapy modification Multivitamins/Minerals (with ADEK, Folate, Iron): May increase the serum concentration of Calcium Salts. Monitor therapy Phosphate Supplements: Calcium Salts may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate and calcium administration. Administering oral phosphate supplements as far apart from the administration of an oral calcium salt as possible may be able to minimize the significance of the interaction. Exceptions: Sodium Glycerophosphate Pentahydrate. Consider therapy modification Tetracyclines: Calcium Salts may decrease the serum concentration of Tetracyclines. Management: If coadministration of oral calcium with oral tetracyclines can not be avoided, consider separating administration of each agent by several hours. Consider therapy modification Thiazide and Thiazide-Like Diuretics: May decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. Monitor therapy Thyroid Products: Calcium Salts may diminish the therapeutic effect of Thyroid Products. Management: Separate the doses of the thyroid product and the oral calcium supplement by at least 4 hours. Consider therapy modification Trientine: Calcium Salts may decrease the serum concentration of Trientine. Trientine may decrease the serum concentration of Calcium Salts. Consider therapy modification Vitamin D Analogs: Calcium Salts may enhance the adverse/toxic effect of Vitamin D Analogs. Monitor therapy Adverse Reactions Frequency not defined. IV: Cardiovascular (following rapid IV injection): Bradycardia, cardiac arrest, cardiac arrhythmia, hypotension, syncope, vasodilatation Central nervous system: Feeling abnormal (sense of oppression; with rapid IV injection), tingling sensation (with rapid IV injection) Endocrine & metabolic: Hot flash (with rapid IV injection), hypercalcemia Gastrointestinal: Dysgeusia (chalky taste), gastrointestinal irritation, increased serum amylase Local: Local tissue necrosis (following extravasation) Renal: Nephrolithiasis Postmarketing and/or case reports (Limited to important or life-threatening): Cutaneous calcification Warnings/Precautions Disease-related concerns: Acidosis: Use with caution in patients with respiratory acidosis, renal impairment, or respiratory failure; acidifying effect of calcium chloride may potentiate acidosis. Extravasation: Vesicant; ensure proper catheter or needle position prior to and during infusion. Avoid extravasation. Extravasation may result in severe necrosis and sloughing. Monitor the IV site closely. Hyperphosphatemia: Use with caution in patients with severe hyperphosphatemia as elevated levels of phosphorus and calcium may result in soft tissue and pulmonary arterial calcium-phosphate precipitation. Hypokalemia: Use with caution in patients with severe hypokalemia as acute rises in serum calcium levels may result in life-threatening cardiac arrhythmias. Hypomagnesemia: Hypomagnesemia is a common cause of hypocalcemia; therefore, correction of hypocalcemia may be difficult in patients with concomitant hypomagnesemia. Evaluate serum magnesium and correct hypomagnesemia (if necessary), particularly if initial treatment of hypocalcemia is refractory. Renal impairment: Use with caution in patients with chronic renal failure to avoid hypercalcemia; frequent monitoring of serum calcium and phosphorus is necessary. Concurrent drug therapy issues: Ceftriaxone: Ceftriaxone may complex with calcium causing precipitation. Fatal lung and kidney damage associated with calcium-ceftriaxone precipitates has been observed in premature and term neonates. Due to reports of precipitation reaction in neonates, do not coadminister ceftriaxone with calcium-containing solutions, even via separate infusion lines/sites or at different times in any neonate. Ceftriaxone should not be administered simultaneously with any calcium-containing solution via a Y-site in any patient. However, ceftriaxone and calcium-containing solutions may be administered sequentially of one another for use in patients other than neonates if infusion lines are thoroughly flushed (with a compatible fluid) between infusions. Digoxin: Use with caution in digitalized patients; hypercalcemia may precipitate cardiac arrhythmias; use is contraindicated with known or suspected digoxin toxicity. Dosage form specific issues: Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer s labeling. Other warnings/precautions: Appropriate product selection: Multiple salt forms of calcium exist; close attention must be paid to the salt form when ordering and administering calcium; incorrect selection or substitution of one salt for another without proper dosage adjustment may result in serious over or under dosing. Duration of use: Avoid metabolic acidosis (ie, administer only up to 2 to 3 days then change to another calcium salt). IV administration: For IV use only; do not inject SubQ or IM Avoid too rapid IV administration (do not exceed 100 mg/minute except in emergency situations). Monitoring Parameters Monitor infusion site, ECG when appropriate; serum calcium and ionized calcium; albumin; serum phosphate; magnesium (to facilitate calcium repletion) Calcium channel blocker overdose, beta-blocker overdose (off-label uses) : Monitor hemodynamic response; monitor serum ionized calcium levels every 30 minutes initially then every 2 hours and maintain ionized calcium ~2 times the ULN; avoid severe hypercalcemia (ionized calcium levels >2 times ULN) (Kerns 2007). Pregnancy Risk Factor C Pregnancy Considerations Animal reproduction studies have not been conducted. Calcium crosses the placenta. The amount of calcium reaching the fetus is determined by maternal physiological changes. Calcium requirements are the same in pregnant and nonpregnant females (IOM 2011). Information related to use as an antidote in pregnancy is limited. In general, medications used as antidotes should take into consideration the health and prognosis of the mother; antidotes should be administered to pregnant women if there is a clear indication for use and should not be withheld because of fears of teratogenicity (Bailey 2003). Medications used for the treatment of cardiac arrest in pregnancy are the same as in the non-pregnant woman. Doses and indications should follow current Advanced Cardiovascular Life Support guidelines. Appropriate medications should not be withheld due to concerns of fetal teratogenicity (Jeejeebhoy [AHA] 2015). Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience bad taste, hot flashes, lack of appetite, nausea, vomiting, constipation, loss of strength and energy, increased thirst, or bone pain. Have patient report immediately to prescriber dizziness, passing out, mood changes, change in amount of urine passed, abnormal heartbeat, signs of a kidney stone (back pain, abdominal pain, or hematuria), or severe injection site pain, redness, burning, edema, or irritation (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients. Next Interactions Print this page Add to My Med List More about calcium chloride Side Effects During Pregnancy Drug Interactions Support Group Pricing & Coupons 0 Reviews Add your own review/rating Drug class: minerals and electrolytes Consumer resources Calcium Chloride Professional resources Calcium Chloride (FDA) Related treatment guides Asystole Hypermagnesemia Hyperkalemia Electromechanical Dissociation Hypocalcemia} Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Calcium chloride Rating No Reviews - Be the first! No Reviews - Be the first! Not Rated - Be the first! Manufacturers Pfizer Inc. American Regent, Inc. Drug Class Minerals and electrolytes Related Drugs minerals and electrolytes potassium chloride , calcium carbonate , Caltrate , magnesium oxide , Klor-Con , sodium chloride Hyperkalemia sodium bicarbonate , Kayexalate , calcium gluconate , Humulin R , Kionex , Veltassa , More... Electromechanical Dissociation epinephrine , Adrenalin , Adrenaclick , Primatene Mist , Adrenalin Chloride , More... Hypocalcemia calcium carbonate , ergocalciferol , Caltrate , calcitriol , Vitamin D2 , Drisdol , More... 2 more conditions...} } yet another
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