came upon [6:<0.93 mEq of calcium; may be repeated every 1 3 days depending on the patient s response. 140 141 b Children: Usually, initial dose of 0.93 2.3 mEq of calcium; may be repeated every 1 3 days depending on the patient s response. 140 141 b Alternatively, one manufacturer recommends a pediatric IV calcium dose of 0.272 mEq/kg, up to a maximum total daily dosage of 1.36 13.6 mEq, in the treatment of hypocalcemic disorders. 138 Hypocalcemic Tetany IV Neonates: May be treated with divided doses of calcium totaling about 2.4 mEq/kg daily. b Children: Usually, calcium dose of 0.5 0.7 mEq/kg administered IV 3 or 4 times daily or until tetany is controlled. b Exchange Transfusions of Citrated Blood IV Neonates: 0.45 mEq of calcium concurrently with each 100 mL of citrated blood. b ACLS IV/IO If calcium is indicated during pediatric resuscitation for treatment of hypocalcemia, calcium-channel blocker overdosage, hypermagnesemia, or hyperkalemia, experts recommend a dose of 0.272 mEq/kg administered slowly using calcium chloride. 403 In critically ill children, calcium chloride may provide a greater increase in ionized calcium than calcium gluconate. 403 Adults Dietary Requirements Oral Calcium replacement requirements can be estimated by clinical condition and/or serum calcium determinations. b Prophylactic administration of calcium supplements may be necessary in some patients in order to maintain serum calcium> 9 mg/dL. b The AI of elemental calcium for healthy adults are: Adults 19 50 Years of Age: 1 g daily. 112 Adults 51 Years of Age: 1.2 g daily. 112 Pregnant or Lactating Women: Generally, the usual AI of calcium appropriate for their age. 112 Hypocalcemia Calcium gluconate usually is administered IV as a 10% solution and calcium chloride as a 2 10% solution. b j Calcium replacement requirements can be estimated by clinical condition and/or serum calcium determinations. b Prevention Oral Usually, about 1 g of elemental calcium daily. b Treatment Oral Usually, 1 2 g or more of elemental calcium daily. b IM Usually, 0.8 mEq of calcium as the calcium glycerophosphate and calcium lactate fixed-combination preparation 1 4 times weekly or as directed by a clinician. 142 Treatment When Prompt Elevation of Serum Calcium Is Required IV Usual initial dose of 2.3 14 mEq of calcium; doses may be repeated every 1 3 days depending on the patient s response. 136 137 138 139 140 141 b Hypocalcemic Tetany IV 4.5 16 mEq doses of calcium, administered until therapeutic response occurs. b Exchange Transfusions of Citrated Blood IV About 1.35 mEq of calcium concurrently with each 100 mL of citrated blood. b ACLS IV b If calcium is necessary during cardiac arrest, a dose of 0.109 0.218 mEq/kg (repeated as necessary) using calcium chloride has been recommended. 175 Alternatively, 7 14 mEq of calcium as calcium chloride has been given. b However, routine use not recommended. 400 401 403 (See Uses.) Hyperphosphatemia in Chronic Renal Failure Oral Usual initial dose of 1.334 g of calcium acetate (338 mg of calcium) with each meal; 113 increase dosage gradually according to serum phosphate concentrations, provided hypercalcemia does not occur. 113 Manufacturer states that most patients require about 2 2.67 g (about 500 680 mg of calcium) with each meal. 113 However, some experts recommend limiting dosage of calcium provided by phosphate binders to 1.5 g daily and limiting total calcium intake (including dietary calcium) to 2 g daily; dialysis patients who remain hyperphosphatemic despite such therapy should receive a calcium-containing phosphate binder in combination with a non-calcium-, non-aluminum-, non-magnesium-containing phosphate binder. 130 Monitor serum calcium concentrations twice weekly during initiation of therapy and subsequent dosage adjustment; also monitor serum phosphorus concentrations periodically. 113 If hypercalcemia occurs, reduce dosage or withhold the salt. 113 If severe hypercalcemia occurs, specific measures (e.g., hemodialysis) for the management of overdosage may be necessary. 113 Zollinger-Ellison Syndrome, Diagnosis IV Usually, 0.25 mEq/kg of calcium per hour for a 3-hour period; serum gastrin concentrations are determined 30 minutes before the infusion, at the start of the infusion, and at 30-minute intervals thereafter for 4 hours. b In most patients with Zollinger-Ellison syndrome, preinfusion serum gastrin concentrations increase by more than 50% or by greater than 500 pg/mL during the infusion. b Magnesium Intoxication IV Initially, 7 mEq of calcium; adjust subsequent doses according to patient response. b b Medullary Thyroid Carcinoma, Diagnosis IV Usually, about 7 mEq of calcium over 5 10 minutes; in patients with medullary thyroid carcinoma, plasma calcitonin concentrations are elevated above normal basal concentrations. b Osteoporosis Primary Prevention in Women Oral Usually, 1 1.5 g daily of elemental calcium; 1 g daily in premenopausal women and 1.5 g daily in postmenopausal women not receiving estrogen replacement. 100 126 Corticosteroid-induced Osteoporosis To limit the extent of corticosteroid-induced osteoporosis, adults receiving chronic systemic corticosteroid therapy should maintain an adequate calcium intake. 119 Oral About 1.5 g of elemental calcium daily. 119 Special Populations Hepatic Impairment No specific dosage recommendations for hepatic impairment. a b c Renal Impairment No specific dosage recommendations for renal impairment. a b c Geriatric Patients No specific geriatric dosage recommendations. a Cautions for Calcium Salts Contraindications Ventricular fibrillation. b Hypercalcemia. b Hypophosphatemia. b Renal calculi. b IV administration contraindicated when serum calcium concentrations are above normal. b Warnings/Precautions Warnings Use calcium salts cautiously, if at all, in sarcoidosis, b renal or cardiac disease, b or patients receiving cardiac glycosides (see Digoxin under Interactions). b Because it is acidifying, use calcium chloride cautiously in cor pulmonale, b respiratory acidosis, b renal disease, b or respiratory failure. b Non-lipid-soluble drugs (e.g., calcium) may injure the airway; avoid endotracheal administration. 403 Calcium Monitoring Frequently perform determinations of serum calcium concentrations. b Maintain serum calcium concentrations at 9 10.4 mg/dL (4.5 5.2 mEq/L). b Some clinicians prefer to maintain serum calcium at slightly lower concentrations. b Usually, do not allow serum calcium concentrations to exceed 12 mg/dL. b Determinations of urine calcium are generally unreliable and hypercalciuria can occur in the presence of hypocalcemia. b Forcing fluids may produce increased urine volume and thus prevent the formation of renal stones in patients with hypercalciuria. b Citrated Blood Transfusion Administration of calcium in patients who have received transfusions of citrated blood may result in higher than normal total serum calcium concentrations. b In these patients, however, most of the excess calcium is bound to citrate and is inactive; therefore, serious toxicity usually does not result. b Discontinuing calcium when hypercalcemia occurs usually is sufficient to return serum calcium concentrations to normal. b Local Effects Calcium salts are irritating to tissue when administered by IM or sub-Q injection and cause mild to severe local reactions including burning, necrosis and sloughing of tissue, cellulitis, and soft tissue calcification; venous irritation may occur with IV administration. b (See IV Administration and also see IM or Sub-Q Injection, under Dosage and Administration.) IV Injection Effects Extravasation of calcium solution into surrounding tissues during IV injection can cause necrosis. b Patients may complain of tingling sensations, a sense of oppression or heat waves, and a calcium or chalky taste following IV administration of calcium salts. b Cardiovascular Effects Rapid IV injection of calcium salts may cause vasodilation, decreased BP, bradycardia, cardiac arrhythmias, syncope, and cardiac arrest. b Inadvertent injection of calcium into the myocardium during attempted intracardiac injection into the ventricular cavity can result in lacerated coronary arteries, cardiac tamponade or pneumothorax, and intractable ventricular fibrillation may result. b GI Effects Orally administered calcium salts may be irritating to the GI tract. b Calcium salts are constipating. b Calcium chloride, by any route of administration, produces more irritation than the other calcium salts and has been reported to cause GI hemorrhage when taken orally. b Hypercalcemia Hypercalcemia is rarely produced by administration of calcium alone, but may occur with large doses in patients with chronic renal failure. b Avoid overtreatment of hypocalcemia since hypercalcemia may be more dangerous than hypocalcemia. b Mild hypercalcemia may be asymptomatic or manifest as constipation, anorexia, nausea, and vomiting, with mental changes such as confusion, delirium, stupor, and coma becoming evident as the degree of hypercalcemia increases. 113 Mild hypercalcemia usually is readily controlled by reducing calcium intake (e.g., decreasing the dose of or avoiding supplemental calcium); more severe hypercalcemia may require specific management (e.g., hemodialysis). 113 Dialysis patients with chronic renal failure receiving calcium salts may require adjustments in calcium concentrations in the dialysate to reduce the risk of hypercalcemia. 113 126 Long-term effects of chronic calcium administration (e.g., for hyperphosphatemia in chronic renal failure) on progression of vascular or soft-tissue calcification is unknown. 113 127 Renal Calculi High dietary intake of calcium has long been suspected as contributing to the risk of renal calculi, and restriction of calcium intake (i.e., low-calcium diets) had long been considered a reasonable measure in an attempt to prevent calculi formation in patients with idiopathic hypocalciuria. 122 123 124 Recent evidence indicates that high dietary intake of calcium actually decreases the risk of symptomatic renal calculi, while intake of supplemental calcium may increase the risk of symptomatic stones. 122 123 124 General Precautions Use of Fixed Combination When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents. Specific Populations Pregnancy Category C. c i Lactation Manufacturers state that it is not known whether calcium salts are distributed into milk, a c and to observe caution with parenteral therapy. c Calcium is an important component of human milk in women not receiving supplemental calcium salts, 112 and maternal calcium supplementation does not substantially affect milk calcium concentrations since the principal source is from maternal bone resorption. 112 Pediatric Use Give calcium cautiously to children by IV route. PDH Geriatric Use Calcium absorption (after oral administration) may be decreased in geriatric patients. PDH Common Adverse Effects Constipation, nausea, vein irritation. PDH Interactions for Calcium Salts Consider the possibility that other drug interactions reported with antacids could occur. k Specific Drugs and Laboratory Tests Drug or Test Interaction Comments Bisphosphonates, oral (e.g., alendronate, etidronate, ibandronate, risedronate) Concomitant administration may result in reduced bisphosphonate absorption 144 145 146 147 148 150 Administer calcium salts 30 minutes after alendronate or risedronate, 60 minutes after ibandronate, and not within 2 hours of etidronate administration 144 145 146 147 148 Digoxin Inotropic and toxic effects are synergistic and arrhythmias may occur (particularly when calcium is given IV) b b Iron preparations, oral Concomitant administration may result in reduced iron absorption 149 150 Advise patients to take the drugs at different times, whenever possible 149 150 Levothyroxine Calcium carbonate may form insoluble chelate with levothyroxine, resulting in decreased levothyroxine absorption and increased serum thyrotropin concentrations 143 150 Administer oral levothyroxine and calcium carbonate 4 hours apart 143 Quinolones Concomitant administration of calcium salts and some fluoroquinolones (e.g., ciprofloxacin) may reduce oral bioavailability of the fluoroquinolone 151 152 Recommended timing of fluoroquinolone administration relative to the calcium dose may vary depending on the specific fluoroquinolone preparation used 151 152 Test, corticosteroids (Glenn-Nelson technique) Transient elevations of plasma 11-hydroxycorticosteroid concentrations with IV calcium, but concentrations return to control values after 1 hour b Test, magnesium (serum and urine) False-negative values as measured by the Titan yellow method b Tetracyclines Calcium complexes tetracycline antibiotics rendering them inactive b Do not give the 2 drugs together orally nor should they be mixed for parenteral administration b Thiazide diuretics Risk of hypercalcemia PDH Avoid concomitant use PDH Calcium Salts Pharmacokinetics Absorption Oral bioavailability of calcium from nonfood sources and supplements depends on intestinal pH, the presence or absence of a meal, and the dose. 112 Calcium is actively absorbed in the duodenum and proximal jejunum and, to a lesser extent, in the more distal segments of the small intestine. b Degree of absorption depends on a number of factors; absorption from the intestine is never complete. b Absorption requires a soluble, ionized form. b An acidic intestinal pH is necessary for ionization of calcium; thus an alkaline pH impedes absorption. b 112 Vitamin D, in its activated forms, is required for calcium absorption and increases the capability of the absorptive mechanisms. b Decreased absorption with hypocalcemia secondary to deficiency of either parathyroid hormone or vitamin D. b IM or IV administered calcium salts are absorbed directly into the blood stream. b Glucocorticoids and low serum concentrations of calcitonin may depress calcium absorption. b Bioavailability When a 250-mg dose of calcium is administered with a standardized breakfast, average oral bioavailability in adults ranges from 25 35% with various salts; under the same conditions, absorption from milk is about 29%. 112 Extent of calcium absorption from supplements is greatest when taken in doses 500 mg. 112 Food Calcium absorption is decreased in the absence of a meal. 112 Calcium absorption is retarded by certain anions (e.g., oxalates, phytates, sulfates) and by fatty acids which precipitate or complex calcium ions; however, an intestinal pH of 5 7 facilitates maximal dissolution and dissociation of these complexes. b Calcium may be poorly absorbed from foods rich in oxalic acid (e.g., spinach, sweet potatoes, rhubarb, beans) or phytic acid (e.g., unleavened bread, raw beans, seeds, nuts, grains, soy isolates). 112 Although soybeans contain high concentrations of phytic acid, calcium absorption is relatively high from this food. 112 Plasma Concentrations Following IV injection of calcium salts, serum calcium concentrations increase almost immediately and may return to previous values in 30 minutes to 2 hours. b Normal total serum calcium concentrations range from 9 10.4 mg/dL (4.5 5.2 mEq/L), but only ionized calcium is physiologically active. b Serum calcium concentrations are not necessarily accurate indications of total body calcium; total body calcium may be decreased in the presence of hypercalcemia, and hypocalcemia can occur even though total body calcium is increased. b Of total serum calcium concentration, 50% is in the ionic form and 5% is complexed by phosphates, citrates, and other anions. b Hyperproteinemia is associated with increased total serum calcium concentrations. b Hypoproteinemia is associated with decreased total serum calcium concentrations. b Acidosis results in increased concentrations of ionic calcium, while alkalosis promotes a decrease in the ionic serum calcium concentration. b Special Populations Fractional calcium absorption varies with age as follows: Infancy: about 60%. 112 Children, prepubertal: about 28%. 112 Early puberty: about 34%. 112 Young adults: about 25%, although it increases during the last 2 trimesters of pregnancy. 112 Fractional absorption declines with aging, decreasing on average by 0.21% annually in postmenopausal women. 112 Similar declines with aging in men. 112 Absorption is decreased in certain disease states such as achlorhydria, renal osteodystrophy, steatorrhea, or uremia. b Efficiency of intestinal calcium absorption may be increased when calcium intake is reduced and during pregnancy 112 b but not lactation (maternal bone resorption is principal source) 112 when calcium requirements are higher than normal. b Distribution CSF concentrations of calcium are about 50% of serum concentrations and tend to reflect ionized serum calcium concentrations. b Calcium enters extracellular fluid and is incorporated rapidly into skeletal tissue. b Bone contains 99% of total calcium; 1% is distributed equally between the intracellular and extracellular fluids. b Extent Following absorption, calcium first enters the extracellular fluid and is then rapidly incorporated into skeletal tissue. b Bone formation is not stimulated by calcium administration. b Plasma Protein Binding Approximately 45%; for a change in serum albumin of 1 g/dL, serum calcium concentration may change about 0.8 mg/dL (0.04 mEq/dL). b Calcium crosses the placenta; reaches higher concentrations in fetal than maternal blood. b 112 Calcium is distributed into milk. b Elimination Elimination Route Excreted mainly in the feces as unabsorbed calcium and that secreted via bile and pancreatic juice into the GI tract lumen. b Most of the calcium filtered by renal glomeruli is reabsorbed in the ascending limb of the loop of Henle and proximal and distal convoluted tubules. b Only small amounts of the cation are excreted in urine. b Parathyroid hormone, vitamin D, and thiazide diuretics decrease urinary excretion of calcium, whereas other diuretics, calcitonin, and growth hormone promote renal excretion of the cation. b Urinary excretion decreases with reduction of ionic serum concentrations but is proportionately increased as serum ionized concentrations increase. b In healthy adults on a regular diet, urinary excretion of calcium may be as high as 250 300 mg daily. b With low calcium diets, urinary excretion usually does not exceed 150 mg daily. b Calcium also is excreted by the sweat glands. b Special Populations Urinary excretion of calcium decreases during pregnancy and in the early stages of renal failure. b Urinary excretion decreases with aging, possibly because of age-related decreases in intestinal calcium absorption efficiency and an associated decrease in filtered calcium load. 112 Endogenous fecal calcium excretion does not change appreciably with aging. 112 Stability Storage Oral Capsules 25 C (may be exposed to 15 30 C). i Solution Tight container at 15 30 C. f Tablets Cool, dry place at 15 30 C. e Parenteral Injection 15 30 C; do not freeze. a c j Compatibility For information on systemic interactions resulting from concomitant use, see Interactions. Interaction of calcium and phosphate in parenteral nutrition solutions is a complex phenomenon; various factors have been identified as playing a role in solubility or precipitation of a given combination. 135 Calcium salts are conditionally compatible with phosphate in parenteral nutrition solutions; incompatibility dependent on a solubility and concentration phenomenon and not entirely predictable. 135 Precipitation may occur during compounding or at some time after compounding is completed. 135 Consult specialized references for specific stability and compatibility information. Calcium Chloride Parenteral Solution CompatibilityHID Incompatible Fat emulsion 10%, IV Drug Compatibility Admixture CompatibilityHID Compatible Amikacin sulfate Ascorbic acid injection Chloramphenicol sodium succinate Dopamine HCl Hydrocortisone sodium succinate Isoproterenol HCl Lidocaine HCl Norepinephrine bitartrate Penicillin G potassium Penicillin G sodium Pentobarbital sodium Phenobarbital sodium Verapamil HCl Incompatible Amphotericin B Ceftriaxone sodium Magnesium sulfate Variable Dobutamine HCl Sodium bicarbonate Y-site CompatibilityHID Compatible Amiodarone HCl Ceftaroline fosamil Dobutamine HCl Doxapram HCl Epinephrine HCl Esmolol HCl Hydroxyethyl starch 130/0.4 in sodium chloride 0.9% Micafungin sodium Milrinone lactate Morphine sulfate Paclitaxel Sodium nitroprusside Incompatible Amphotericin B cholesteryl sulfate complex Propofol Sodium bicarbonate Calcium Gluconate Parenteral Solution CompatibilityHID Compatible Alcohol 5%, dextrose 5% Amino acids 4%, dextrose 25% Dextrose 5% in Ringer s injection, lactated Dextrose 5% in sodium chloride 0.9% Dextrose 5% in water Dextrose 10% in sodium chloride 0.18% Dextrose 10 or 20% in water Fructose 10% in water Invert sugar 10% in Electrolyte #1 or #2 Polysal M with dextrose 5% Ringer s injection, lactated Sodium chloride 0.9% Sodium lactate (1/6) M Incompatible Fat emulsion 10%, IV Drug Compatibility Admixture CompatibilityHID Compatible Amikacin sulfate Aminophylline Ascorbic acid injection Chloramphenicol sodium succinate Furosemide Heparin sodium Hydrocortisone sodium succinate Lidocaine HCl Norepinephrine bitartrate Penicillin G potassium Penicillin G sodium Phenobarbital sodium Potassium chloride Prochlorperazine edisylate Tobramycin sulfate Vancomycin HCl Verapamil HCl Incompatible Amphotericin B Ceftriaxone sodium Dobutamine HCl Methylprednisolone sodium succinate Variable Magnesium sulfate Y-Site CompatibilityHID Compatible Aldesleukin Allopurinol sodium Amifostine Amiodarone HCl Aztreonam Bivalirudin Cefazolin sodium Ceftaroline fosamil Ciprofloxacin Cisatracurium besylate Cladribine Dexmedetomidine HCl Dobutamine HCl Docetaxel Doripenem Doxapram HCl Doxorubicin HCl liposome injection Enalaprilat Epinephrine HCl Etoposide phosphate Famotidine Fenoldopam mesylate Filgrastim Gemcitabine HCl Granisetron HCl Heparin sodium with hydrocortisone sodium succinate Hetastarch in lactated electrolyte injection (Hextend) Hydroxyethyl starch 130/0.4 in sodium chloride 0.9% Labetalol HCl Linezolid Melphalan HCl Micafungin sodium Midazolam HCl Milrinone lactate Nicardipine HCl Oxaliplatin Piperacillin sodium tazobactam sodium Potassium chloride Prochlorperazine edisylate Propofol Remifentanil HCl Sargramostim Tacrolimus Telavancin HCl Teniposide Thiotepa Vinorelbine tartrate Incompatible Amphotericin B cholesteryl sulfate complex Fluconazole Indomethacin sodium trihydrate Pemetrexed disodium Variable Ampicillin sodium Meropenem Actions Calcium is essential for maintenance of the functional integrity of nervous, muscular, and skeletal systems and cell-membrane and capillary permeability. b Calcium is an important activator in many enzymatic reactions and essential to a number of physiologic processes including transmission of nerve impulses; contraction of cardiac, smooth, and skeletal muscles; renal function; respiration; and blood coagulation. b Calcium plays regulatory roles in the release and storage of neurotransmitters and hormones, in the uptake and binding of amino acids, and in cyanocobalamin (vitamin B 12 ) absorption and gastrin secretion. b Calcium accounts for 1 2% of adult body weight, and more than 99% of total body calcium is found in bone and teeth. 112 Calcium is present in blood, extracellular fluid, muscle, and other tissues where it has roles in mediating vascular contraction and vasodilation, muscle contraction, nerve transmission, and glandular secretion. 112 Skeleton serves as a reservoir for calcium in addition to serving as a structural support for the body. 112 Conditions associated with reduced concentrations of circulating estrogen alter calcium homeostasis. 112 Reduced estrogen concentrations are associated with reduced calcium absorption efficiency and increased bone turnover rates. 112 Advice to Patients Advise patients of the importance of dosage compliance, adherence to instructions about diet, and avoidance of concomitant use of antacids or other preparations containing clinically important concentrations of calcium. 113 127 i PDH Advise patients of importance of taking calcium with meals or milk for maximum absorption. 112 b Advise patients that daily supplemental intake >2 g is unlikely to provide additional benefit. h Advise patients of potential manifestations of hypercalcemia. 113 Warn patients not to use bone meal or dolomite as a source of calcium; they may contain lead. PDH Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs. a b Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed. a Importance of informing patients of other important precautionary information. a b j (See Cautions.) Preparations Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details. Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations. * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Calcium Acetate Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder* Calcium Acetate Powder Oral Capsules 667 mg (169 mg calcium; 8.45 mEq of Ca ++ )* Calcium Acetate Capsules PhosLo GelCaps Fresenius * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Calcium Carbonate, Precipitated Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder* Calcium Carbonate, Precipitated Powder Oral Capsules 1.25 g (500 mg calcium) Calcium Carbonate, Precipitated Calci-Mix Watson Capsules, liquid-filled 600 mg (240 mg of calcium) Liqui-Cal Softgels Advanced Nutritional Technology Suspension 1.25 g (500 mg calcium) per 5 mL* Calcium Carbonate Suspension Tablets 650 mg (260 mg calcium)* Calcium Carbonate Tablets 1.25 g (500 mg calcium)* Calcium Carbonate Tablets Os-Cal 500 GlaxoSmithKline Tablets, chewable 420 mg (168 mg calcium) Titralac 3M 500 mg (200 mg calcium) Chooz Insight Tums GlaxoSmithKline 750 mg (300 mg calcium) Tums E-X 750 GlaxoSmithKline 850 mg (340 mg calcium) Alka-Mints Bayer 1 g (400 mg calcium) Tums Ultra 1000 GlaxoSmithKline 1.25 g (500 mg calcium)* Calcium Carbonate Chewable Tablets Calci-Chew Watson Os-Cal 500 GlaxoSmithKline Tablets, film-coated 1.5 g (600 mg calcium)* Calcium Carbonate Tablets Caltrate 600 Wyeth * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Calcium Carbonate, Precipitated, Combinations Routes Dosage Forms Strengths Brand Names Manufacturer Oral Pieces, chewable 1.25 g (500 mg calcium) with Cholecalciferol 100 units and Phytonadione 40 mcg Viactiv Soft Calcium Chews McNeil Tablets Calcium Carbonate 240 mg with Calcium Gluconate 240 mg, Calcium Lactate 240 mg (152.8 mg calcium), and Cholecalciferol 100 units Calcet Mission 1.25 g (500 mg calcium) with Cholecalciferol 200 units* Calcium Carbonate, Precipitated, and Cholecalciferol Tablets Os-Cal 500+D GlaxoSmithKline 1.5 g (600 mg calcium) with Cholecalciferol 125 units* Calcium Carbonate, Precipitated, and Cholecalciferol Tablets 1.5 g (600 mg calcium) with Cholecalciferol 280 units* Calcium Carbonate, Precipitated, and Cholecalciferol Tablets Healthy Woman (scored) Personal Products Tablets, film-coated 1.5 g (600 mg calcium) with Cholecalciferol 400 units Caltrate 600 + Vitamin D Wyeth * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Calcium Chloride Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder* Calcium Chloride Powder Parenteral Injection 10% (1.36 1.4 mEq of Ca ++ and Cl - per mL)* Calcium Chloride Injection Calcium Citrate Routes Dosage Forms Strengths Brand Names Manufacturer Oral Tablets 950 mg (200 mg calcium) Citracal Bayer Calcium Citrate Combinations Routes Dosage Forms Strengths Brand Names Manufacturer Oral Tablets 1.5 g (315 mg calcium) with Cholecalciferol 250 units Citracal + D Caplets Bayer * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Calcium Gluceptate Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder* Calcium Gluceptate Powder * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Calcium Gluconate Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder* Calcium Gluconate Powder Oral Tablets 500 mg (45 mg calcium)* Calcium Gluconate Tablets 650 mg (58.5 mg calcium)* Calcium Gluconate Tablets 1 g (90 mg calcium)* Calcium Gluconate Tablets Parenteral Injection 10% (0.45 0.48 mEq of Ca ++ per mL provided by calcium gluconate and other calcium salt stabilizers)* Calcium Gluconate Injection Injection, for preparation of IV admixtures 10% (0.45 0.48 mEq of Ca ++ per mL provided by calcium gluconate and calcium saccharate or other calcium salts stabilizers) pharmacy bulk package* Calcium Gluconate Injection Pharmacy Bulk Package * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Calcium Glycerophosphate Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder* Calcium Glycerophosphate Powder Calcium Glycerophosphate and Calcium Lactate Routes Dosage Forms Strengths Brand Names Manufacturer Parenteral Injection 0.08 mEq of Ca ++ (provided by calcium glycerophosphate 5 mg and calcium lactate 5 mg) per mL Calphosan Glenwood * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Calcium Lactate Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder* Calcium Lactate Powder Oral Tablets 325 mg (42.25 mg calcium)* Calcium Lactate Tablets 650 mg (84.5 mg calcium)* Calcium Lactate Tablets * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Calcium Phosphate Dibasic Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder* Calcium Phosphate Dibasic Powder * available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name Calcium Phosphate Tribasic Routes Dosage Forms Strengths Brand Names Manufacturer Bulk Powder* Calcium Phosphate Tribasic Powder Oral Tablets, film-coated 1.5652 g (600 mg calcium) Posture (scored) Inverness Calcium Phosphate Tribasic Combinations Routes Dosage Forms Strengths Brand Names Manufacturer Oral Tablets, film-coated 1.5652 g (600 mg calcium) with Cholecalciferol 125 units Posture-D (scored) Inverness Calcium salts are also commercially available in combination with vitamins, minerals, electrolytes, and antacids. AHFS DI Essentials. Copyright 2017, Selected Revisions January 31, 2017. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814. Use is not currently included in the labeling approved by the US Food and Drug Administration. References Only references cited for selected revisions after 1984 are available electronically. 100. National Institutes of Health Office of Medical Applications of Research. Consensus conference: osteoporosis. JAMA . 1984; 252:799-802. [PubMed 6748181] 101. McCarron DA, Morris CD, Cole C. Dietary calcium in human hypertension. Science . 1982; 217:267-9. [PubMed 7089566] 102. McCarron DA, Morris CD, Henry HJ et al. Blood pressure and nutrient intake in the United States. Science . 1984; 224:1392-8. [PubMed 6729459] 103. Kaplan NM. Non-drug treatment of hypertension. Ann Intern Med . 1985; 102:359-73. [PubMed 3882040] 104. Belizan JM, Villar J, Pineda O et al. Reduction of blood pressure with calcium supplementation in young adults. JAMA . 1983; 249:1161-5. [PubMed 6337285] 105. Belizan JM, Villar J, Zalazar A et al. Preliminary evidence of the effect of calcium supplementation on blood pressure in normal pregnant women. Am J Obstet Gynecol . 1983; 146:175-80. [PubMed 6846435] 106. McCarron DA, Morris CD. Blood pressure response to oral calcium in persons with mild to moderate hypertension: randomized, double-blind, placebo-controlled, crossover trial. Ann Intern Med . 1985; 103(6 Part 1): 825-31. [PubMed 3904559] 107. Resnick LM. Calcium and hypertension: the emerging connection. Ann Intern Med . 1985; 103(6 Part 1): 944-6. [PubMed 4062094] 108. Heath H III, Callaway CW. Calcium tablets for hypertension? Ann Intern Med bargain
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