Calcium gluconate
Dosing in kidney impairment
Dosage in Renal Impairment For patients with renal impairment, initiate calcium gluconate injection at the lowest dose of the recommended dose ranges for all age groups and monitor serum calcium levels every 4 hours.
Dosing in liver impairment
Hepatic Impairment Hepatic function does not impact the availability of ionized calcium after calcium gluconate intravenous administration. Dose adjustment in hepatically impaired patients may not be necessary.
Preparation and administration
Important Administration Instructions Calcium gluconate injection contains 100 mg of calcium gluconate per mL which contains 9.3 mg (i.e. 0.465 mEq) of elemental calcium. Dilute calcium gluconate injection prior to use in 5% dextrose or normal saline and assess for potential drug or intravenous fluid incompatibilities [see Dosage and Administration ].
Inspect calcium gluconate injection visually prior to administration. The solution should appear clear and colorless to slightly yellow. Do not administer if there is particulate matter or discoloration. Use the diluted solution immediately after preparation. Administer calcium gluconate injection intravenously via a secure intravenous line to avoid calcinosis cutis and tissue necrosis [see Warnings and Precautions ] .
Administer calcium gluconate injection by bolus administration or continuous infusion. For bolus intravenous administration Dilute the dose [see Dosage and Ad ministration ] of calcium gluconate injection in 5% dextrose or normal saline to a concentration of 10 mg/mL to 50 mg/mL prior to administration. Administer the dose slowly and DO NOT exceed an infusion rate of 200 mg/minute in adults or 100 mg/minute in pediatric patients, including neonates.
Monitor patients, vitals and electrocardiograph (ECG) during administration [see Warnings and Precautions ] . For continuous intravenous infusion Dilute calcium gluconate injection in 5% dextrose or normal saline to a concentration of 5.8 mg/mL to 10 mg/mL prior to administration. Administer at the rate recommended in Table 1 [see Dosage and Administration ] and monitor patients, vitals, calcium and ECG during the infusion [see Warnings and Precautions ] .
Calcium gluconate injection is supplied in single-dose vials and pharmacy bulk packages [see Dosage and Administration ].
Serum Calcium Monitoring Measure serum calcium every 4 to 6 hours during intermittent infusions with calcium gluconate injection and measure serum calcium every 1 to 4 hours during continuous infusion.
Drug Incompatibilities Do not mix calcium gluconate injection with ceftriaxone. Concurrent use of intravenous ceftriaxone and calcium gluconate injection can lead to the formation of ceftriaxone-calcium precipitates. Concomitant use of ceftriaxone and intravenous calcium-containing products is contraindicated in neonates (28 days of age or younger) [see Contraindications ] .
In patients older than 28 days of age, ceftriaxone and calcium-containing products may be administered sequentially, provided the infusion lines are thoroughly flushed between infusions with a compatible fluid. Ceftriaxone must not be administered simultaneously with intravenous calcium-containing solutions via a Y-site in any age group [see Warnings and Precautions , Drug Interactions ].
Do not mix calcium gluconate injection with fluids containing bicarbonate or phosphate. Calcium gluconate injection is not physically compatible with fluids containing phosphate or bicarbonate. Precipitation may result if mixed. Do not mix calcium gluconate injection with minocycline injection. Calcium complexes minocycline rendering it inactive.
Preparation of Pharmacy Bulk Package The pharmacy bulk package (PBP) of calcium gluconate injection is intended for dispensing of single-doses to multiple patients in a pharmacy admixture program. Penetrate the container closure only one time with a suitable sterile transfer device or dispensing set that allows measured dispensing of the contents.
Use the PBP only in a suitable ISO Class 5 work area such as a laminar flow hood (or an equivalent clean air compounding area). Complete dispensing from the pharmacy bulk vial within 4 hours after the container closure is penetrated. Each dose dispensed from the pharmacy bulk package vial must be used immediately.
| Patient Population | Initial Dose | Subsequent Doses (if needed) | |
| Bolus | Continuous Infusion | ||
| Neonate (≤ 1 month) | 100 mg/kg to 200 mg/kg | 100 mg/kg to 200 mg/kgevery 6 hours | Initiate at 17 to 33 mg/kg/hour |
| Pediatric (> 1 month to < 17 years) | 29 mg/kg to 60 mg/kg | 29 mg/kg to 60 mg/kgevery 6 hours | Initiate at 8 to 13 mg/kg/hour |
| Adult | 1,000 mg to 2,000 mg | 1,000 mg to 2,000 mgevery 6 hours | Initiate at 5.4 to 21.5 mg/kg/hour |
| For bolus administration, DO NOT exceed an infusion rate of: 200 mg/minute in adult patients 100 mg/minute in pediatric patientsFor continuous infusions, adjust rate as needed based on serum calcium levels. | |||