No

Calcium Salt

Adjunct in treatment and prevention of postmenopausal osteoporosis; treatment and prevention of calcium depletion or hyperphosphatemia (eg, osteoporosis, osteomalacia, mild/moderate renal insufficiency, hypoparathyroidism, rickets)

C

Hypercalcemia, renal calculi, ventricular fibrillation

Calcium absorption is impaired in achlorhydria (common in elderly - try alternate salt, administer with food); administration is followed by increased gastric acid secretion within 2 hours of administration; while hypercalcemia and hypercalciuria may result when therapeutic replacement amounts are given for prolonged periods, they are most likely to occur in hypoparathyroid patients receiving high doses of vitamin D

Mild hypercalcemia (calcium: >10.5 mg/dL) may be asymptomatic or manifest itself as constipation, anorexia, nausea, and vomiting

More severe hypercalcemia (calcium: >12 mg/dL) is associated with confusion, delirium, stupor, and coma

<1%: Headache, hypophosphatemia, hypercalcemia, nausea, anorexia, vomiting, abdominal pain, constipation, thirst

Acute single ingestions of calcium salts may produce mild gastrointestinal distress, but hypercalcemia or other toxic manifestations are extremely unlikely

Treatment is supportive

Decreased effect:

Calcium glubionate may significantly decrease the bioavailability of tetracyclines

Large intakes of dietary fiber may decrease calcium absorption due to a decreased GI transit time and the formation of fiber-calcium complexes

Increased effect: Calcium glubionate may increase the effects of quinidine

As dietary supplements, to prevent or treat negative calcium balance (eg, osteoporosis), the calcium in calcium salts moderates nerve and muscle performance and allows normal cardiac function

Absorption: From the GI tract requires vitamin D; minimal absorption unless chronic, high doses are given; calcium is absorbed in soluble, ionized form; solubility of calcium is increased in an acid environment

Distribution: Crosses the placenta; appears in breast milk

Elimination: Mainly in feces as unabsorbed calcium with 20% eliminated by the kidneys

Dosage is in terms of elemental calcium

0-6 months: 210 mg/day

7-12 months: 270 mg/day

1-3 years: 500 mg/day

4-8 years: 800 mg/day

Adults, male/female:

9-18 years: 1300 mg/day

19-50 years: 1000 mg/day

>51 years: 1200 mg/day

Female: Pregnancy:

less than or equal to 18 years: 1300 mg/day

>19 years: 1000 mg/day

Female: Lactating:

less than or equal to 18 years: 1300 mg/day

>19 years: 1000 mg/day

Syrup is a hyperosmolar solution; dosage is in terms of calcium glubionate, elemental calcium is in parentheses

Neonatal hypocalcemia: 1200 mg (77 mg Ca⁺⁺)/kg/day in 4-6 divided doses

Maintenance: Infants and Children: 600-2000 mg (38-128 mg Ca⁺⁺)/kg/day in 4 divided doses up to a maximum of 9 g (575 mg Ca⁺⁺)/day

Adults: 6-18 g (~0.5-1 g Ca⁺⁺)/day in divided doses

Dosing adjustment in renal impairment: Cl_cr <25 mL/minute: Dosage adjustments may be necessary depending on the serum calcium levels

Should be administered 1-3 hours after meals; may decrease iron absorption so should be administered 1-2 hours before or after iron supplementation; should not be administered with bran, foods high in oxalates or whole grain cereals which may decrease calcium absorption

Serum calcium: 8.4-10.2 mg/dL: Monitor plasma calcium levels if using calcium salts as electrolyte supplements for deficiency

Due to a poor correlation between the serum ionized calcium (free) and total serum calcium, particularly in states of low albumin or acid/base imbalances, direct measurement of ionized calcium is recommended

In low albumin states, the corrected total serum calcium may be estimated by: Corrected total calcium = total serum calcium + 0.8 (4.0 - measured serum albumin)

calcium (S); magnesium

May cause confusion and delirium (as a consequence of hypercalcemia)

None reported

No information available to require special precautions

No effects or complications reported

Do not take calcium supplements within 1-2 hours of taking other medicine by mouth or eating large amounts of fiber-rich foods; do not take other calcium-containing products or antacids, drink large amounts of alcohol or caffeine-containing beverages

Monitor serum calcium, magnesium, phosphate

Elemental calcium listed in brackets