Names and pronunciation
Cal-Lac
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Drug reference
Cal-Lac
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Func. class.: Electrolyte replacement— calcium product
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ACTION: Calcium needed for mainte- nance of nervous, muscular, skeletal function; enzyme reactions; normal car- diac contractility; coagulation of blood; affects secretory activity of endocrine, exocrine glands
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USES: Prevention and treatment of hypocalcemia, hypermagnesemia, hypo- parathyroidism, neonatal tetany, cardiac toxicity caused by hyperkalemia, lead colic, hyperphosphatemia, vitamin D deficiency, osteoporosis prophylaxis, cal- cium antagonist toxicity (calcium chan- nel blocker toxicity)
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Unlabeled uses: Electrolyte abnormali- ties in cardiac arrest, CPR
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CONTRAINDICATIONS: Hyper- calcemia, digoxin toxicity, ventricular fibrillation, renal calculi Precautions: Pregnancy, breastfeeding, children, respiratory/renal disease, cor pulmonale, digitalized patient, respiratory failure, diarrhea, dehydration
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SIDE EFFECTS CV: Hypotension, bradycardia, dysrhyth- mias; cardiac arrest (IV) GI: Vomiting, nausea, constipation GU: Hypercalciuria, renal calculi META: Hypercalcemia INTEG: Pain, burning at IV site, severe venous thrombosis, necrosis, extravasation
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INTERACTIONS C Increase: milk-alkali syndrome—antacids Increase: dysrhythmias—digoxin glycosides Increase: toxicity—verapamil, dilTIAzem Increase: hypercalcemia—thiazide diuretics Decrease: absorption of fluoroquinolones, tetracyclines, iron salts, phenytoin, thyroid hormones when calcium is taken PO Decrease: effects of atenolol—verapamil Drug/Herb Increase: action/side effects—lily of the valley, pheasant’s eye, shark cartilage, squill Drug/Food Decrease: calcium absorption—cereal, spinach Drug/Lab Test Increase: calcium
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DOSAGE AND ROUTES Acute hypocalcemia C • Adult: IV 7-14 mEq for tetany 4.5-16 mEq • Child/infant: IV 1-7 mEq for tetany 0.5-0.7 mEq/kg tid-qid For nutritional supplementation PO (any oral calcium salt; dosage expressed as elemental calcium) • Adult: PO 1-2 g mg/day • Child: PO 45-65 mg/kg/day
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Available forms: Calcium chloride: injection 10% (1.36 mEq); calcium citrate: tablets 250 mg; calcium gluco- nate: tablets 500, 650, 975, 1 g; injection 10% (0.45 mEq); calcium lactate: tablets 325, 500, 650 mg
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Administer: PO route (only acetate, carbonate, citrate, lactate, phosphate) • Give in 3-4 divided doses with or 1 hr after meals, follow with full glass of water; if using as phosphate binder in renal dialy- sis, do not follow with water, do not give oral medications within 1 hr of oral cal- cium; chewable tablet: chew thoroughly; effervescent tablet: dissolve in full glass of water; oral powder: mix and give with food; oral solution: give before meals; oral suspension: shake well • Store at room temperature IV route • Warm to room temperature • Undiluted or diluted with equal amounts of NS to a 5% solution for injec- tion, give 0.5-1 mL/min, give slowly, rapid administration may cause cardiac arrest • Through small-bore needle into large vein, do not use scalp vein; if extravasa- tion occurs, necrosis will result (IV) • Remain recumbent ½ hr after IV dose, drop in B/P may result Calcium chloride Y-site compatibilities: Acyclovir, alemtu- zumab, alfentanil, amikacin, aminocaproic acid, aminophylline, amiodarone, anidula- fungin, argatroban, arsenic trioxide, ascor- bic acid injection, asparaginase, atenolol, atracurium, atropine, azithromycin, aztre- onam, benztropine, bivalirudin, bleomy- cin, bumetanide, buprenorphine, butor- phanol, calcium gluconate, CARBOplatin, carmustine, caspofungin acetate, cefotax- ime, cefoTEtan, cefOXitin, ceftaroline, ceftizoxime, chloramphenicol, chlorothia- zide, chlorpheniramine, chlorproMAZINE, cimetidine, CISplatin, clindamycin, cloxa- cillin, colistimethate, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytara- bine, DACTINomycin, DAPTOmycin, DAU- NOrubicin, dexmedetomidine, dexrazox- ane, digoxin, diltiaZEM, diphenhydrAMINE, DOBUTamine, DOCEtaxel, dolasetron, DOPamine, doxacurium, doxapram, DOXOrubicin, doxycycline, edetate cal- cium disodium, enalaprilat, ePHEDrine, EPINEPHrine, epiRUBicin, epoetin alfa, eptifibatide, ergonovine, ertapenem, eryth- romycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fen- taNYL, fluconazole, fludarabine, furose- mide, gallamine, gallium, ganciclovir, gatifloxacin, gemcitabine, gentamicin, gly- copyrrolate, granisetron, heparin sodium, HYDROmorphone, hydrOXYzine, IDArubi- cin, ifosfamide, inamrinone, insulin (regu- lar), irinotecan, isoproterenol, kanamycin, labetalol, lactated Ringer’s, lepirudin, leu- covorin, lidocaine, lincomycin, linezolid, LORazepam, mannitol, meperidine, mephentermine, mesna, methohexital, methotrexate, methyldopate, metoclo- pramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, milrinone, mino- cycline, mitoMYcin, mitoXANTRONE, miva- curium, morphine, moxifloxacin, multiple vitamins injection, mycophenolate mofetil, nafcillin, nalbuphine, nalorphine, nalox- one, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxytocin, PACLitaxel (sol- vent/surfactant), pancuronium, papaver- ine, penicillin G potassium/sodium, pen- tazocine, PENTobarbital, PHENobarbital, phentolamine, phenylephrine, phytonadi- one, piperacillin, piperacillin-tazobactam, polymyxin B, potassium, potassium chlo- ride, procainamide, prochlorperazine, promazine, promethazine, propranolol, protamine, pyridoxine, quinupristin-dalfo- pristin, raNITIdine, Ringer’s injection, rocuronium, streptomycin, suc- cinylcholine, SUFentanil, tacrolimus, tenipo- side, theophylline, thiamine, thiotepa, ticarcillin-clavulanate, tigecycline, tirofi- ban, TNA (3-in-1), tobramycin, tolazoline, topotecan, trimetaphan, tubocurarine, urokinase, vancomycin, vasopressin, vecuronium, verapamil, vinBLAStine, vin- CRIStine, vinorelbine, voriconazole Calcium gluconate Y-site compatibilities: Acyclovir, aldes- leukin, alemtuzumab, alfentanil, allopuri- nol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, anidulafungin, argatroban, arsenic trioxide, ascorbic acid injection, asparaginase, ateno- lol, atracurium, atropine, azaTHIOprine, azithromycin, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, CARBOplatin, carmustine, caspofungin, ceFAZolin, cefepime, cefopera- zone, cefotaxime, cefoTEtan, cefOXitin, cef- taroline, cefTAZidime, ceftizoxime, cefurox- ime, chloramphenicol sodium succinate, chlorothiazide, chlorpheniramine, chlor- proMAZINE, cimetidine, ciprofloxacin, cisa- tracurium, CISplatin, cladribine, clindamy- cin, cloxacillin, codeine, colistimethate, cyanocobalamin, cyclophosphamide, cyclo SPORINE, cytarabine, DACTINomycin, DAP- TOmycin, DAUNOrubicin liposome, DAU- NOrubicin, dexmedetomidine, dexrazoxane, digoxin, diltiaZEM, dimenhyDRINATE, diphenhydrAMINE, DOBUTamine, DOCE taxel, dolasetron, DOPamine, doripenem, doxacurium, doxapram, DOXOrubicin, DOXOrubicin liposomal, doxycycline, ede- tate calcium disodium, enalaprilat, ePHED- rine, EPINEPHrine, epiRUBicin, epoetin alfa, eptifibatide, ergonovine, ertapenem, eryth- romycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fen- taNYL, filgrastim, fludarabine, fluorouracil, folic acid (as sodium salt), furosemide, gallamine, gallium, ganciclovir, gatifloxacin, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin sodium, HYDROmor- phone, hydrOXYzine, IDArubicin, ifosfamide, insulin (regular), irinotecan, isoproterenol, kanamycin, ketamine, labet- alol, lactated Ringer’s injection, lepirudin, leucovorin, levoFLOXacin, lidocaine, linco- mycin, linezolid, LORazepam, magnesium sulfate, mannitol, melphalan, meperidine, mephentermine, mesna, methohexital, methotrexate, methyldopate, metoclo- pramide, metoprolol, metroNIDAZOLE, micafungin, midazolam, milrinone, mito- MYcin, mitoXANTRONE, mivacurium, mor- phine, moxifloxacin, multiple vitamins injection, nafcillin, nalbuphine, nalorphine, naloxone, nesiritide, netilmicin, niCARdipine, nitroglycerin, nitroprusside, norepineph rine, octreotide, ondansetron, oritavancin, oxaliplatin, oxytocin, PACLitaxel (solvent/ surfactant), palonosetron, pancuronium, papaverine, penicillin G potassium/sodium, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentolamine, phenyleph- rine, phytonadione, piperacillin, polymyxin B, potassium acetate/chloride, procainamide, prochlorperazine, promazine, promethazine, propofol, propranolol, protamine, pyridox- ine, quiNIDine, raNITIdine, remifentanil, Ringer’s, riTUXimab, rocuronium, sargra mostim, sodium acetate, streptomycin, suc- cinylcholine, SUFentanil, tacrolimus, tela- vancin, teniposide, theophylline, thiamine, thiotepa, ticarcillin, ticarcillin-clavulanate, tigecycline, tirofiban, TNA (3-in-1), tobra- mycin, tolazoline, TPN (2-in-1), trastuzu mab, trimetaphan, tubocurarine, urokinase, vancomycin, vasopressin, vecuronium, verap amil, vinBLAStine, vinCRIStine, vinorelbine, vitamin B complex with C, voriconazole
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Assess: • ECG for decreased QT and T wave inversion: hypercalcemia, product should be reduced or discontinued, consider car- diac monitoring • Calcium levels during treatment (8.5- 11.5 g/dL is normal level); urine calcium if hypercalciuria occurs • Cardiac status: rate, rhythm, CVP (PWP, PAWP if being monitored directly) • Hypocalcemia: muscle twitching, par- esthesia, dysrhythmias, laryngospasm • Digoxin therapy: monitor frequently; an increase in calcium increases digoxin toxicity risk • Store at room temperature
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Evaluate: • Therapeutic response: decreased twitching, paresthesias, muscle spasms; absence of tremors, seizures, dysrhyth- mias, dyspnea, laryngospasm; negative Chvostek’s sign, negative Trousseau’s sign
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To increase fluids to 2 L/day unless contraindicated; to add bulk to diet for constipation; to notify prescriber of constipation • Not to switch antacids unless directed by prescriber; not to use as antacid for >2 wk without approval by prescriber • That therapeutic dose recommenda- tions are figured as elemental calcium • To avoid excessive use of alcohol, caf- feine, tobacco
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PHARMACOKINETICS Crosses placenta, enters breast milk, excreted via urine and feces, half-life unknown, protein binding 40%-50% PO: Onset, peak, duration unknown, absorption from GI tract IV: Onset immediate, duration ½-2 hr
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• Adult: IV 7-14 mEq for tetany 4.5-16 mEq
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• Child/infant: IV 1-7 mEq for tetany 0.5-0.7 mEq/kg tid-qid For nutritional supplementation PO (any oral calcium salt; dosage expressed as elemental calcium)
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• Adult: PO 1-2 g mg/day
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• Child: PO 45-65 mg/kg/day
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