Drugs List

Therapeutic Indications

Uses

Hypocalcaemia
Electrolyte imbalance

Administration

For slow intravenous use only.

When possible solutions should be warmed to body temperature.

Inject slowly through a small needle into a large vein to minimise venous irritation and avoid undesirable effects. Calcium chloride is considered to be the most irritant of the injectable calcium salts. Care should be taken to avoid extravasation.

Infusions should be diluted with at least 4 times its volume of sodium chloride.

Infant injections should not be given thorough the scalp.

Incompatibilities

Calcium salts are incompatible with a wide range of drugs. Complexes may form resulting in the formation of a precipitate. Generally the mixing of calcium with carbonates, citrates, oxidising agents, phosphates, sulfates, tartrates, tetracyclines or parenteral mixtures including total parenteral nutrition should be avoided.

Contraindications

Patients receiving cardiac glycosides
Respiratory acidosis
Respiratory failure
Hypercalcaemia
Hypercalciuria
Nephrolithiasis
History of nephrolithiasis
Chronic renal impairment
Digitalis toxicity

For slow intravenous use only - other routes are contraindicated due to the risk of necrosis.

Precautions and Warnings

Sarcoidosis
Renal impairment (see 'Dosage; Renal impairment' section)
Cardiac disease

A moderate fall in blood pressure due to vasodilatation may accompany the injection.

Not suitable for the treatment of hypocalcaemia caused by renal impairment (due to calcium chloride's acidifying nature).

The severe tissue necrosis caused upon extravasation of calcium chloride may limit the choice of this calcium salt to life threatening indications.

Excessive amounts of calcium may lead to hypercalcaemia. Symptoms may include: anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia, polyuria, bone pain, nephrocalcinosis, renal calculi, cardiac arrhythmias and coma.

Calcium chloride is considered to be the most irritant of the injectable calcium salts. Severe tissue necrosis and sloughing may occur. Care should be taken to avoid extravasation or accidental injection into perivascular tissues.

If calcium chloride is administered too rapidly, may lead to many of the symptoms of hypercalcaemia and in addition; chalky (calcium) taste, hot flushes, a sense of oppression, tingling sensations and peripheral vasodilatation.

Monitoring of calcium serum levels is necessary following intravenous administration of calcium.

Monitor serum electrolytes

Pregnancy (see Pregnancy section).
Breastfeeding (see Lactation section).

Pregnancy and Lactation

Pregnancy

Evaluate risk / benefit of treatment in pregnancy.

There are no studies on the effects of calcium chloride on pregnant women. No problems have been documented. However calcium crosses the placenta and absorption of calcium is increased during pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use with caution in lactation

Calcium is excreted in breast milk, but there are no data on the effects, if any, on the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Side Effects

Gastro-intestinal symptoms
Bradycardia
Arrhythmias
Irritation (after intravenous injection)
Decrease in blood pressure
Hot flushes
Tingling sensation
Peripheral vasodilatation
Sense of oppression
Symptoms of hypercalcaemia
Hypertension
Drowsiness
Nausea
Sweating
Flushing

Presentation

Sterile aqueous solution of calcium chloride for slow intravenous injection or infusion.

This product is available in two strengths:

Calcium chloride dihydrate 7.35%
Each 5ml ampoule contains 2.5mmol of Ca
Each 10ml ampoule contains 5mmol of Ca

Calcium chloride dihydrate 14.7%
Each 5ml ampoule contains 5mmol of Ca
Each 10ml ampoule contains 10mmol of Ca

Drugs List

Therapeutic Indications

Uses

Hypocalcaemia
Electrolyte imbalance

Dosage

Adults

Elderly

Children

Patients with Renal Impairment

Administration

For slow intravenous use only.

When possible solutions should be warmed to body temperature.

Inject slowly through a small needle into a large vein to minimise venous irritation and avoid undesirable effects. Calcium chloride is considered to be the most irritant of the injectable calcium salts. Care should be taken to avoid extravasation.

Infusions should be diluted with at least 4 times its volume of sodium chloride.

Infant injections should not be given thorough the scalp.

Incompatibilities

Calcium salts are incompatible with a wide range of drugs. Complexes may form resulting in the formation of a precipitate. Generally the mixing of calcium with carbonates, citrates, oxidising agents, phosphates, sulfates, tartrates, tetracyclines or parenteral mixtures including total parenteral nutrition should be avoided.

Contraindications

Patients receiving cardiac glycosides
Respiratory acidosis
Respiratory failure
Hypercalcaemia
Hypercalciuria
Nephrolithiasis
History of nephrolithiasis
Chronic renal impairment
Digitalis toxicity

For slow intravenous use only - other routes are contraindicated due to the risk of necrosis.

Precautions and Warnings

Sarcoidosis
Renal impairment (see 'Dosage; Renal impairment' section)
Cardiac disease

A moderate fall in blood pressure due to vasodilatation may accompany the injection.

Not suitable for the treatment of hypocalcaemia caused by renal impairment (due to calcium chloride's acidifying nature).

The severe tissue necrosis caused upon extravasation of calcium chloride may limit the choice of this calcium salt to life threatening indications.

Excessive amounts of calcium may lead to hypercalcaemia. Symptoms may include: anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia, polyuria, bone pain, nephrocalcinosis, renal calculi, cardiac arrhythmias and coma.

Calcium chloride is considered to be the most irritant of the injectable calcium salts. Severe tissue necrosis and sloughing may occur. Care should be taken to avoid extravasation or accidental injection into perivascular tissues.

If calcium chloride is administered too rapidly, may lead to many of the symptoms of hypercalcaemia and in addition; chalky (calcium) taste, hot flushes, a sense of oppression, tingling sensations and peripheral vasodilatation.

Monitoring of calcium serum levels is necessary following intravenous administration of calcium.

Monitor serum electrolytes

Pregnancy (see Pregnancy section).
Breastfeeding (see Lactation section).

Pregnancy and Lactation

Pregnancy

Evaluate risk / benefit of treatment in pregnancy.

There are no studies on the effects of calcium chloride on pregnant women. No problems have been documented. However calcium crosses the placenta and absorption of calcium is increased during pregnancy.

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

Use with caution in lactation

Calcium is excreted in breast milk, but there are no data on the effects, if any, on the infant.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Effects on Ability to Drive and Operate Machinery

Some side effects may effect the patients ability to drive or operate machinery.

Counselling

Advise patients that side effects may effect their ability to drive or operate machinery

Side Effects

Gastro-intestinal symptoms
Bradycardia
Arrhythmias
Irritation (after intravenous injection)
Decrease in blood pressure
Hot flushes
Tingling sensation
Peripheral vasodilatation
Sense of oppression
Symptoms of hypercalcaemia
Hypertension
Drowsiness
Nausea
Sweating
Flushing

Overdosage

It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

The following number will direct the caller to the relevant local centre (0844) 892 0111

Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Shelf Life and Storage

None stated.

Further Information

Last Full Review Date: May 2011

Reference Sources

British National Formulary, 61st Edition (2011) Pharmaceutical Press, London.

BNF for Children (2010-2011) Pharmaceutical Press, London.

Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.

Summary of Product Characteristics: Calcium chloride injection 5mmol in 10ml. Martindale Pharmaceuticals (Macarthys Laboratories Ltd). Revised December 2000.

Summary of Product Characteristics: Calcium chloride injection 10mmol in 10ml. Martindale Pharmaceuticals (Macarthys Laboratories Ltd). Revised January 2001.