Drugs List

Therapeutic Indications

Uses

As an adjunct to conventional therapy in the arrest or slowing down of bone demineralisation in osteoporosis where other effective treatment is contraindicated.

In the arrest or slowing down of bone demineralisation in osteoporosis where other effective treatment is contraindicated.

Therapeutic supplementation in osteomalacia, rickets, post-gastrectomy malabsorption, pregnancy, lactation, malnutrition or dietary deficiency.

Administration

To be dissolved in water for oral administration.

Contraindications

Hypercalcaemia
Hypercalciuria

Precautions and Warnings

Use with caution in patients with cardiac disease or sarcoidosis.

Careful monitoring of blood levels and urinary calcium excretion is necessary, particularly when high dose or parenteral calcium therapy has been used, especially in children.

In mild hypercalciuria (exceeding 300mg (7.5mmol)/24hours) as well as mild to moderate renal failure, or where there is evidence of stone formation in the urinary tract, adequate checks must be kept on urinary calcium excretion; If necessary the dosage should be reduced or calcium therapy discontinued. High vitamin D intake should be avoided during calcium therapy, unless especially indicated.

Effervescent calcium gluconate tablets must be used with care in patients receiving alternative compound vitamin or mineral preparations, which often contain sources of additional calcium.

Treatment should be suspended if blood calcium levels exceed 2.625mmol/litre to 2.75mmol/litre (105mg/litre to 110mg/litre) or if urinary calcium excretion exceeds 5mg/kg.

Pregnancy and Lactation

Pregnancy

The manufacturer notes that the likelihood of hypercalcaemia is increased in pregnant women in whom calcium and vitamin D are co-administered. Epidemiological studies with calcium have shown no increase in the teratogenic hazard to the foetus if used in the doses recommended.

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

The manufacturer notes that although supplemental calcium may be excreted in breast milk, the concentration is unlikely to be sufficient to produce any adverse effect on the neonate.

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 disturbances
Bradycardia
Arrhythmias
Hypercalcaemia
Kidney stones
Constipation
Diarrhoea

Presentation

Effervescent tablets containing 1g of calcium gluconate BP equivalent to 2.23mmol of calcium (Ca2+).

Drugs List

Therapeutic Indications

Uses

As an adjunct to conventional therapy in the arrest or slowing down of bone demineralisation in osteoporosis where other effective treatment is contraindicated.

In the arrest or slowing down of bone demineralisation in osteoporosis where other effective treatment is contraindicated.

Therapeutic supplementation in osteomalacia, rickets, post-gastrectomy malabsorption, pregnancy, lactation, malnutrition or dietary deficiency.

Dosage

Calcium supplements are required where dietary calcium intake is deficient. The dietary requirement varies with age and is higher in childhood, pregnancy and lactation due to an increased demand. It is also higher in old age due to the impaired absorption of calcium.

In osteoporosis a calcium intake that is double the recommended amount reduces the rate of bone loss.

If the actual dietary intake is less than the recommended amount, a supplement of as much as 40mmol is appropriate.

In health, the concentration of calcium in serum is maintained close to 2.5mmol/l (normal range 2.25mmol to 2.75mmol or 4.5mEq/l to 5.5mEq/l).

Adults

Children

Neonates

Patients with Renal Impairment

Administration

To be dissolved in water for oral administration.

Contraindications

Hypercalcaemia
Hypercalciuria

Precautions and Warnings

Use with caution in patients with cardiac disease or sarcoidosis.

Careful monitoring of blood levels and urinary calcium excretion is necessary, particularly when high dose or parenteral calcium therapy has been used, especially in children.

In mild hypercalciuria (exceeding 300mg (7.5mmol)/24hours) as well as mild to moderate renal failure, or where there is evidence of stone formation in the urinary tract, adequate checks must be kept on urinary calcium excretion; If necessary the dosage should be reduced or calcium therapy discontinued. High vitamin D intake should be avoided during calcium therapy, unless especially indicated.

Effervescent calcium gluconate tablets must be used with care in patients receiving alternative compound vitamin or mineral preparations, which often contain sources of additional calcium.

Treatment should be suspended if blood calcium levels exceed 2.625mmol/litre to 2.75mmol/litre (105mg/litre to 110mg/litre) or if urinary calcium excretion exceeds 5mg/kg.

Pregnancy and Lactation

Pregnancy

The manufacturer notes that the likelihood of hypercalcaemia is increased in pregnant women in whom calcium and vitamin D are co-administered. Epidemiological studies with calcium have shown no increase in the teratogenic hazard to the foetus if used in the doses recommended.

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

The manufacturer notes that although supplemental calcium may be excreted in breast milk, the concentration is unlikely to be sufficient to produce any adverse effect on the neonate.

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

None known.

Side Effects

Gastro-intestinal disturbances
Bradycardia
Arrhythmias
Hypercalcaemia
Kidney stones
Constipation
Diarrhoea

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

Store below 25 degrees C in a dry place.

Further Information

Last Full Review Date: February 2012.

Reference Sources

Summary of Product Characteristics: Effervescent Calcium Gluconate Tablets BP 1g. Actavis UK Ltd. Revised March 2007

NICE Evidence Services Available at: www.nice.org.uk Last accessed: 22 August 2017