CALCIUM GLUCEPTATE
Clinical safety rating
cautionComprehensive clinical and safety monograph for CALCIUM GLUCEPTATE (CALCIUM GLUCEPTATE).
Calcium gluceptate is a calcium salt that dissociates to provide calcium ions, which are essential for various physiological processes including nerve conduction, muscle contraction, blood coagulation, and cardiac function. It acts as a calcium replenisher.
| Metabolism | Calcium gluceptate is not metabolized; it dissociates into calcium ions and gluceptate. Calcium ions are excreted primarily in feces and urine, with renal handling involving reabsorption and secretion. |
| Excretion | Renal: >90% excreted unchanged in urine. Biliary/fecal: <5%. |
| Half-life | Terminal elimination half-life: 2-4 hours (normal renal function); prolonged to 12-24 hours in renal impairment. |
| Protein binding | ~45% bound to albumin. |
| Volume of Distribution | 0.15-0.25 L/kg; represents distribution mainly in extracellular fluid. |
| Bioavailability | IV: 100%; IM: not well characterized; oral: negligible (absorbed poorly, systemic bioavailability <1% as calcium gluceptate dissociates in GI tract). |
| Onset of Action | IV: immediate (seconds to minutes); IM: 10-15 minutes. |
| Duration of Action | IV: 2-4 hours; IM: 2-6 hours. Duration depends on baseline calcium level and underlying condition. |
| Molecular Weight | 448.4 Da |
IV: 2-4 mg/kg elemental calcium (5-10 mL of 0.45 mEq/mL solution) administered slowly over 10-20 minutes. May repeat if needed. Maximum dose: 20 mL per infusion.
| Dosage form | INJECTABLE |
| Renal impairment | GFR >50: No adjustment. GFR 30-50: Reduce dose by 25%. GFR <30: Reduce dose by 50% and monitor serum calcium closely. Dialysis: Dose after hemodialysis. |
| Liver impairment | No dose adjustment required for hepatic impairment. However, monitor ionized calcium in severe hepatic failure due to altered binding proteins. |
| Pediatric use | Neonates and infants: 100-200 mg elemental calcium/kg/day IV divided every 6 hours. Children: 200-500 mg elemental calcium/kg/day IV divided every 6 hours. Maximum: 1 g elemental calcium per dose. |
| Geriatric use | Use lower initial doses (e.g., 1-2 mg/kg elemental calcium) due to reduced renal function and increased risk of hypercalcemia. Monitor serum calcium and phosphate levels. |
| 1st trimester | Calcium gluceptate is generally considered safe during the first trimester when used at recommended doses for calcium supplementation or as an antidote for magnesium toxicity. No teratogenic effects have been reported in animal studies. |
| 2nd trimester | Safe for use in the second trimester for approved indications. Monitor serum calcium levels in cases of prolonged therapy to avoid hypercalcemia, which could affect fetal development. |
| 3rd trimester | Use with caution in the third trimester due to risk of maternal hypercalcemia and potential suppression of fetal parathyroid hormone. Avoid excessive doses. |
Clinical note
Comprehensive clinical and safety monograph for CALCIUM GLUCEPTATE (CALCIUM GLUCEPTATE).
| Placental transfer | Calcium crosses the placenta by active transport. Calcium gluceptate, as a calcium salt, provides ionic calcium which readily crosses the placental barrier. Fetal serum calcium levels are maintained at a higher concentration than maternal levels due to active transport mechanisms. |
| Breastfeeding | Calcium gluceptate is excreted into breast milk in low amounts and is considered compatible with breastfeeding. However, high maternal doses may lead to elevated calcium levels in milk. Monitor infant for signs of hypercalcemia if prolonged high-dose therapy is required. |
| Lactation Rating | L1 (Compatible) |
| Teratogenic Risk | Calcium gluceptate is a calcium salt used for calcium supplementation. No specific teratogenic effects are reported; calcium is essential for fetal development. First trimester: No increased risk of major malformations. Second and third trimesters: Adequate intake supports fetal skeletal mineralization; excess may cause hypercalcemia in the infant. No known teratogenicity. |
| Fetal Monitoring | Monitor serum calcium levels periodically in mother to avoid hypercalcemia. Fetal monitoring not routinely required unless maternal hypercalcemia develops, which may cause fetal bradycardia or hypocalcemia in neonate. |
| Fertility Effects | No known adverse effects on fertility. Calcium is essential for normal reproductive function; deficiency may impair fertility, while supplementation restores homeostasis. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
HypercalcemiaHypersensitivity to calcium gluceptate or any component of the formulationSevere renal failure (anuria or oliguria) without adequate dialysisConditions associated with hypercalciuria (e.g., nephrocalcinosis) unrelated to osteoporosis
| Precautions | Risk of hypercalcemia, especially in patients with renal impairment, Avoid rapid intravenous administration to prevent cardiac arrest, Use with caution in patients with sarcoidosis or digitalis toxicity, Monitor serum calcium levels during therapy, Extravasation may cause tissue necrosis |
| Food/Dietary | Avoid high-calcium foods (dairy, fortified cereals) during acute therapy to prevent hypercalcemia. Limit vitamin D-rich foods (fatty fish, fortified milk). Do not take oral calcium within 1 hour of iron or thyroid medications. Avoid excessive caffeine and alcohol. |
| Clinical Pearls | Calcium gluceptate is used for acute hypocalcemia, hyperkalemia cardiotoxicity, and hypermagnesemia. Administer IV slowly (0.5-1 mL/min) to avoid arrhythmias; monitor ECG during infusion. Do not mix with bicarbonate, phosphate, or sulfate-containing solutions. Extravasation causes tissue necrosis; use central line for peripheral therapy. Correct hypomagnesemia before calcium therapy to prevent refractory hypocalcemia. |
| Patient Advice | Report any burning or pain at injection site immediately. · Avoid taking calcium supplements or antacids without consulting your doctor. · Tell your doctor if you have kidney stones, parathyroid disorders, or heart disease. · Do not stop other calcium medications abruptly. · Seek emergency care for difficulty breathing or chest tightness after infusion. |
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