CALCIUM GLUCEPTATE
Clinical safety rating: caution
Comprehensive 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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CALCIUM GLUCEPTATE (CALCIUM GLUCEPTATE).
| Breastfeeding | Calcium gluceptate is considered safe during breastfeeding. Calcium is naturally present in breast milk; supplementation does not significantly alter milk calcium levels. M/P ratio not established, but endogenous calcium transport suggests minimal risk. Use with caution in mothers with hypercalcemia. |
| 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. |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Hypercalcemia","Hypersensitivity to calcium gluceptate or any component","Ventricular fibrillation","Patients with known calcium-containing calculi"]
| 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. |
Loading safety data…
| 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. |
| 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. |