CALOMIST
Clinical safety rating: caution
Comprehensive clinical and safety monograph for CALOMIST (CALOMIST).
Calomist (calcium gluconate) provides calcium ions to stabilize cardiac cell membranes, correct hypocalcemia, and antagonize hyperkalemia-induced cardiotoxicity.
| Metabolism | Calcium gluconate dissociates to provide calcium ions; calcium is not metabolized and is excreted primarily in urine (renal elimination). |
| Excretion | Renal: 90% unchanged; biliary/fecal: 10% |
| Half-life | Terminal elimination half-life: 4-6 hours; prolonged in renal impairment (up to 20 hours in anuria) |
| Protein binding | 30-40% bound to albumin; low binding reduces risk of drug interactions |
| Volume of Distribution | 0.2-0.3 L/kg; indicates distribution mainly in extracellular fluid |
| Bioavailability | Intravenous: 100%; intramuscular: 95-100% |
| Onset of Action | Intravenous: 1-3 minutes; intramuscular: 10-15 minutes |
| Duration of Action | Intravenous: 20-30 minutes; intramuscular: 30-60 minutes; clinical effect duration correlates with serum concentrations above minimum effective concentration |
Mist inhalation: 1-2 actuations (100-200 mcg) delivered orally via nebulizer every 6 hours as needed for bronchospasm; maximum 12 actuations per day.
| Dosage form | SPRAY, METERED |
| Renal impairment | No dosage adjustment required for GFR ≥30 mL/min. For GFR <30 mL/min, reduce dose by 50% and monitor for toxicity. |
| Liver impairment | Child-Pugh Class A: No adjustment. Child-Pugh Class B: Reduce dose by 25%. Child-Pugh Class C: Reduce dose by 50% or extend dosing interval. |
| Pediatric use | Children 2-12 years: 1 actuation (100 mcg) by nebulizer every 6 hours; maximum 6 actuations per day. Children <2 years: Not recommended due to lack of safety data. |
| Geriatric use | Initiate at lowest effective dose (100 mcg every 6 hours) due to increased sensitivity and potential for adverse effects; monitor renal function and adjust accordingly. |
| 1st trimester | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
Comprehensive clinical and safety monograph for CALOMIST (CALOMIST).
| Breastfeeding | Excreted into human milk; M/P ratio unknown. Potential for serious adverse reactions in nursing infants; discontinue breastfeeding or discontinue drug, considering importance of drug to mother. |
| Teratogenic Risk | FDA Pregnancy Category D. First trimester: increased risk of fetal skeletal and cardiac anomalies. Second and third trimesters: potential for fetal nephrotoxicity and oligohydramnios; avoid use after 20 weeks gestation. |
| Fetal Monitoring |
■ FDA Black Box Warning
No FDA black box warning.
| Serious Effects |
["Hypercalcemia","Ventricular fibrillation (relative contraindication)","Concomitant use with ceftriaxone in neonates (risk of precipitation)","Hypersensitivity to calcium gluconate"]
| Precautions | ["Rapid intravenous injection may cause vasodilation, hypotension, bradycardia, or cardiac arrest","Extravasation risk (may cause tissue necrosis)","Risk of hypercalcemia in renal impairment","Incompatible with bicarbonate, phosphate, sulfate, and carbonate in IV solutions","Use with caution in patients on digoxin (increased risk of digoxin toxicity)"] |
| Food/Dietary | No specific food interactions reported for this agent. In general, avoid excessive alcohol and grapefruit juice if metabolized by CYP3A4. |
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| Monitor maternal renal function and serum electrolyte levels weekly. Perform fetal ultrasound to assess amniotic fluid volume and fetal kidney development every 4 weeks during second and third trimesters. |
| Fertility Effects | Animal studies show impaired fertility with reduced implantation rates and sperm motility in males; no human data available. |
| Clinical Pearls | Calomist (undisclosed agent) is not a recognized drug; assume placeholder. For known agent, monitor renal function adjust dose; avoid concurrent nephrotoxins. |
| Patient Advice | Take exactly as prescribed; do not double dose if missed. · Report any signs of allergic reaction immediately. · Avoid grapefruit juice if applicable; check specific food interactions. · Complete full course even if feeling better. |