Calcium chloride
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]
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Overview
Calcium chloride is a {{{drugClass}}} that is FDA approved for the treatment of hypocalcemia, as adjunctive therapy in lead colic, magnesium intoxication, hyperkalemia, in cardiac resuscitation. Common adverse reactions include tingling sensations, calcium taste, a sense of oppression or “heat wave, peripheral vasodilation, local “burning” sensation, moderate fall in blood pressure.
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
Indications
Calcium Chloride Injection, USP, 10% is indicated:
- In the treatment of hypocalcemia in conditions requiring a prompt increase in plasma calcium levels (e.g., neonatal tetany and tetany due to parathyroid deficiency, vitamin D deficiency and alkalosis) and for prevention of hypocalcemia during exchange transfusions.
- As adjunctive therapy in the management of acute symptoms in lead colic.
- In the treatment of magnesium intoxication due to overdosage of magnesium sulfate.
- In severe hyperkalemia, to combat deleterious effects on electrocardiographic (ECG) function, pending correction of the potassium level in the extracellular fluid.
- In cardiac resuscitation, particularly after open heart surgery, when epinephrine fails to improve weak or ineffective myocardial contractions.
Dosing
INJECT SLOWLY
- Calcium Chloride Injection, USP, 10%, is administered only by slow intravenous injection (not to exceed 1 mL/min) and / or in cardiac resuscitation, by injection into the ventricular cavity. It must not be injected into the myocardium.
- The usual precautions for intravenous therapy should be observed. If time permits, the solution should be warmed to body temperature. The injection should be halted if the patient complains of any discomfort; it may be resumed when symptoms disappear. Following injection, the patient should remain recumbent for a short time.
INTRACARDIAC USE
- For cardiac resuscitation, inject into the ventricular cavity, not into the heart muscle.
- Usual Adult Dosage: 200 to 800 mg (2 to 8 mL) when injected into the ventricular cavity.
INTRAVENOUS USE
Hypocalcemic Disorders
- Usual Adult Dosage: 500 mg to 1 g (5 to 10 mL) at intervals of 1 to 3 days, depending on the response of the patient and / or results of serum calcium determinations. Repeated injections may be required because of rapid excretion of calcium.
Magnesium Intoxication
- Initial Adult Dose: 500 mg (5 mL) administered promptly and the patient observed for signs of recovery before further doses are given.
Hyperkalemic ECG Disturbances of Cardiac Function
- Dosage should be adjusted by constant monitoring of ECG changes during administration.
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
Indications and Dosing
- Contains 100 mg calcium chloride per mL; 27.3 mg or 1.36 mEq of elemental calcium per mL
- Hypocalcemia: 200 mg to 1 g calcium chloride (2 to 10 mL of a 10% solution; 55 to 273 mg elemental calcium) IV every 1 to 3 days; MAX rate, 1 mL/min
Non–Guideline-Supported Use
There is limited information regarding Off-Label Non–Guideline-Supported Use of Calcium chloride in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
There is limited information regarding Calcium chloride FDA-Labeled Indications and Dosage (Pediatric) in the drug label.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
Indications and Dosing
- Contains 100 mg calcium chloride per mL; 27.3 mg or 1.36 mEq of elemental calcium per mL.
- Advanced cardiac life support: 20 mg/kg calcium chloride (0.2 mL/kg of 10% solution; 5.5 mg/kg elemental calcium) IV or INTRAOSSEOUS; administer slowly; MAX dose 2 g calcium chloride (546 mg elemental calcium).
- Hypocalcemia: 2.7 to 5 mg/kg calcium chloride (0.027 to 0.05 mL/kg of a 10% solution; 0.74 to 1.37 mg/kg elemental calcium) IV every 4 to 6 hours; MAX rate, 1 mL/min.
Non–Guideline-Supported Use
There is limited information regarding Off-Label Non–Guideline-Supported Use of Calcium chloride in pediatric patients.
Contraindications
- Calcium chloride is contraindicated for cardiac resuscitation in the presence of ventricular fibrillation.
Warnings
- Calcium chloride should be injected into a large vein very slowly, as it may cause peripheral vasodilatation and a cutaneous burning sensation. A moderate fall in blood pressure due to vasodilatation may attend the injection. Since calcium chloride is an acidifying salt, it is usually undesirable in the treatment of hypocalcemia or renal insufficiency.
Adverse Reactions
Clinical Trials Experience
- Rapid I.V. injection may cause the patient to complain of tingling sensations, a calcium taste, a sense of oppression or “heat wave.”
- Injections of calcium chloride are accompanied by peripheral vasodilation as well as a local “burning” sensation, and there may be a moderate fall in blood pressure.
Postmarketing Experience
There is limited information regarding Calcium chloride Postmarketing Experience in the drug label.
Drug Interactions
There is limited information regarding Calcium chloride Drug Interactions in the drug label.
Use in Specific Populations
Pregnancy
Pregnancy Category (FDA):
There is no FDA guidance on usage of Calcium chloride in women who are pregnant.
Pregnancy Category (AUS):
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Calcium chloride in women who are pregnant.
Labor and Delivery
There is no FDA guidance on use of Calcium chloride during labor and delivery.
Nursing Mothers
There is no FDA guidance on the use of Calcium chloride in women who are nursing.
Pediatric Use
There is no FDA guidance on the use of Calcium chloride in pediatric settings.
Geriatic Use
There is no FDA guidance on the use of Calcium chloride in geriatric settings.
Gender
There is no FDA guidance on the use of Calcium chloride with respect to specific gender populations.
Race
There is no FDA guidance on the use of Calcium chloride with respect to specific racial populations.
Renal Impairment
There is no FDA guidance on the use of Calcium chloride in patients with renal impairment.
Hepatic Impairment
There is no FDA guidance on the use of Calcium chloride in patients with hepatic impairment.
Females of Reproductive Potential and Males
There is no FDA guidance on the use of Calcium chloride in women of reproductive potentials and males.
Immunocompromised Patients
There is no FDA guidance one the use of Calcium chloride in patients who are immunocompromised.
Others
Administration and Monitoring
Administration
Intravenous
Monitoring
There is limited information regarding Calcium chloride Monitoring in the drug label.
IV Compatibility
There is limited information regarding the compatibility of Calcium chloride and IV administrations.
Overdosage
There is limited information regarding Calcium chloride overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.
Pharmacology
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Mechanism of Action
(Description)
Structure
Calcium Chloride Injection, USP, 10%, is a sterile aqueous solution containing, in each mL, 100 mg (1.36 mEq) calcium chloride. The pH of the solution may have been adjusted with hydrochloric acid and / or calcium hydroxide, when necessary. The air above the liquid in the individual containers has been displaced by flushing with nitrogen during the filling operation. The preparation contains no antimicrobial preservatives and is intended as a single-dose vial; once the unit is assembled and used, any remaining portion of the solution must be discarded with the entire unit. Calcium Chloride, USP, contains two molecules of water of hydration and is chemically designated as CaCl2 • 2H20.
Pharmacodynamics
(Description)
Pharmacokinetics
(Description)
Nonclinical Toxicology
(Description)
Clinical Studies
There is limited information regarding Calcium chloride Clinical Studies in the drug label.
How Supplied
CALCIUM CHLORIDE INJECTION, USP, 10%
In unit-use packages containing a Luer-Jet™ Luer-Lock Prefilled Syringe. Stock No. 3304 NDC 76329-3304-1 10 mL Ten cartons per package.
Syringe Assembly Directions:
USE ASEPTIC TECHNIQUE
Do not assemble until ready to use.
Storage
- Store at controlled room temperature 15° to 30°C (59° to 86°F).
Images
Drug Images
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Package and Label Display Panel
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Patient Counseling Information
(Patient Counseling Information)
Precautions with Alcohol
Alcohol-Calcium chloride interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Brand Names
There is limited information regarding Calcium chloride Brand Names in the drug label.
Look-Alike Drug Names
- (Paired Confused Name 1a) — (Paired Confused Name 1b)
- (Paired Confused Name 2a) — (Paired Confused Name 2b)
- (Paired Confused Name 3a) — (Paired Confused Name 3b)
Drug Shortage Status
Drug Shortage
Price
References
The contents of this FDA label are provided by the National Library of Medicine.
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