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Drug Detailed Description (Generic name) - Calcium Salts
Calcium plays an important role in neuromuscular activity, pan-creatic insulin release, gastric hydrogen secretion, blood coagulation, and platelet aggregation; as a cofactor for some enzyme reactions; and in bone and tooth me-tabolism.53
Administration and Adult Dosage
PO as dietary supplement (elemental cal-cium) recommended intake is (19–50 yr, including pregnant and lactating women) 1000 mg/day; (=50 yr) 1200 mg/day.54,55 PO to lower serum phosphate in end-stage renal disease (ESRD) (calcium carbonate) 650 mg with each meal initially, adjust dosage to decrease serum phosphate to <6 mg/dL;56 (calcium acetate) 1334 mg with each meal initially, adjust dosage to decrease serum phosphate to < 6 mg/dL. IV for emergency elevation of serum calcium (calcium glu-conate) 15 mg/kg in NS or D5W infused over 8–10 hr (typically raises serum cal-cium by 2–3 mg/dL),57 may repeat q 1–3 days depending on response; (calcium gluceptate) 1.1–1.4 g infused at a rate not to exceed 36 mg/min of elemental cal-cium. IV for hypocalcemic tetany 10–20 mL calcium gluconate infused over 10 min, may repeat until tetany is controlled. Faster IV infusion rates can result in cardiac dysfunction.58
PO as dietary supplement (elemental calcium) adequate intake is (0–6 months) 210 mg/day; (7–12 months) 270 mg/day; (1–3 yr) 500 mg/day; (4–8 yr) 800 mg/day; (9–18 yr) 1300 mg/day.54 PO for hypocalcemia (elemental calcium) (neonates) 50–150 mg/kg/day in 4– 6 divided doses, to a maximum of 1 g/day; (children) 20–65 mg/kg/day in 4 di-vided doses. IV for emergency elevation of serum calcium (infants) <1 mEq, may repeat q 1–3 days depending on response; (children) 1–7 mEq, may repeat q 1–3 days depending on response. IV for hypocalcemic tetany (infants) 2.4 mEq/day in divided doses; (children) 0.5–0.7 mEq/kg tid–qid, or more until tetany controlled.
Postmenopausal women have a requirement of 1200 mg/day, in-cluding those on estrogen replacement or a bisphosphonate.55 Lower dosage might be required in some patients because of the age-related decrease in renal function; conversely, requirements might increase with advanced renal insufficiency. Other Conditions. Adolescence, renal impairment, and pregnancy might increase requirements; base maintenance dosage on serum calcium, serum phosphate, and diet.53,54
ORAL CALCIUM PRODUCTS COMPARISON CHART PERCENTAGE ELEMENTAL PRODUCT CALCIUM CALCIUM CONTENT Calcium Acetate 25 667 mg Tab = 169 mg Calphron 667 mg Tab = 169 mg PhosLo Calcium Carbonate 40 5 mL Susp = 500 mg Calciday-667 650 mg Tab = 260 mg Cal-Sup 667 mg Tab = 267 mg Caltrate 600 750 mg Tab = 300 mg Os-Cal 1250 mg Tab = 500 mg Titralac 1500 mg Tab = 600 mg Tums Calcium Citrate 21.1 950 mg Tab = 200 mg Citracal Tablets 2376 mg Tab = 500 mg Citracal Liquitabs Calcium Glubionate 6.5 5 mL Syrup = 115 mg Neo-Calglucon Calcium Gluconate 9.3 500 mg Tab = 45 mg Various 650 mg Tab = 58.5 mg 975 mg Tab = 87.8 mg 1000 mg Tab = 90 mg Calcium Lactate 13 325 mg Tab = 42.3 mg Various 650 mg Tab = 84.5 mg Calcium Phosphate, Tribasic 39 1565 mg Tab = 600 mg Posture Dairy Products — Cheese 28 g = 300–400 mg Skim milk 250 mL = 300 mg Yogurt 28 g = 43 mg From references 54–57 and product information.