CALCIGLUC 10% SOLUTION FOR INJECTION

Indications

• Calcium deficiency
• Support for bone health
• Dental health improvement
• Prevention of osteoporosis

Dosage

Children: For children, the dose is typically 0.11 mmol/kg, administered over 5–10 minutes, with a maximum of 4.5 mmol.

Adults: Dose according to requirements as per clinical guidelines.

Mechanism of action

The phosphate ions in calcium phosphate interact with hydrochloric acid in the stomach, neutralizing pH levels. In systemic circulation, it provides calcium and phosphate ions crucial for remineralizing teeth and maintaining bone homeostasis. The increase in plasma calcium decreases calcium flux from osteocytes by reducing parathyroid hormone (PTH) secretion, leading to enhanced calcium deposition in bones and improved bone mineral density.

Pharmacodynamics

Calcium phosphate raises gastric pH by reacting with stomach acid. It supplies calcium and phosphate ions needed for bone health and dental remineralization. Its role in modulating PTH levels further influences calcium absorption and excretion, thereby playing a crucial role in calcium homeostasis.

Pharmacokinetics

Calcium phosphate is absorbed in the gastrointestinal tract, where it dissociates into calcium and phosphate ions. The absorption of calcium can be influenced by factors such as dietary composition, the presence of vitamin D, and gastrointestinal pH. Its biological effects include modulation of bone density and calcium metabolism through interactions with hormones like PTH and vitamin D.

Adverse effects

• Gastrointestinal disorder
• Hypercalciuria
• Epigastric pain

Interactions

• Calcium salts

Precautions

• Correct dehydration when administering

Pregnancy

Calcium phosphate can be used during pregnancy, but consult a healthcare provider for individual assessment.

Breast-feeding

Calcium phosphate is considered safe during breastfeeding, but individual assessment by a healthcare provider is recommended.

Storage

Store in a cool, dry place away from direct sunlight.

Formulations

• Calcium lactate 300mg tablets
• Calcium phosphate solution for infusion
• Calcium phosphate oral solution

Indications

• Severe acute hypocalcaemia
• Hypocalcaemic tetany
• Calcium deficiency
• Mild asymptomatic hypocalcaemia
• Acute severe hyperkalaemia

Dosage

Adults: For severe acute hypocalcaemia: 30 mL of calcium gluconate 10% (providing approximately 6.8 mmol of calcium) by slow intravenous injection as a single dose, repeat if no improvement in ECG within 5 to 10 minutes. For acute severe hyperkala

Mechanism of action

Calcium chloride dissociates in solution to release calcium ions (Ca2+), which play a key role in numerous cellular processes. Calcium ions facilitate muscle contraction by interacting with proteins involved in the contraction mechanism, such as troponin. They also stabilize excitable membranes, improve cardiac contractility, and enhance neurotransmitter release at synaptic junctions. Additionally, calcium ions are essential for blood clotting, helping to activate enzymes in the coagulation cascade.

Pharmacodynamics

Calcium chloride increases serum calcium levels and enhances myocardial contractility, which is particularly important in conditions such as cardiac arrest or severe hypocalcaemia. The pharmacodynamic effects can lead to improved heart function and reduced symptoms associated with low calcium levels, including muscle spasms and tetany. The onset of action is relatively fast when administered intravenously, making it suitable for emergency situations.

Pharmacokinetics

Calcium chloride is rapidly absorbed when administered intravenously. The distribution of calcium ions occurs throughout the extracellular fluid and is influenced by various factors including pH and the presence of other ions. Calcium ions are primarily excreted through the kidneys, and careful monitoring of renal function is essential during treatment, particularly in patients with renal impairment. The half-life of calcium ions can vary, depending on physiological needs and the overall status of calcium metabolism in the body.

Contra-indications

• Hypercalcaemia
• Severe renal impairment
• Respiratory acidosis
• Respiratory failure
• Hypersensitivity to calcium salts

Adverse effects

• Arrhythmias
• Vasodilation
• Soft tissue calcification
• Gastrointestinal discomfort
• Flatus
• Hypercalciuria
• Skin reactions

Interactions

• Calcium salts may interact with phosphates, bicarbonates, or sulfates
• Caution with medications that affect calcium metabolism

Precautions

• Monitor plasma calcium levels and ECG during intravenous use
• Use with caution in patients with renal impairment to avoid aluminum accumulation
• Consider alternative formulations in patients under 18 years

Pregnancy

Calcium chloride is generally considered safe during pregnancy when used appropriately for medical indications, but caution is advised.

Breast-feeding

Calcium chloride is excreted in breast milk; however, it is generally considered safe to use during breastfeeding.

Storage

Store in a cool, dry place, protected from light. Keep out of reach of children.

Formulations

• Calcium chloride 10% solution for injection
• Calcium gluconate 10% solution for injection
• Effervescent tablets containing calcium salts

Indications

• Severe acute hypocalcaemia
• Hypocalcaemic tetany
• Calcium deficiency
• Mild asymptomatic hypocalcaemia
• Acute severe hyperkalaemia

Dosage

Children: Refer to the BNF for Children for specific paediatric dosing guidance, as it varies based on the condition being treated and

Adults: For intravenous infusion, the initial rate is 50 mL/hour of a 10% calcium gluconate solution, adjusted according to response. For severe acute hypocalcaemia, 30 mL of calcium gluconate 10% may be administered as a single dose, with repeat doses if no improvement in ECG occurs within 5 to 10 minutes. Oral dosing is according to individual requirements.

Mechanism of action

Calcium gluconate acts as a source of calcium ions (Ca2+) which are critical for various physiological functions, such as muscle contraction, neurotransmitter release, and blood coagulation. The calcium ions help restore calcium levels in the body, which can alleviate symptoms associated with calcium deficiency.

Pharmacodynamics

Calcium is essential for many cellular processes and plays a significant role in muscle contraction, neurotransmission, and maintaining bone density. Calcium gluconate provides a bioavailable source of calcium, which is crucial in treating conditions resulting from calcium deficiency. It influences cardiac function and neuromuscular activity by modulating the excitability of nerve and muscle cells.

Pharmacokinetics

Calcium gluconate is well absorbed when administered orally, though the exact bioavailability can vary. After intravenous administration, peak plasma levels of calcium are achieved rapidly. Calcium is distributed throughout the body, primarily in the bones and teeth, with a small fraction circulating in the blood. The renal system regulates calcium excretion, and factors such as age, dietary intake, and hormonal levels can influence calcium metabolism.

Contra-indications

• Severe renal impairment
• Hypercalcaemia
• Respiratory failure
• Severe pulmonary disease

Adverse effects

• Arrhythmias
• Vasodilation
• Soft tissue calcification
• Gastrointestinal discomfort
• Flatus
• Taste unpleasant

Interactions

• May interact with calcium salts
• Incompatible with bicarbonates, phosphates, or sulfates
• May alter the effects of certain medications that affect electrolyte levels

Precautions

• Monitor plasma-calcium levels and ECG during intravenous administration
• Use with caution in patients with renal impairment due to risk of aluminium accumulation
• Avoid in respiratory acidosis

Pregnancy

Calcium gluconate is generally considered safe during pregnancy when used as directed to treat deficiencies. However, always consult a healthcare provider for personalized advice.

Breast-feeding

Calcium gluconate is excreted in breast milk but is not expected to cause adverse effects in nursing infants when used appropriately.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Formulations

• Calcium gluconate 10% solution for injection
• Effervescent tablets
• Calcium carbonate tablets

Indications

• Hyperphosphataemia in patients on haemodialysis
• Management of elevated serum phosphate levels in chronic kidney disease

Dosage

Children: For children aged 6-17 years, the initial dose is 0.8–1.6 g three times a day, taken with meals, and adjusted according to serum-phosphate concentrations. For children under 6 years, specific dosing should be determined by a healthcare professional based on clinical needs.

Adults: The usual adult dose is 1 g (equivalent to 250 mg of elemental calcium) taken with meals, adjusted according to serum-phosphate concentrations. Doses may be increased based on clinical response and phosphate levels.

Mechanism of action

Calcium acetate acts primarily by binding phosphate in the gastrointestinal tract, forming insoluble calcium phosphate complexes that are excreted in the feces. This reduces the absorption of phosphate from the diet, thereby decreasing serum phosphate levels and mitigating the risks associated with hyperphosphataemia, such as vascular calcification and bone disease.

Pharmacodynamics

Calcium acetate effectively lowers serum phosphate levels in patients with chronic kidney disease. The drug's calcium content also contributes to maintaining adequate calcium levels, which is important in the management of bone health and metabolic functions. The phosphate binding capacity allows for control over phosphate levels without significantly altering calcium levels in patients when dosed correctly.

Pharmacokinetics

Calcium acetate is administered orally and its calcium content is bioavailable, contributing to systemic calcium levels. The absorption of calcium is influenced by various factors including dietary composition. The drug's phosphate binding action occurs in the gastrointestinal tract, and its efficacy in reducing serum phosphate levels is dependent on the dose and timing of administration relative to meals. The pharmacokinetics of calcium acetate are not significantly altered with renal impairment; however, its phosphate binding ability is crucial for patients with decreased renal function.

Adverse effects

• Gastrointestinal discomfort
• Constipation
• Diarrhoea
• Nausea
• Vomiting
• Skin reactions

Interactions

• Calcium salts may interact with other medications

Precautions

• Caution in patients with gastrointestinal disorders
• Monitor phosphate levels in patients on dialysis

Pregnancy

Manufacturer advises to avoid use unless potential benefit outweighs risk.

Breast-feeding

Unlikely to be present in milk but manufacturer advises to avoid.

Storage

Store in a cool, dry place, away from direct sunlight.

Formulations

• Phosex 1g tablets
• Renvela 2.4g oral powder sachets
• Renagel 800mg tablets

Mechanism of action

Calcium acetate and other calcium salts are phosphate binders. They work by binding with the phosphate in the food you eat, so that it is eliminated from the body without being absorbed.

Pharmacodynamics

Patients with advanced renal insufficiency (creatinine clearance less than 30 ml/min) exhibit phosphate retention and some degree of hyperphosphatemia. The retention of phosphate plays a pivotal role in causing secondary hyperparathyroidism associated with osteodystrophy, and soft-tissue calcification. The mechanism by which phosphate retention leads to hyperparathyroidism is not clearly delineated. Therapeutic efforts directed toward the control of hyperphosphatemia include reduction in the dietary intake of phosphate, inhibition of absorption of phosphate in the intestine with phosphate binders, and removal of phosphate from the body by more efficient methods of dialysis. The rate of removal of phosphate by dietary manipulation or by dialysis is insufficient. Dialysis patients absorb 40% to 80% of dietary phosphorus. Therefore, the fraction of dietary phosphate absorbed from the diet needs to be reduced by using phosphate binders in most renal failure patients on maintenance dialysis. Calcium acetate when taken with meals combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the feces. Maintenance of serum phosphorus below 6.0 mg/dl is generally considered as a clinically acceptable outcome of treatment with phosphate binders. Calcium acetate is highly soluble at neutral pH, making the calcium readily available for binding to phosphate in the proximal small intestine.

Mechanism of action

The phosphate ions in calcium phosphate likely react with hydrochloric acid in the stomach to neutralize the pH. In toothpaste and in systemic circulation, calcium phosphate provides a source of calcium and phosphate ions to support remineralization of the teeth and bone homeostasis respectively. The increase in plasma calcium reduces calcium flux from osteocyte activity by reducing the secretion of parathyroid hormone (PTH). Calcium does this by stimulating a G-protein coupled calcium receptor on the surface of parathyroid cells. The reduction in calcium flux increases the amount of calcium deposited in bone resulting in an increase in bone mineral density. The reduction in PTH secretion also reduces the amount of vitamin D metabolized to its active form, calcidiol. Since calcidiol increases the expression of calcium dependent ATPases and transient receptor potential cation channel subfamily V member 6 (TRPV6) both of which are involved in calcium uptake from the gut, a reduction in calcidiol results in less calcium absorption. Additionally, TRPV5, the channel responsible for calcium reabsorption in the kidney, is downregulated when PTH secretion is reduced thus increasing calcium excretion via the kidneys. Another hormone, calitonin, is likely involved in the reduction of bone resorption during periods of high plasma calcium.

Pharmacodynamics

Calcium phosphate reacts with acid in the stomach to raise the pH. In toothpaste it provides a source of calcium and phosphate ions to support remineralization of the teeth. As a supplement it provides a source of calcium and phospate, both of which are important ions in bone homeostasis.