Usage
Calcium Gluconate + Calcium Lactobionate is primarily prescribed for the treatment of hypocalcemia, a condition characterized by low calcium levels in the blood. This can manifest as various symptoms like muscle cramps, spasms, tetany, and cardiac arrhythmias. This combination is particularly useful in acute settings requiring rapid calcium replacement. It is classified as a mineral supplement.
The mechanism of action involves directly increasing serum calcium levels, restoring the physiological functions dependent on calcium, such as nerve impulse transmission, muscle contraction, and blood coagulation.
Alternate Names
While “Calcium Gluconate + Calcium Lactobionate” accurately represents the combined components, there isn’t a widely recognized alternate name. Brand names may vary depending on the manufacturer and region, a prominent example being Calcium Sandoz.
How It Works
Pharmacodynamics: Calcium is vital for numerous physiological processes, including neuromuscular function, cardiac contractility, blood coagulation, and bone health. This combination increases serum ionized calcium, which is crucial for these functions.
Pharmacokinetics: Calcium gluconate is readily dissociated into calcium and gluconate ions upon administration. Calcium lactobionate also contributes to calcium replenishment. Absorption from oral formulations can be influenced by factors such as vitamin D levels and gastrointestinal conditions. Intravenous administration provides direct delivery into the bloodstream, bypassing absorption. Calcium is primarily excreted by the kidneys, with a minor portion eliminated through feces.
Dosage
Standard Dosage
Adults:
For acute hypocalcemia, 1 to 2 grams of calcium gluconate + calcium lactobionate is administered intravenously over 2 hours. Subsequent doses are adjusted according to serum calcium levels and clinical response. The rate of infusion should not exceed 200 mg/minute.
Children:
In pediatric patients, the recommended dosage of calcium gluconate is 25 to 50 mg/kg/dose, while the dosage for calcium lactobionate varies based on age and specific needs. Pediatric doses should be carefully adjusted based on weight, age, and serum calcium monitoring.
Special Cases:
- Elderly Patients: Start with the lower end of the recommended dose range and monitor carefully due to potential age-related decreases in renal function.
- Patients with Renal Impairment: Dosage adjustments are crucial in renal impairment as calcium excretion is primarily renal. Careful monitoring of serum calcium is essential.
- Patients with Hepatic Dysfunction: Dosage adjustments are generally not necessary in hepatic dysfunction.
- Patients with Comorbid Conditions: Considerations for underlying conditions, such as cardiac disease or concurrent medication use, may be necessary.
Clinical Use Cases
Dosing in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations depends entirely on the severity of hypocalcemia and the patient’s clinical status. Dosage adjustments are made based on frequent serum calcium monitoring and the response to therapy. For instance, in cardiac arrest due to hyperkalemia, calcium may be administered to stabilize the myocardium.
Side Effects
Common Side Effects
Constipation, nausea, vomiting, metallic taste, flushing (warmth or redness of the skin).
Rare but Serious Side Effects
Cardiac arrhythmias (especially with rapid IV administration), syncope, hypotension, tissue necrosis at the injection site (due to extravasation).
Contraindications
Hypercalcemia, ventricular fibrillation, hypersensitivity to calcium salts. Caution is advised in patients with digoxin therapy, renal impairment, or sarcoidosis.
Drug Interactions
Cardiac glycosides (e.g., digoxin), tetracycline antibiotics, certain diuretics (thiazides), and drugs that may cause hypercalcemia (e.g., vitamin D).
Pregnancy and Breastfeeding
Calcium crosses the placenta and is present in breast milk. While generally considered safe for use during pregnancy and lactation if clinically indicated, it should only be administered when the benefits outweigh the potential risks. Close monitoring of serum calcium in both mother and neonate is important.
Drug Profile Summary
- Mechanism of Action: Replenishes calcium levels, essential for various physiological processes.
- Side Effects: Constipation, nausea, vomiting, rare but serious cardiac effects with rapid IV administration.
- Contraindications: Hypercalcemia, ventricular fibrillation.
- Drug Interactions: Cardiac glycosides, tetracycline antibiotics.
- Pregnancy & Breastfeeding: Generally safe when clinically indicated; monitor calcium levels.
- Dosage: Varies based on the severity of hypocalcemia and age; requires close monitoring and adjustment.
- Monitoring Parameters: Serum calcium, magnesium, phosphate, ECG (during IV administration).
Popular Combinations
Calcium is sometimes combined with vitamin D to enhance absorption, particularly in cases of long-term calcium supplementation for conditions like osteoporosis.
Precautions
Administer IV calcium gluconate slowly to prevent adverse cardiovascular events. Monitor closely for extravasation at the injection site. Assess for pre-existing renal or cardiac conditions.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcium Gluconate + Calcium Lactobionate?
A: The dosage varies depending on the severity of hypocalcemia and the patient’s age and clinical status. Typical adult doses range from 1 to 2 g IV, while pediatric dosages are weight-based.
Q2: What are the common side effects?
A: Common side effects include constipation, nausea, vomiting, metallic taste, and flushing.
Q3: What are the serious side effects?
A: Serious, though rare, side effects include cardiac arrhythmias, syncope, hypotension, and extravasation-induced tissue necrosis.
Q4: When is this medication contraindicated?
A: It’s contraindicated in hypercalcemia, ventricular fibrillation, and hypersensitivity to calcium. Caution is needed in patients with renal impairment, digoxin therapy, or sarcoidosis.
Q5: Are there any significant drug interactions?
A: Yes, it can interact with digoxin, tetracycline antibiotics, and thiazide diuretics.
Q6: Can it be used during pregnancy and breastfeeding?
A: It can be used if clinically indicated but requires careful monitoring of calcium levels in mother and neonate.
Q7: What are the essential monitoring parameters during treatment?
A: Serum calcium, magnesium, phosphate, and ECG (during IV administration).
Q8: How is the medication administered?
A: Usually administered intravenously, either as a slow bolus or continuous infusion. Oral calcium supplements may be used for less acute or maintenance therapy.
Q9: How does Calcium Gluconate + Calcium Lactobionate work on a cellular level?
A: Calcium plays an important role in stabilizing cell membranes and affecting membrane permeability. It’s crucial for muscle contraction and nerve impulse transmission, working at neuromuscular junctions by enabling neurotransmitter release.
Q10: What’s the role of calcium in cardiac function?
A: Calcium is involved in the excitation-contraction coupling of cardiac muscle cells, influencing myocardial contractility.
