Calcium chloride

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# Overview
Calcium chloride is a mineral that is FDA approved for the treatment of hypocalcemia, lead colic, magnesium intoxication, hyperkalemia,.   Common adverse reactions include tingling sensations, calcium taste, a sense of oppression or heat wave, peripheral vasodilation, local burning sensation, hypotention.

# 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
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
There is limited information regarding Off-Label Guideline-Supported Use of Calcium chloride in adult patients.

### NonGuideline-Supported Use

# Indications and Dosing
- 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

# Pediatric Indications and Dosage

## FDA-Labeled Indications and Dosage (Pediatric)

# Indications
INTRACARDIAC USE
- 0.2 mL/kg of body weight.
INTRAVENOUS USE
'Hypocalcemic Disorders'
- 0.2 mL /kg of body weight. Maximum 1-10 mL/day.

## Off-Label Use and Dosage (Pediatric)

### Guideline-Supported Use
There is limited information regarding Off-Label Guideline-Supported Use of Calcium chloride in pediatric patients.

### NonGuideline-Supported Use

# Indications and Dosing
- 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.

# 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 of 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
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.

### 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

## Mechanism of Action
There is limited information regarding Calcium chloride Mechanism of Action in the drug label.

## 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
There is limited information regarding Pharmacodynamics of Calcium chloride in the drug label.

## Pharmacokinetics
There is limited information regarding Pharmacokinetics of Calcium chloride in the drug label.

## Nonclinical Toxicology
There is limited information regarding Nonclinical Toxicology of Calcium chloride in the drug label.

# Clinical Studies
There is limited information regarding Clinical Studies of Calcium chloride in the drug label.

# How Supplied
CALCIUM CHLORIDE INJECTION, USP, 10%
In unit-use packages containing a Luer-JetTM 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 30C (59 to 86F).

# Images

## Drug Images

## Package and Label Display Panel

# Patient Counseling Information
There is limited information regarding Patient Counseling Information of Calcium chloride in the drug label.

# 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
- CALCIUM CHLORIDE

# Look-Alike Drug Names
There is limited information regarding Calcium chloride Look-Alike Drug Names in the drug label.

# Drug Shortage Status
Drug Shortage

# Price