Tums

calcium acetate

Phos-Ex (UK), PhosLo, PhosLo Gelcap

calcium carbonate

Adcal (UK), Alka-Mints, Cacit (UK), Calcarb 600, Calci-Chew, Calci-Mix, Caltrate 600, Children's Pepto Chooz, Florical, Maalox Regular Chewable, Mylanta Children's, Nephro-Calci, Nu-Cal (CA), Os-Cal, Os-Cal 500, Oysco, Oyst-Cal 500, Oystercal 500, Rapeze (UK), Remegel (UK), Rennie Soft Chews (UK), Rolaids Calcium Rich, SeapCal (UK), Setlers (UK), Tums, Tums E-X, Tums Ultra

calcium chloride

Calciject (CA), Cal-San (CA), Cal-500 (CA) Calcarea (CA), Calciforte (CA), Cal Supp (CA)

calcium citrate

Cal-C-Caps, Cal-CEE

calcium gluconate

calcium lactate

tricalcium phosphate

Posture

Pharmacologic class: Mineral

Therapeutic class: Dietary supplement, electrolyte replacement agent

Pregnancy risk category C (calcium acetate, chloride, glubionate, gluceptate, phosphate), NR (calcium carbonate, citrate, gluconate, lactate)

Action

Increases serum calcium level through direct effects on bone, kidney, and GI tract. Decreases osteoclastic osteolysis by reducing mineral release and collagen breakdown in bone.

Availability

Calcium acetate-

Gelcaps: 667 mg

Tablets: 667 mg

Calcium carbonate-

Capsules: 1,250 mg

Lozenges: 600 mg

Oral suspension: 1,250 mg

Powder: 6.5 g

Tablets: 650 mg, 1,250 mg, 1,500 mg

Tablets (chewable): 750 mg, 1,000 mg, 1,250 mg

Tablets (gum): 300 mg, 450 mg, 500 mg

Calcium chloride-

Injection: 10% solution

Calcium citrate-

Tablets: 950 mg

Calcium gluceptate-

Injection: 22% solution

Calcium gluconate-

Injection: 10% solution

Tablets: 500 mg, 650 mg, 975 mg

Calcium lactate-

Tablets: 325 mg, 650 mg

Tricalcium phosphate-

Tablets: 600 mg

Indications and dosages

➣ Hypocalcemic emergency

Adults: 7 to 14 mEq I.V. of 10% calcium gluconate solution, 2% to 10% calcium chloride solution, or 22% calcium gluceptate solution

Children: 1 to 7 mEq calcium gluconate I.V.

Infants: Up to 1 mEq calcium gluconate I.V.

➣ Hypocalcemic tetany

Adults: 4.5 to 16 mEq calcium gluconate I.V., repeated as indicated until tetany is controlled

Children: 0.5 to 0.7 mEq/kg calcium gluconate I.V. three to four times daily as indicated until tetany is controlled

Neonates: 2.4 mEq/kg calcium gluconate I.V. daily in divided doses

➣ Cardiac arrest

Adults: 0.027 to 0.054 mEq/kg calcium chloride I.V., 4.5 to 6.3 mEq calcium gluceptate I.V., or 2.3 to 3.7 mEq calcium gluconate I.V.

Children: 0.27 mEq/kg calcium chloride I.V., repeated in 10 minutes if needed. Check calcium level before giving additional doses.

➣ Magnesium intoxication

Adults: Initially, 7 mEq I.V.; subsequent dosages based on patient response

➣ Exchange transfusions

Adults: 1.35 mEq calcium gluconate I.V. with each 100 ml of citrated blood

➣ Hyperphosphatemia in patients with end-stage renal disease

Adults: Two tablets P.O. daily, given in divided doses t.i.d. with meals. May increase gradually to bring serum phosphate level below 6 mg/dl, provided hypercalcemia doesn't develop.

➣ Dietary supplement

Adults: 500 mg to 2 g P.O. daily

Off-label uses

• Osteoporosis

Contraindications

• Hypersensitivity to drug

• Ventricular fibrillation

• Hypercalcemia and hypophosphatemia

• Cancer

• Renal calculi

• Pregnancy or breastfeeding

Precautions

Use cautiously in:

• renal insufficiency, pernicious anemia, heart disease, sarcoidosis, hyperparathyroidism, hypoparathyroidism

• history of renal calculi

• children.

Administration

See When infusing I.V., don't exceed a rate of 200 mg/minute.

• Keep patient supine for 15 minutes after I.V. administration to prevent orthostatic hypotension.

• Administer P.O. doses 1 to 1½ hours after meals.

• Know that I.M. or subcutaneous administration is never recommended.

• Be aware that I.V. route is preferred in children.

• Be alert for extravasation, which causes tissue necrosis.

Adverse reactions

CNS: headache, weakness, dizziness, syncope, paresthesia

CV: mild blood pressure decrease, bradycardia, arrhythmias, cardiac arrest (with rapid I.V. injection)

GI: nausea, vomiting, diarrhea, constipation, epigastric pain or discomfort

GU: urinary frequency, renal calculi

Metabolic: hypercalcemia

Musculoskeletal: joint pain, back pain

Respiratory: dyspnea

Skin: rash

Other: altered or chalky taste, excessive thirst, allergic reactions (including facial flushing, swelling, tingling, tenderness in hands, and anaphylaxis)

Interactions

Drug-drug. Atenolol, fluoroquinolones, tetracycline: decreased bioavailability of these drugs

Calcium channel blockers: decreased calcium effects

Cardiac glycosides: increased risk of cardiac glycoside toxicity

Iron salts: decreased iron absorption

Sodium polystyrene sulfonate: metabolic alkalosis

Verapamil: reversal of verapamil effects

Drug-diagnostic tests. Calcium: increased level

Drug-food. Foods containing oxalic acid (such as spinach), phytic acid (such as whole grain cereal), or phosphorus (such as dairy products): interference with calcium absorption

Patient monitoring

• Monitor calcium levels frequently, especially in elderly patients.

Patient teaching

• Instruct patient to consume plenty of milk and dairy products during therapy.

• Refer patient to dietitian for help in meal planning and preparation.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

calcium carbonate

(kal-see-um kar-bo-nate) calciumcarbonate,

Alka-Mints

(trade name),

Amitone

(trade name),

Apo-Cal

(trade name),

BioCal

(trade name),

Calcarb

(trade name),

Calci-Chew

(trade name),

Calciday

(trade name),

Calcilac

(trade name),

Calci-Mix

(trade name),

Calcite

(trade name),

Calglycine

(trade name),

Cal-Plus

(trade name),

Calsan

(trade name),

Caltrate

(trade name),

Chooz

(trade name),

Dicarbosil

(trade name),

Equilet

(trade name),

Gencalc

(trade name),

Liqui-Cal

(trade name),

Liquid Cal-600

(trade name),

Maalox Antacid Caplets

(trade name),

Mallamint

(trade name),

Mylanta Lozenges

(trade name),

Nephro-Calci

(trade name),

Nu-Cal

(trade name),

Os-Cal

(trade name),

Oysco

(trade name),

Oyst-Cal

(trade name),

Oystercal

(trade name),

Rolaids Calcium Rich

(trade name),

Surpass

(trade name),

Surpass Extra Strength

(trade name),

Titralac

(trade name),

Tums

(trade name),

Tums E-X

(trade name)

Classification

Therapeutic: mineral electrolyte replacements supplements
Pregnancy Category: C

Indications

Treatment and prevention of hypocalcemia.Adjunct in the prevention of postmenopausal osteoporosis.Relief of acid indigestion or heartburn.Treatment of hyperphosphatemia in end-stage renal disease.

Action

Essential for nervous, muscular, and skeletal systems.Maintain cell membrane and capillary permeability.Act as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle.Essential for bone formation and blood coagulation.

Therapeutic effects

Replacement of calcium in deficiency states. Control of hyperphosphatemia in end-stage renal disease without promoting aluminum absorption.

Pharmacokinetics

Absorption: Absorption from the GI tract requires vitamin D.Distribution: Readily enters extracellular fluid. Crosses the placenta and enters breast milk.Metabolism and Excretion: Excreted mostly in the feces; 20% eliminated by the kidneys.Half-life: Unknown.

Time/action profile (effects on serum calcium)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	unknown
IV	immediate	immediate	0.5–2 hr

Contraindications/Precautions

Contraindicated in: Hypercalcemia; Renal calculi; Ventricular fibrillation.Use Cautiously in: Patients receiving digitalis glycosides; Severe respiratory insufficiency; Renal disease; Cardiac disease.

Adverse Reactions/Side Effects

Central nervous system

headche
tingling

Cardiovascular

arrhythmias (most frequent)
bradycardia

Gastrointestinal

constipation (most frequent)
nausea
vomiting

Genitourinary

calculi
hypercalciuria

Interactions

Drug-Drug interaction

Hypercalcemia increases the risk of digoxin toxicity.Chronic use with antacids in renal insufficiency may lead to milk-alkali syndrome.Ingestion by mouth decreases the absorption of orally administered tetracyclines, fluoroquinolones, phenytoin, and iron salts.Excessive amounts may decrease the effects of calcium channel blockers.Decreases absorption of etidronate and risedronate (do not take within 2 hr of calcium supplements).May decrease the effectiveness of atenolol.Concurrent use with diuretics (thiazide) may result in hypercalcemia.May decrease the ability of sodium polystyrene sulfonate to decrease serum potassium.Cereals, spinach, or rhubarb may decrease the absorption of calcium supplements.Calcium acetate should not be given concurrently with other calcium supplements.

Route/Dosage

1 gram of calcium carbonate contains 400 mg elemental calcium (20 mEq calcium). Doses expressed in terms of elemental calcium.Oral (Adults) Prevention of hypocalcemia, treatment of depletion, osteoporosis—1–2 g/day in 3–4 divided doses. Antacid—0.5–1.5 g as needed. Hyperphosphatemia in end-stage renal disease —1 g with each meal, increase to 4–7 g as needed.Oral (Children) Supplementation—45–65 mg/kg/day in 4 divided doses.Oral (Infants) Neonatal hypocalcemia—50–150 mg/kg in 4–6 divided doses (not to exceed 1 g/day).

Availability

Tablets: 500 mg (200 mg Ca)^OTC, 600 mg (240 mg Ca)^OTC, 650 mg (260 mg Ca)^OTC, 667 mg (266.8 mg Ca)^OTC, 1 g (400 mg Ca)^OTC, 1.25 g (500 mg Ca)^OTC, 1.5 g (600 mg Ca)^OTCChewable tablets: 350 mg (300 mg Ca)^OTC, 420 mg (168 mg Ca)^OTC, 450 mg ^OTC, 500 mg (200 mg Ca)^OTC, 750 mg (300 mg Ca)^OTC, 1 g (400 mg Ca)^OTC, 1.25 g (500 mg Ca)^OTCGum tablets: 300 mg ^OTC, 450 mg ^OTC, 500 mg (200 mg Ca)^OTCCapsules: 1.25 g (500 mg Ca)^OTCLozenges: 600 mg (240 mg Ca)^OTCOral suspension: 1.25 g (500 mg Ca)/5 mL^OTCPowder: 6.5 g (2400 mg Ca)/packet^OTC

Nursing implications

Nursing assessment

Calcium Supplement/Replacement: Observe patient closely for symptoms of hypocalcemia (paresthesia, muscle twitching, laryngospasm, colic, cardiac arrhythmias, Chvostek’s or Trousseau’s sign). Notify physician or other health care professional if these occur. Protect symptomatic patients by elevating and padding siderails and keeping bed in low position.
- Monitor patient on digitalis glycosides for signs of toxicity.
Antacid: When used as an antacid, assess for heartburn, indigestion, and abdominal pain. Inspect abdomen; auscultate bowel sounds.
Lab Test Considerations: Monitor serum calcium or ionized calcium, chloride, sodium, potassium, magnesium, albumin, and parathyroid hormone (PTH) concentrations before and periodically during therapy for treatment of hypocalcemia.
- May cause decreased serum phosphate concentrations with excessive and prolonged use. When used to treat hyperphosphatemia in renal failure patients, monitor phosphate levels.

Potential Nursing Diagnoses

Imbalanced nutrition: less than body requirements (Indications)
Risk for injury, related to osteoporosis or electrolyte imbalance (Indications)

Implementation

Oral: Administer calcium carbonate 1–1.5 hr after meals and at bedtime. Chewable tablets should be well chewed before swallowing. Dissolve effervescent tablets in glass of water. Follow oral doses with a full glass of water, except when using calcium carbonate as a phosphate binder in renal dialysis. Administer on an empty stomach before meals to optimize effectiveness in patients with hyperphosphatemia.

Patient/Family Teaching

Instruct patient not to take enteric-coated tablets within 1 hr of calcium carbonate; this will result in premature dissolution of the tablets.
- Do not administer concurrently with foods containing large amounts of oxalic acid (spinach, rhubarb), phytic acid (brans, cereals), or phosphorus (milk or dairy products). Administration with milk products may lead to milk-alkali syndrome (nausea, vomiting, confusion, headache). Do not take within 1–2 hr of other medications if possible.
- Instruct patients on a regular schedule to take missed doses as soon as possible, then go back to regular schedule.
- Advise patient that calcium carbonate may cause constipation. Review methods of preventing constipation (increasing bulk in diet, increasing fluid intake, increasing mobility) and using laxatives. Severe constipation may indicate toxicity.
- Advise patient to avoid excessive use of tobacco or beverages containing alcohol or caffeine.
Calcium Supplement: Encourage patients to maintain a diet adequate in vitamin D (see ).
Osteoporosis: Advise patients that exercise has been found to arrest and reverse bone loss. Patient should discuss any exercise limitations with health care professional before beginning program.

Evaluation/Desired Outcomes

Increase in serum calcium levels.
Decrease in the signs and symptoms of hypocalcemia.
Resolution of indigestion.
Control of hyperphosphatemia in patients with renal failure.

Tums

(tŭmz) A trademark for an over-the-counter preparation of calcium carbonate, taken chiefly to treat heartburn.