CALCIUM CHLORIDE Sterile solution for slow intravenous infusion Ref.[8814] Active ingredients: Calcium chloride

Calcium chloride must be administered slowly through the vein.

Too rapid intravenous injection may lead to symptoms of hypercalcaemia.

The use of calcium chloride is undesirable in patients with respiratory acidosis or respiratory failure due to the acidifying nature of the salt.

In patients of any age ceftriaxone must not be mixed or administered simultaneously with any calcium-containing IV solutions, even via different infusion lines or at different infusion sites. However, in patients older than 28 days of age ceftriaxone and calcium-containing solutions may be administered sequentially one after another if infusion lines at different sites are used, or if the infusion lines are replaced or thoroughly flushed between infusions with physiological salt-solution to avoid precipitation. In patients requiring continuous infusion with calcium-containing TPN solutions, healthcare professionals may wish to consider the use of alternative antibacterial treatments which do not carry a similar risk of precipitation. If use of ceftriaxone is considered necessary in patients requiring continuous nutrition, TPN solutions and ceftriaxone can be administered simultaneously, albeit via different infusion lines at different sites. Alternatively, infusion of TPN solution could be stopped for the period of ceftriaxone infusion, considering the advice to flush infusion lines between solutions.

A moderate fall in blood pressure due to vasodilation may attend the injection.

Since calcium chloride is an acidifying salt, it is usually undesirable in the treatment of hypocalcaemia of renal insufficiency.

Calcium chloride injection is irritating to veins and must not be injected into tissues, since severe necrosis and sloughing may occur. Great care should be taken to avoid extravasation or accidental injection into perivascular tissues. Should perivascular infiltration occur, IV administration at that site should be discontinued at once. Local infiltration of the affected area with 1 % procaine hydrochloride, to which hyaluronidase may be added, will often reduce venospasm and dilute the calcium remaining in the tissues locally. Local application of heat may also be helpful.

Excessive amounts of calcium salts may cause hypercalcaemia. Careful monitoring of serum-electrolyte concentrations is essential throughout therapy.

It is particularly important to prevent a high concentration of calcium from reaching the heart because of danger of cardiac syncope. If injected into the ventricular cavity in cardiac resuscitation care must be taken to avoid injection into the myocardial tissue.

Care should be taken not to infiltrate the perivascular tissue due to possible necrosis. Solutions should be warmed to body temperature. Injections should be made slowly through a small needle into a large vein to minimize venous irritation and avoid undesirable reactions.

Calcium Chloride is generally considered to be the most irritant of the commonly used calcium salts.

For interaction between calcium containing products and ceftriaxone, please see sections 4.4 above.

Calcium-containing products may decrease the effectiveness of calcium channel blockers.

Large intravenous doses of calcium can precipitate arrhythmias by interacting with cardiac glycosides (e.g. digitoxin and digoxin).

Because of the danger involved in the simultaneous use of calcium salts and drugs of the digitalis group, a digitalized patient should not receive an intravenous injection of a calcium compound unless the indications are clearly defined.

Calcium salts should not generally be mixed with carbonates, phosphates, sulfates or tartrate in parenteral mixtures.

Calcium salts reduce the absorption of bisphosphonates (in the treatment of Paget’s disease or hypercalcaemia of malignancy) and must be given at least 12 hours apart.

Thiazide diuretics may increase the risk of hypercalcaemia.

Calcium salts reduce the absorption of tetracyclines.

Studies on the effects of calcium chloride on pregnant women have not been carried out and problems have not been documented. Calcium crosses the placenta. The benefits of administration must outweigh any potential risk.

Calcium is excreted in breast milk but there are no data on the effects, if any, on the infant. It is recommended in the UK for an increase in calcium intake during lactation. Furthermore, the absorption of calcium is increased during pregnancy and lactation.

No adverse effects have been reported.

Rapid intravenous injections may cause the patient to complain of tingling sensations, a calcium taste, and 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.

Necrosis and sloughing with subcutaneous or intramuscular administration or if extravasation occurs have been reported. Soft tissue calcification, bradycardia or arrhythmias have also been reported.

Hypertension

Venous thrombosis

Excessive amounts of calcium salts may lead to hypercalcaemia.

Symptoms of hypercalcaemia may include:

• anorexia,
• nausea,
• vomiting,
• constipation,
• abdominal pain,
• muscle weakness,
• mental disturbances,
• polydipsia,
• polyuria,
• bone pain,
• nephrocalcinosis,
• renal calculi, and,
• in severe cases, cardiac arrhythmias and coma.

Too rapid intravenous injection of calcium salts may also lead to many of the symptoms of hypercalcaemia as well as a chalky taste, hot flushes and peripheral vasodilation.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Calcium salts should not be mixed with carbonates, phosphates, sulfates, tartrates or tetracycline antibiotics in parenteral mixtures.

Calcium containing solutions should not be mixed with Ceftriaxone because a precipitate can form. Calcium containing solutions should not be administered simultaneously with Ceftriaxone (see section 4.4).

Calcium salts have been reported to be incompatible with a wide range of drugs (see section 4.5). Complexes may form resulting in the formation of a precipitate.