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 Formulary Chapter 9: Nutrition and blood - Full Chapter
09.05.01.01  Expand sub section  Calcium supplements
 note 

Notes:

  • Patients should be encouraged to increase their dietary intake of calcium.
  • Calcium supplements are usually only required where dietary calcium intake is deficient. Patients with coeliac disease are at increased risk of osteoporosis due to malabsorption of calcium, weight loss and low BMI. With a good response to a gluten free diet, bone mineral density increases. However, many coeliacs require supplementary calcium. (see section 9.6.4)
  • Approximately 700mg of calcium is required per day. In osteoporosis, double the recommended daily amount reduces the risk of bone loss. For specific advice on the use of calcium in treatment and prophylaxis of osteoporosis see chapter 6 section 6.6 ‘Drugs affecting bone metabolism’.
  • Calcium Sandoz® syrup is included where a liquid form of calcium is required.
  • Calcium and vitamin D products are included in Section 9.6.4.
Calcium Chloride
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Red

Min-I-jet 10mL 

 

Shortage of supply (23/03/2020) - Calcium chloride 10% pre-filled syringes:

Calcium chloride pre-filled syringes 10% (6.8 mmol in 10 ml) are licensed for use in cardio-pulmonary resuscitation, as well as the treatment of hypocalcaemia and calcium deficiency states. 

The 10 ml pre-filled syringe of calcium chloride 10% is the preparation listed in the Resus Council list of drugs for intravenous use for cardiac- and peri-arrest. In cardiac arrest caused by hyperkalaemia, hypocalcaemia, or overdose of calcium channel-blocking drugs, an initial dose of 10 ml of 10% calcium chloride (6.8 mmol Ca2+) is recommended, which may be repeated if necessary.

Calcium chloride 10% pre filled syringes are out of stock, we do not currently have a clear date for resolution.

Alternative agents and management options

Calcium gluconate injection is an alternative to calcium chloride. In order to manage this shortage, some of the cardiac arrest boxes will contain calcium gluconate ampoules instead of calcium chloride pre-filled syringes.

It is important to note that there is a difference in calcium content:

10 ml of 10% calcium chloride pre-filled syringes contains 6.8 mmol calcium whereas 10 ml of 10% calcium gluconate contains 2.26 mmol calcium.

The Resus Council mentions use of calcium gluconate as an alternative, highlighting difference in calcium content, you would need to administer 30mls of calcium gluconate to achieve 6.78 mmol calcium and during CPR, if required, it should be given as a rapid bolus injection followed by a 0.9% sodium chloride flush.

Administration

Calcium gluconate can be given as a slow IV injection in an emergency (e.g. severe acute hypocalcaemia, cardiac resuscitation, hypocalcaemic tetany). Give each 10mL of undiluted injection over at least 5 minutes, while monitoring plasma-calcium and ECG. (Resus Council advises can be given as rapid bolus injection during CPR).

Safety:

Calcium gluconate undiluted has a high osmolarity and may cause venous irritation and tissue damage in cases of extravasation.

There may be certain patients, for example in critical care and those with severe liver impairment, for whom the increased volume of gluconate or the time taken to infuse this additional volume may be problematic, and any remaining stock of chloride may need to be prioritised for this group.

 

 

 
   
Calcium Gluconate
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Red

10mL ampoule 

 
   
Sandocal-1000
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Green

Effervescent tablets containing 1000mg calcium (25mmol)

Note:  Approved for the short term treatment of hypocalcaemia post thyroidectomy.

 
   
 ....
 Non Formulary Items
Cacit
(Calcium carbonate)

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Non Formulary
 
Calcichew
(Calcium carbonate)

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Non Formulary
 
Calcium Salts
(Calcium lactate)

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Non Formulary
 
Calcium Salts

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Non Formulary
 
Calcium Syrup  (Alliance Pharma)

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Non Formulary
 
Calcium-Sandoz

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Non Formulary
 
  
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Green

Routine prescribing within licensed indication  

Amber 1

Specialist recommendation followed by GP initiation and continuation  

Amber 2

Specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation   

Amber 3

Specialist initiation and stabilisation followed by GP continuation  

Amber SCG

Specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline  

Red

Hospital or specialist prescribing only  

Red Red

These medicines have been evaluated and rejected by MKPAG and are NOT approved for use within MK. They are not recommended for use because of lack of clinical effectiveness, cost effectiveness or safety.  

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