2 DOSAGE AND ADMINISTRATION
2.1 Important Administration Instructions
Administer Calcium Chloride Injection by slow intravenous infusion in a central or deep vein in adults and pediatric patients (with or without renal impairment); do not administer by bolus [see Warnings and Precautions (5.2, 5.4)]. The maximum recommended infusion rate is 1 mL/minute (100 mg/minute).
Additional important administration instructions regarding Calcium Chloride Injection are as follows:
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- Do not use intramuscularly or subcutaneously to avoid tissue necrosis calcinosis cutis [see Warnings and Precautions (5.4)].
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- Visually inspect for particulate matter and discoloration prior to administration (the solution is clear, and the seal is intact). Do not administer if the solution is unclear or the seal is not intact.
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- Stop the administration if the patient complains of any administration-related discomfort; administration may be resumed when symptoms disappear.
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- Discard the unused portion.
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- If time permits, allow the solution to warm to body temperature.
2.2 Recommended Dosage and Administration
The recommended dose range of Calcium Chloride Injection in:
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- Adults is from 200 mg to 1,000 mg.
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- Pediatric patients is from 2.7 to 5 mg/kg of calcium chloride.
Dosing of this Calcium Chloride Injection product is not possible in patients who require doses less than 200 mg because the recommended dose cannot be achieved with the supplied syringe. For patients who require doses less than 200 mg, use another calcium chloride injection product that allows dosing of less than 200 mg.
Individualize the dose for a patient within these dose ranges depending on serum ionized calcium level, severity of hypocalcemia symptoms, and the acuity of hypocalcemia onset.
Repeated injections may be required because of rapid excretion of calcium.
2.3 Recommended Starting Dose in Patients with Renal Impairment
The recommended starting dose of Calcium Chloride Injection in [see Use in Specific Populations (8.6)]:
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- Adults with renal impairment is 200 mg.
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- Pediatric patients is 2.7 mg/kg of calcium chloride.
2.4 Drug Incompatibilities
Do not mix Calcium Chloride Injection with other drugs simultaneously. Do not mix Calcium Chloride Injection with ceftriaxone or administer these products simultaneously via a Y-site because concurrent use can lead to the formation of ceftriaxone-calcium precipitates [see Warnings and Precautions (5.1)]:
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- In neonates (28 days of age or younger), concomitant use of Calcium Chloride Injection and ceftriaxone is contraindicated [see Contraindications (4)].
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- In patients older than 28 days of age, ceftriaxone and calcium-containing products may be administered sequentially, provided the infusion lines are thoroughly flushed between infusions with a compatible fluid.