Calcium Chloride ASHP INJECTABLE DRUG INFORMATION

234 Calcium Chloride ASHP INJECTABLE DRUG INFORMATION

Calcium Chloride AHFS 40:12

Products Intravenous administration should be performed slowly at a rate not exceeding 0.7 to 1.8 mEq/min. The drug may also be Calcium chloride is available in 10-mL single-dose vials and injected into the ventricular cavity in cardiac resuscitation. It prefilled syringes containing 1 g of calcium chloride (dihydrate), must not be injected into the myocardium. Severe necrosis providing 13.6 mEq (270 mg) of calcium and 13.6 mEq of chlo- and sloughing may result if calcium chloride is injected intra- ride in water for injection. The pH may have been adjusted with 1(5/06) 4 muscularly or subcutaneously or leaks into the perivascular hydrochloric acid and/or calcium hydroxide. tissue.1(5/06) 4 pH From 5.5 to 7.5 diluted in water to a 5% concentration.1(5/06) 4 Stability Osmolarity The injection is clear and colorless. Intact vials should be stored at controlled room temperature. The single-use vials The 10% injection is labeled as having an osmolarity of 2.04 do not contain a preservative; the manufacturer recommends 1(5/06) mOsm/mL. discarding any unused solution.1(5/06) Osmolality Calcium chloride injection under simulated summer condi- The osmolality of a calcium chloride 10% solution was deter- tions in paramedic vehicles was exposed to temperatures mined by osmometer to be 1765 mOsm/kg.1233 ranging from 26 to 38°C over 4 weeks. Analysis found no loss of the drug under these conditions.2562 Administration Calcium chloride is administered by direct intravenous injection or by continuous or intermittent intravenous infusion.

Compatibility Information Additive Compatibility

Calcium chloride

Test Drug Test Conc/L or % Mfr Conc/L or % Test Solution Remarks Ref C/I

Amikacin sulfate BR 5 g UP 1 g D5LR, D5R, Physically compatible and both stable 294 C D5S, D5W, for 24 hr at 25°C D10W, LR, NS, R, SL

Amphotericin B 200 mg BP 4 g D5W Haze develops over 3 hr 26 I

Ascorbic acid UP 500 mg UP 1 g D5W Physically compatible 15 C

Ceftriaxone sodium Incompatible. Precipitate may form in 2222, 2731, I calcium-containing solutions 2784

Chloramphenicol PD 10 g UP 1 g D5W Physically compatible 15 C sodium succinate

Dobutamine HCl LI 182 mg UP 9 g NS Physically compatible for 20 hr. Haze 552 I forms at 24 hr

Dobutamine HCl LI 1 g ES 2 g D5W, NS Deeply pink in 24 hr at 25°C 789 I

Dobutamine HCl LI 1 g ES 50 g D5W, NS Physically compatible for 24 hr at 21°C 812 C

Dopamine HCl AS 800 mg UP D5W No dopamine loss in 24 hr at 25°C 312 C

Fat emulsion, CU 10% 1 g Immediate flocculation with visually 656 I intravenous apparent layer in 2 hr at room temperature

DOI: 10.37573/9781585286850.065 ASHP INJECTABLE DRUG INFORMATION Calcium Chloride 235

Additive Compatibility (Cont.)

Test Drug Test Conc/L or % Mfr Conc/L or % Test Solution Remarks Ref C/I

Fat emulsion, CU 10% 500 mg Flocculation within 4 hr at room 656 I intravenous temperature

Fat emulsion, VT 10% DB 1 g Coalescence and creaming in 8 hr at 8 825 I intravenous and 25°C

Fat emulsion, KV 10% 10 and 20 Immediate flocculation, aggregation, 1018 I intravenous mEq and creaming

Hydrocortisone UP 500 mg UP 1 g D5W Physically compatible 15 C sodium succinate

Isoproterenol HCl WI 4 mg UP 1 g Physically compatible 59 C

Lidocaine HCl AST 2 g UP 1 g Physically compatible 24 C

Magnesium sulfate DB 10 to 50 g DB 4 to 20 g D5W, NS Visible precipitate or microprecipitate 2597 I forms at room temperature

Magnesium sulfate DB 4 g DB 2 g D5W, NS No visible precipitate. Microscopic 2597 ? examination was inconclusive

Magnesium sulfate DB 2.5 g DB 2 g TPN #266a No visible precipitate or microprecipi- 2597 C tate in 24 hr at room temperature

Norepinephrine WI 8 mg UP 1 g D5W, D10W, Physically compatible 77 C bitartrate D2.5½S, D2.5S, D5¼S, D5½S, D5S, D10S, NS, ½S

Penicillin G potassium SQ 20 million UP 1 g D5W Physically compatible 15 C units

Penicillin G sodium UP 20 million UP 1 g D5W Physically compatible 15 C units

Pentobarbital sodium AB 1 g UP 1 g D5W Physically compatible 15 C

Phenobarbital WI 200 mg UP 1 g D5W Physically compatible 15 C sodium

Potassium phos- Compatibility dependent on solubility 1777, 2803 ? phates and concentration and is not entirely predictable. See the monograph discus- sion under Additional Compatibility Information

Sodium bicarbonate AB UP D5W Conditionally compatible depending on 15 ? concentrations

Sodium bicarbonate AB 2.4 mEqb 1 g D5W Physically compatible for 24 hr 772 C

Sodium phosphates Compatibility dependent on solubility 1777, 2803 ? and concentration and is not entirely predictable. See the monograph discus- sion under Additional Compatibility Information

Verapamil HCl KN 80 mg ES 2 g D5W, NS Physically compatible for 24 hr 764 C

a Refer to Appendix for the composition of parenteral nutrition solutions. TPN indicates a 2-in-1 admixture. b One vial of Neut added to a liter of admixture.