Usual Adult Dose for Hypocalcemia

325 to 650 mg orally 2 to 3 times a day before meals. Treatment may also consist of vitamin D orally.

Usual Adult Dose for Osteomalacia

325 to 650 mg orally 2 to 3 times a day before meals. Treatment may also consist of vitamin D orally.

Usual Adult Dose for Hypoparathyroidism

325 mg orally 3 times a day before meals. Treatment may also consist of vitamin D orally.

Usual Adult Dose for Pseudohypoparathyroidism

325 mg orally once a day before the breakfast meal. Treatment may also consist of vitamin D orally.

Usual Adult Dose for Osteoporosis

325 to 650 mg orally 3 times a day before meals. Osteoporosis can be affected by increased serum parathyroid hormone, excessive alcohol intake, tobacco use, certain drugs (corticosteroids, anticonvulsants, heparin, thyroid hormone), dietary vitamin D, and weight bearing exercise.

Usual Pediatric Dose for Hypocalcemia

Neonatal:
Oral:
Hypocalcemia (dose depends on clinical condition and serum calcium level):
Dose expressed in mg of elemental calcium: 50 to 150 mg/kg/day in 4 to 6 divided doses; not to exceed 1 g/day
Dose expressed in mg of calcium lactate: 400 to 500 mg/kg/day divided every 4 to 6 hours

Oral:
Hypocalcemia (dose depends on clinical condition and serum calcium level):
Dose expressed in mg of elemental calcium:
Children: 45 to 65 mg/kg/day in 4 divided doses
Dose expressed in mg of calcium lactate:
Infants: 400 to 500 mg/kg/day divided every 4 to 6 hours
Children: 500 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 9 g

Renal Dose Adjustments

Patients with renal dysfunction have an increased risk of hypercalcemia. Periodically checking the serum calcium level, especially if signs or symptoms of hypercalcemia are detected, is recommended.

Liver Dose Adjustments

Data not available

Precautions

Calcium lactate is contraindicated in patients with renal calculi, hypophosphatemia, or hypercalcemia.

Dialysis

Calcium is removed by hemodialysis. To ensure a positive net calcium flux into the patient during dialysis, a dialysate calcium concentration of 3.0 to 3.5 mEq/L is usually required. Mid-dialysis modest hypercalcemia is not uncommon when this concentration is used.

Calcium is removed by peritoneal dialysis. The standard peritoneal dialysate contains 3.5 mEq/L of calcium (in 1.5% dextrose) to maintain a positive calcium balance and to prevent calcium losses. When higher concentrations of dextrose are used, the net calcium balance may be negative because of a greater convective removal of calcium during ultrafiltration, which counterbalances the diffusion of calcium from the dialysate to the patient.

Other Comments

Recommended daily allowance (RDA): Dosage is in terms of elemental calcium:
1 to 6 months: 400 mg/day
6 to 12 months: 600 mg/day
1 to 10 years: 800 mg/day
11 to 24 years: 1200 mg/day
Adults greater than 24 years: 800 mg/day

Adequate intake (1997 National Academy of Science Recommendations): Dosage is in terms of elemental calcium:
1 to 6 months: 210 mg/day
7 to 12 months: 270 mg/day
1 to 3 years: 500 mg/day
4 to 8 years: 800 mg/day
9 to 18 years: 1300 mg/day
19 to 50 years: 1000 mg/day
Greater than 50 years: 1200 mg/day

Calcium lactate:
Elemental calcium: 130 mg/1 g (6.5 mEq calcium/gram)
Approximate equivalent dose: 700 mg of calcium salt