CALCIUM Drug Interactions: What You Need to Know

INTERACTIONS

• Drugs that Affect Electrolyte and/or Fluid Balance : Avoid concomitant use. If concomitant use cannot be avoided, closely monitor electrolyte concentrations and fluid balance. ( 7.1 )
• Lithium : Avoid concomitant use. If concomitant use is unavoidable, monitor serum lithium concentrations more frequently. ( 7.2 )
• Digoxin : Consider reducing the volume or rate of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection due to the increased risk of digoxin toxicity with calcium-containing solutions. ( 7.3 )
• Drugs with pH-Dependent Renal Elimination : Renal clearance of acidic drugs may be increased. In contrast, renal clearance of alkaline drugs may be decreased. ( 7.4 )

7.1 Drugs that Affect Electrolyte and/or Fluid Balance Hyperkalemia Administration of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection to patients concomitantly treated or recently treated with drugs that are associated with hyperkalemia increases the risk of severe and potentially fatal hyperkalemia, especially in the presence of other hyperkalemia risk factors. Avoid use of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection in patients receiving drugs that are associated with hyperkalemia (e.g., potassium-sparing diuretics, ACE inhibitors, angiotensin II receptor antagonists, or calcineurin inhibitors). If concomitant use cannot be avoided, closely monitor serum potassium concentrations during concomitant use <span class="opacity-50 text-xs">[see Warnings and Precautions (5.4) ]</span>.

Hyponatremia

Administration of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection to patients treated concomitantly with drugs associated with hyponatremia may increase the risk of developing hyponatremia. These drugs include diuretics and those that cause SIADH (e.g., arginine vasopressin analogs, certain antiepileptic, psychotropic, or cytotoxic drugs). Avoid use of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection in patients receiving such drugs. If use cannot be avoided, closely monitor serum sodium concentrations during concomitant use [see Warnings and Precautions (5.5) ].

Hypercalcemia

Avoid the use of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection in patients treated with thiazide diuretics or vitamin D because these drugs can increase the risk of hypercalcemia. If use cannot be avoided, closely monitor serum calcium concentrations during concomitant use [see Warnings and Precautions (5.8) ]. Hypernatremia and Fluid Retention Administration of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection to patients treated concomitantly with drugs associated with sodium and fluid retention (e.g., corticosteroids or corticotropin) may increase the risk of hypernatremia and volume overload. Avoid use of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection in patients receiving such drugs. If use cannot be avoided, closely monitor serum electrolytes, fluid balance, and acid-base balance during concomitant use.

7.2 Lithium Renal sodium and lithium clearance may be increased during concomitant use of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection and lithium and may result in decreased lithium concentrations. Avoid use of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection in patients receiving lithium. If use cannot be avoided, increase the frequency of monitoring of serum lithium concentrations during concomitant use.

7.3 Digoxin Administration of calcium via use of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection may increase digoxin’s effects and lead to digoxin toxicity including serious or fatal cardiac arrhythmias. In digoxin-treated patients, consider reducing the volume and/or rate of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection administration.

7.4 Drugs with pH-Dependent Renal Elimination Due to the alkalinizing action of lactate (formation of bicarbonate), Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection may interfere with the elimination of drugs with pH-dependent renal elimination. Renal clearance of alkaline drugs may be decreased. In contrast, renal clearance of acidic drugs may be increased.

7.5 Interference of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection with Interpretation of Serum Lactate Levels in Patients with Severe Metabolic Acidosis Because administration of Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection may interfere with the interpretation of serum lactate levels in patients with severe metabolic acidosis, including lactic acidosis, assessment of the patient’s clinical status should not solely rely on the measurement of serum lactate.

Potassium Chloride in Lactated Ringer’s and Dextrose (5%) Injection is contraindicated in:

• Neonates (28 days of age or younger) who are receiving concomitant treatment with ceftriaxone, even if separate infusion lines are used, due to the risk of fatal ceftriaxone-calcium salt precipitation in the neonate’s bloodstream [see Warnings and Precautions (5.1) and Specific Populations (8.4) ] .
• Patients with known hypersensitivity to any of the components of Potassium Chloride in Lactated Ringer’s solution and Dextrose (5%) Injection [see Warnings and Precautions (5.3) ] .
• Patients with clinically significant hyperkalemia [see Warnings and Precautions (5.4) ] .
• Patients with clinically significant hyperglycemia [see Warnings and Precautions (5.7) ] .
• Concomitant treatment with ceftriaxone in neonates (28 days of age or younger). ( 4 )
• Patients with known hypersensitivity to any of the components of Potassium Chloride in Lactated Ringer’s solution and Dextrose (5%) Injection ( 4 )
• Patients with clinically significant hyperkalemia ( 4 ).
• Patients with clinically significant hyperglycemia ( 4 ).

Warnings Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if: sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: if sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days. irritation, pain, or redness persists or worsens. Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, swelling, nausea or vomiting, consult a doctor promptly. These may be serious. Stop use and ask a doctor if sore throat does not improve in 7 days Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 7 days, is accompanied or followed by fever, headache, rash, swelling, nausea or vomiting, consult a doctor promptly. These may be serious. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, swelling, nausea or vomiting, consult a doctor promptly. These may be serious. Stop use and ask a doctor if sore throat does not improve in 7 days. Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if: sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if: sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, swelling, nausea or vomiting, consult a doctor promptly. These may be serious. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 7 days, is accompanied or followed by fever, headache, rash, swelling, nausea or vomiting, consult a doctor promptly. These may be serious. Stop use and ask a doctor if Sore throat does not improve in 7 days Irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 7 days, is accompanied or followed by fever, headache, rash, swelling, nausea or vomiting, consult a doctor promptly. These may be serious. Stop use and ask a doctor if Sore throat does not improve in 7 days Irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: if sore throat is severe, persists for more than 7 days, is accompanied or followed by fever, headache, rash, swelling, nausea or vomiting, consult a doctor promptly. These may be serious. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, swelling, nausea or vomiting, consult a doctor promptly. These may be serious. Stop use and ask a doctor if sore throat does not improve in 7 days Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, swelling, nausea, or vomiting, consult a doctor promptly. These may be serious. Stop use and ask a doctor if sore throat does not improve in 7 days. Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, swelling, nausea or vomiting, consult a doctor promptly. These may be serious. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomitting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Ask a doctor or pharmacist before use if the child is: presently taking a prescription drug. Antacids may interact with certain prescription drugs. Stop use and ask a doctor if symptoms last more than 2 weeks Keep this and all drugs out of the reach of children.

Warnings

Ask a doctor or pharmacist before use if the child is: presently taking a prescription drug. Antacids may interact with certain prescription drugs Stop use and ask a doctor if symptoms last more than 2 weeks Keep this and all drugs out of the reach of children.

Warnings

Ask a doctor or pharmacist before use if the child is: presently taking a prescription drug. Antacids may interact with certain prescription drugs. Do not take more than 6 pops (ages 3 to 5) to 12 pops (ages 6 to 12) in a 24-hour period, or use the maximum dosage for more than two weeks, except under the advice and supervision of a doctor Stop use and ask a doctor if symptoms last more than 2 weeks Keep out of reach of children.

Warnings

Ask a doctor or pharmacist before use if the child is: presently taking a prescription drug. Antacids may interact with certain prescription drugs. Do not take more than 6 pops (ages 3 to 5) to 12 pops (ages 6 to 12) in a 24-hour period, or use the maximum dosage for more than two weeks, except under the advice and supervision of a doctor Stop use and ask a doctor if symptoms last more than 2 weeks Keep out of reach of children.

Warnings

Sore throat warning: if sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: if sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: if sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: If sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.

Warnings

Sore throat warning: if sore throat is severe, persists for more than 2 days, is accompanied or followed by fever, headache, rash, nausea, or vomiting, consult a doctor promptly. If sore mouth symptoms do not improve in 7 days, see your dentist or doctor promptly. Stop use and ask a doctor if sore throat does not improve in 7 days irritation, pain, or redness persists or worsens Keep out of reach of children.