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Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D

Name: Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D drug & pharmaceuticals. Available Forms, Doses, Prices
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Published: 2021-11-11T10:10:10+00:00

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Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D uses

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D consists of Calcium (Calcium Citrate), Magnesium (Magnesium Citrate), Magnesium (Magnesium Oxide), Manganese (Manganese Citrate), Potassium (Potassium Citrate), Vitamin D3, Zinc (Zinc Citrate).

Calcium (Calcium Citrate):

Indications and usage
Dosage and administration
Dosage forms and strengths
Contraindications
Warnings and precautions
Adverse reactions
Drug interactions
Use in specific populations
Overdosage
Description
Clinical pharmacology
Nonclinical toxicology
Clinical studies
How supplied/storage and handling
Patient counseling information
Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) reviews

1 INDICATIONS AND USAGE

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate is a phosphate binder indicated to reduce serum phosphorus in patients with end stage renal disease (ESRD).

- Calcium acetate is a phosphate binder indicated for the reduction of serum phosphorus in patients with end stage renal disease. (1)

2 DOSAGE AND ADMINISTRATION

The recommended initial dose of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate for the adult dialysis patient is 2 capsules with each meal. Increase the dose gradually to lower serum phosphorus levels to the target range, as long as hypercalcemia does not develop. Most patients require 3 to 4 capsules with each meal.

- Starting dose is 2 capsules with each meal. (2)

- Titrate the dose every 2 to 3 weeks until acceptable serum phosphorus level is reached. Most patients require 3 to 4 capsules with each meal. (2)

3 DOSAGE FORMS AND STRENGTHS

Capsule: 667 mg Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate capsule.

- Capsule: 667 mg Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate capsule. (3)

4 CONTRAINDICATIONS

Patients with hypercalcemia.

- Hypercalcemia. (4)

5 WARNINGS AND PRECAUTIONS

- Treat mild hypercalcemia by reducing or interrupting Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) acetate and Vitamin D. Severe hypercalcemia may require hemodialysis and discontinuation of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate. (5.1)

- Hypercalcemia may aggravate digitalis toxicity. (5.2)

5.1 Hypercalcemia

Patients with end stage renal disease may develop hypercalcemia when treated with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)), including Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate. Avoid the use of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) supplements, including Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) based nonprescription antacids, concurrently with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate.

An overdose of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate may lead to progressive hypercalcemia, which may require emergency measures. Therefore, early in the treatment phase during the dosage adjustment period, monitor serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) levels twice weekly. Should hypercalcemia develop, reduce the Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate dosage, or discontinue the treatment, depending on the severity of hypercalcemia

More severe hypercalcemia (Ca >12 mg/dL) is associated with confusion, delirium, stupor and coma. Severe hypercalcemia can be treated by acute hemodialysis and discontinuing Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate therapy.

Mild hypercalcemia (10.5 to 11.9 mg/dL) may be asymptomatic or manifest as constipation, anorexia, nausea, and vomiting. Mild hypercalcemia is usually controlled by reducing the Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate dose or temporarily discontinuing therapy. Decreasing or discontinuing Vitamin D therapy is recommended as well.

Chronic hypercalcemia may lead to vascular calcification and other soft-tissue calcification. Radiographic evaluation of suspected anatomical regions may be helpful in early detection of soft tissue calcification. The long term effect of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate on the progression of vascular or soft tissue calcification has not been determined.

Hypercalcemia (>11 mg/dL) was reported in 16% of patients in a 3 month study of solid dose formulation of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate; all cases resolved upon lowering the dose or discontinuing treatment.

Maintain the serum calcium-phosphorus (Ca x P) product below 55 mg²/dL².

5.2 Concomitant Use with Medications

Hypercalcemia may aggravate digitalis toxicity.

6 ADVERSE REACTIONS

Hypercalcemia is discussed elsewhere [see Warnings and Precautions ].

- The most common (>10%) adverse reactions are hypercalcemia, nausea and vomiting. (6.1)

- In clinical studies, patients have occasionally experienced nausea during Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate therapy. (6)

To report SUSPECTED ADVERSE REACTIONS, contact West-Ward Pharmaceuticals Corp. at 1-800-962-8364 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

6.1 Clinical Trial Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In clinical studies, Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate has been generally well tolerated.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate was studied in a 3 month, open-label, non-randomized study of 98 enrolled ESRD hemodialysis patients and an alternate liquid formulation of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate was studied in a two week double-blind, placebo-controlled, cross-over study with 69 enrolled ESRD hemodialysis patients. Adverse reactions (>2% on treatment) from these trials are presented in Table 1.

Preferred Term

Total adverse reactions reported for Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate

N=167

N (%)

3 month, open label study of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate

N=98

N (%)

Double blind, placebo-controlled, cross-over study of liquid Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate

N=69

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate

N (%)

Placebo

N (%)

Nausea

6 (3.6)

6 (6.1)

0 (0)

Vomiting

4 (2.4)

4 (4.1)

0 (0)

Hypercalcemia

21 (12.6)

16 (16.3)

5 (7.2)

0 (0)

Mild hypercalcemia may be asymptomatic or manifest itself as constipation, anorexia, nausea, and vomiting. More severe hypercalcemia is associated with confusion, delirium, stupor, and coma. Decreasing dialysate Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) concentration could reduce the incidence and severity of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate-induced hypercalcemia. Isolated cases pruritus have been reported, which may represent allergic reactions.

6.2 Postmarketing Experience

Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to estimate their frequency or to establish a causal relationship to drug exposure.

The following additional adverse reactions have been identified during post-approval of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate: dizziness, edema, and weakness.

7 DRUG INTERACTIONS

The drug interaction of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) acetate is characterized by the potential of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) to bind to drugs with anionic functions (e.g., carboxyl, and hydroxyl groups). Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate may decrease the bioavailability of tetracyclines or fluoroquinolones via this mechanism.

There are no empirical data on avoiding drug interactions between Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate and most concomitant drugs. When administering an oral medication with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate where a reduction in the bioavailability of that medication would have a clinically significant effect on its safety or efficacy, administer the drug one hour before or three hours after Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate. Monitor blood levels of the concomitant drugs that have a narrow therapeutic range. Patients taking anti-arrhythmic medications for the control of arrhythmias and anti-seizure medications for the control of seizure disorders were excluded from the clinical trials with all forms of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate.

- Calcium acetate may decrease the bioavailability of tetracyclines or fluoroquinolones. (7)

- When clinically significant drug interactions are expected, administer the drug at least one hour before or at least three hours after Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate or consider monitoring blood levels of the drug. (7)

7.1 Ciprofloxacin

In a study of 15 healthy subjects, a co-administered single dose of 4 Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate tablets, approximately 2.7g, decreased the bioavailability of ciprofloxacin by approximately 50%.

8 USE IN SPECIFIC POPULATIONS

8.1 Pregnancy

Pregnancy Category C:

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) acetate capsules contains Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate. Animal reproduction studies have not been conducted with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate, and there are no adequate and well controlled studies of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate use in pregnant women. Patients with end stage renal disease may develop hypercalcemia with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate treatment [see Warnings and Precautions (5.1 ) ]. Maintenance of normal serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) levels is important for maternal and fetal well being. Hypercalcemia during pregnancy may increase the risk for maternal and neonatal complications such as stillbirth, preterm delivery, and neonatal hypocalcemia and hypoparathyroidism. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate treatment, as recommended, is not expected to harm a fetus if maternal Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) levels are properly monitored during and following treatment.

8.2 Labor and Delivery

The effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate on labor and delivery are unknown.

8.3 Nursing Mothers

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) Acetate Capsules contains Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate and is excreted in human milk. Human milk feeding by a mother receiving Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate is not expected to harm an infant, provided maternal serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) levels are appropriately monitored.

8.4 Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

8.5 Geriatric Use

Clinical studies of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other clinical experience has not identified differences in responses between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

10 OVERDOSAGE

Administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate in excess of the appropriate daily dosage may result in hypercalcemia [see Warnings and Precautions (5.1)].

11 DESCRIPTION

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate acts as a phosphate binder. Its chemical name is Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate. Its molecular formula is C₄H₆CaO₄, and its molecular weight is 158.17. Its structural formula is:

Each white opaque/blue opaque capsule contains 667 mg of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate USP (anhydrous; Ca(CH₃COO)₂; MW=158.17 grams) equal to 169 mg (8.45 mEq) Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)), polyethylene glycol 8000 and magnesium stearate. Each capsule shell contains: black monogramming ink, FD&C Blue #1, FD&C Red #3, gelatin and titanium dioxide. The black monogramming ink contains: ammonium hydroxide, iron oxide black, isopropyl alcohol, n-butyl alcohol, propylene glycol and shellac glaze.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) Acetate Capsules are administered orally for the control of hyperphosphatemia in end-stage renal failure.

Chemical Structure

12 CLINICAL PHARMACOLOGY

Patients with ESRD retain phosphorus and can develop hyperphosphatemia. High serum phosphorus can precipitate serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) resulting in ectopic calcification. Hyperphosphatemia also plays a role in the development of secondary hyperparathyroidism in patients with ESRD.

12.1 Mechanism of Action

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate, when taken with meals, combines with dietary phosphate to form an insoluble Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) phosphate complex, which is excreted in the feces, resulting in decreased serum phosphorus concentration.

12.2 Pharmacodynamics

Orally administered Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate from pharmaceutical dosage forms is systemically absorbed up to approximately 40% under fasting conditions and up to approximately 30% under nonfasting conditions. This range represents data from both healthy subjects and renal dialysis patients under various conditions.

13 NONCLINICAL TOXICOLOGY

13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility

No carcinogenicity, mutagenicity, or fertility studies have been conducted with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate.

14 CLINICAL STUDIES

Effectiveness of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate in decreasing serum phosphorus has been demonstrated in two studies of the Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate solid oral dosage form.

Ninety-one patients with end-stage renal disease who were undergoing hemodialysis and were hyperphosphatemic (serum phosphorus >5.5 mg/dL) following a 1 week phosphate binder washout period contributed efficacy data to an open-label, non-randomized study.

The patients received Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate 667 mg tablets at each meal for a period of 12 weeks. The initial starting dose was 2 tablets per meal for 3 meals a day, and the dose was adjusted as necessary to control serum phosphorus levels. The average final dose after 12 weeks of treatment was 3.4 tablets per meal. Although there was a decrease in serum phosphorus, in the absence of a control group the true magnitude of effect is uncertain.

The data presented in Table 2 demonstrate the efficacy of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate in the treatment of hyperphosphatemia in end-stage renal disease patients. The effects on serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) levels are also presented.

* Ninety-one patients completed at least 6 weeks of the study.

† ANOVA of difference in values at pre-study and study completion.

‡ Values expressed as mean ± SE.

Parameter

Pre-Study

Week 4^*

Week 8

Week 12

p-value†

Phosphorus (mg/dL)‡

7.4 ± 0.17

5.9 ± 0.16

5.6 ± 0.17

5.2 ± 0.17

≤0.01

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) (mg/dL)‡

8.9 ± 0.09

9.5 ± 0.10

9.7 ± 0.10

≤0.01

There was a 30% decrease in serum phosphorus levels during the 12 week study period (p<0.01). Two-thirds of the decline occurred in the first month of the study. Serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) increased 9% during the study mostly in the first month of the study.

Treatment with the phosphate binder was discontinued for patients from the open-label study, and those patients whose serum phosphorus exceeded 5.5 mg/dL were eligible for entry into a double-blind, placebo-controlled, cross-over study. Patients were randomized to receive Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate or placebo, and each continued to receive the same number of tablets as had been individually established during the previous study. Following 2 weeks of treatment, patients switched to the alternative therapy for an additional 2 weeks.

The phosphate binding effect of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate is shown in the Table 3.

* ANOVA of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate vs. placebo after 2 weeks of treatment.

^† Values expressed as mean ± SEM.

Parameter

Pre-Study

Post-Treatment

p-value*

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) Acetate

Placebo

Phosphorus (mg/dL)^†

7.3 ± 0.18

5.9 ± 0.24

7.8 ± 0.22

<0.01

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) (mg/dL)^†

8.9 ± 0.11

9.5 ± 0.13

8.8 ± 0.12

<0.01

Overall, 2 weeks of treatment with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate statistically significantly (p<0.01) decreased serum phosphorus by a mean of 19% and increased serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) by a statistically significant (p<0.01) but clinically unimportant mean of 7%.

16 HOW SUPPLIED/STORAGE AND HANDLING

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) Acetate Capsules

667 mg capsule is supplied as a white opaque/blue opaque capsule, imprinted with “54 215” on the cap and body.

NDC 0615-2303-39: Blistercards of 30 Capsules

NDC 0615-2303-30: Unit-dose Boxes of 30 Capsules

STORAGE

Store at 20° to 25°C (68° to 77°F).

17 PATIENT COUNSELING INFORMATION

Inform patients to take Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate capsules with meals, adhere to their prescribed diets, and avoid the use of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) supplements including nonprescription antacids. Inform the patients about the symptoms of hypercalcemia [see Warnings and Precautions (5.1) and Adverse Reactions (6.1) ].

Advise patients who are taking an oral medication where reduction in the bioavailability of that medication would have clinically significant effect on its safety or efficacy to take the drug one hour before or three hours after Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Calcium (Calcium Citrate)) acetate capsules.

Distr. by: West-Ward

Pharmaceuticals Corp.

Eatontown, NJ 07724

10003705/05

Revised April 2016

Magnesium (Magnesium Citrate):

Description
Clinical pharmacology
Indications and usage
Contraindications
Warnings
Precautions
Adverse reactions
Overdosage
Dosage and administration
How supplied
References
Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) reviews

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) Sulfate

Injection, USP

Ansyr Plastic Syringe

Rx only

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DESCRIPTION

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) Sulfate Injection, USP is a sterile solution of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate heptahydrate in Water for Injection, USP administered by the intravenous or intramuscular routes as an electrolyte replenisher or anticonvulsant. Must be diluted before intravenous use. May contain sulfuric acid and/or sodium hydroxide for pH adjustment. The pH is 5.5 to 7.0. The 50% concentration has an osmolarity of 4.06 mOsmol/mL (calc.).

The solution contains no bacteriostat, antimicrobial agent or added buffer (except for pH adjustment) and is intended only for use as a single-dose injection. When smaller doses are required the unused portion should be discarded with the entire unit.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) Sulfate, USP heptahydrate is chemically designated MgSO₄ - 7H₂O with molecular weight of 246.48 and occurs as colorless crystals or white powder freely soluble in water.

The plastic syringe is molded from a specially formulated polypropylene. Water permeates from inside the container at an extremely slow rate which will have an insignificant effect on solution concentration over the expected shelf life. Solutions in contact with the plastic container may leach out certain chemical components from the plastic in very small amounts; however, biological testing was supportive of the safety of the syringe material.

CLINICAL PHARMACOLOGY

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) (Mg⁺⁺) is an important cofactor for enzymatic reactions and plays an important role in neurochemical transmission and muscular excitability.

As a nutritional adjunct in hyperalimentation, the precise mechanism of action for Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) is uncertain. Early symptoms of hypomagnesemia (less than 1.5 mEq/liter) may develop as early as three to four days or within weeks.

Predominant deficiency effects are neurological, e.g., muscle irritability, clonic twitching and tremors. Hypocalcemia and hypokalemia often follow low serum levels of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)). While there are large stores of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) present intracellularly and in the bones of adults, these stores often are not mobilized sufficiently to maintain plasma levels. Parenteral Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) therapy repairs the plasma deficit and causes deficiency symptoms and signs to cease.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) prevents or controls convulsions by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated at the end plate by the motor nerve impulse. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) is said to have a depressant effect on the central nervous system (CNS), but it does not adversely affect the woman, fetus or neonate when used as directed in eclampsia or pre-eclampsia. Normal plasma Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) levels range from 1.5 to 2.5 mEq/liter.

As plasma Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) rises above 4 mEq/liter, the deep tendon reflexes are first decreased and then disappear as the plasma level approaches 10 mEq/liter. At this level respiratory paralysis may occur. Heart block also may occur at this or lower plasma levels of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)). Serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) concentrations in excess of 12 mEq/L may be fatal.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) acts peripherally to produce vasodilation. With low doses only flushing and sweating occur, but larger doses cause lowering of blood pressure. The central and peripheral effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) poisoning are antagonized to some extent by intravenous administration of calcium.

Pharmacokinetics

With intravenous administration the onset of anticonvulsant action is immediate and lasts about 30 minutes. Following intramuscular administration the onset of action occurs in about one hour and persists for three to four hours. Effective anticonvulsant serum levels range from 2.5 to 7.5 mEq/liter. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) is excreted solely by the kidneys at a rate proportional to the plasma concentration and glomerular filtration.

INDICATIONS AND USAGE

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) Sulfate Injection, USP is suitable for replacement therapy in Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) deficiency, especially in acute hypomagnesemia accompanied by signs of tetany similar to those observed in hypocalcemia. In such cases, the serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) (Mg⁺⁺) level is usually below the lower limit of normal (1.5 to 2.5 mEq/liter) and the serum calcium (Ca⁺⁺) level is normal (4.3 to 5.3 mEq/liter) or elevated.

In total parenteral nutrition (TPN), Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate may be added to the nutrient admixture to correct or prevent hypomagnesemia which can arise during the course of therapy.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) Sulfate Injection, USP is also indicated for the prevention and control of seizures (convulsions) in pre-eclampsia and eclampsia, respectively.

CONTRAINDICATIONS

Parenteral administration of the drug is contraindicated in patients with heart block or myocardial damage.

WARNINGS

FETAL HARM: Continuous administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate beyond 5 to 7 days to pregnant women can lead to hypocalcemia and bone abnormalities in the developing fetus. These bone abnormalities include skeletal demineralization and osteopenia. In addition, cases of neonatal fracture have been reported. The shortest duration of treatment that can lead to fetal harm is not known. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate should be used during pregnancy only if clearly needed. If Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate is given for treatment of preterm labor, the woman should be informed that the efficacy and safety of such use have not been established and that use of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate beyond 5 to 7 days may cause fetal abnormalities.

ALUMINUM TOXICITY: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.

Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.

Parenteral use in the presence of renal insufficiency may lead to Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) intoxication. Intravenous use in the eclampsia should be reserved for immediate control of life-threatening convulsions.

PRECAUTIONS

General

Administer with caution if flushing and sweating occurs. When barbiturates, narcotics or other hypnotics (or systemic anesthetics) are to be given in conjunction with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)), their dosage should be adjusted with caution because of additive CNS depressant effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)).

Because Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) is removed from the body solely by the kidneys, the drug should be used with caution in patients with renal impairment. Urine output should be maintained at a level of 100 mL or more during the four hours preceding each dose. Monitoring serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) levels and the patient's clinical status is essential to avoid the consequences of overdosage in toxemia. Clinical indications of a safe dosage regimen include the presence of the patellar reflex (knee jerk) and absence of respiratory depression (approximately 16 breaths or more/minute). When repeated doses of the drug are given parenterally, knee jerk reflexes should be tested before each dose and if they are absent, no additional Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) should be given until they return. Serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) levels usually sufficient to control convulsions range from 3 to 6 mg/100 mL (2.5 to 5 mEq/liter). The strength of the deep tendon reflexes begins to diminish when Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) levels exceed 4 mEq/liter. Reflexes may be absent at 10 mEq magnesium/liter, where respiratory paralysis is a potential hazard. An injectable calcium salt should be immediately available to counteract the potential hazards of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) intoxication in eclampsia.

50% Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) Sulfate Injection, USP must be diluted to a concentration of 20% or less prior to intravenous infusion. Rate of administration should be slow and cautious, to avoid producing hypermagnesemia. The 50% solution also should be diluted to 20% or less for intramuscular injection in infants and children.

Laboratory Tests

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate injection should not be given unless hypomagnesemia has been confirmed and the serum concentration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) is monitored. The normal serum level is 1.5 to 2.5 mEq/L.

Drug Interactions

CNS Depressants - When barbiturates, narcotics or other hypnotics (or systemic anesthetics), or other CNS depressants are to be given in conjunction with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)), their dosage should be adjusted with caution because of additive CNS depressant effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)). CNS depression and peripheral transmission defects produced by Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) may be antagonized by calcium.

Neuromuscular Blocking Agents - Excessive neuromuscular block has occurred in patients receiving parenteral Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate and a neuromuscular blocking agent; these drugs should be administered concomitantly with caution.

Cardiac Glycosides - Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate should be administered with extreme caution in digitalized patients, because serious changes in cardiac conduction which can result in heart block may occur if administration of calcium is required to treat Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) toxicity.

Pregnancy

Teratogenic Effects

Pregnancy Category D (See WARNINGS and PRECAUTIONS )

See WARNINGS and PRECAUTIONS .

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate can cause fetal abnormalities when administered beyond 5 to 7 days to pregnant women. There are retrospective epidemiological studies and case reports documenting fetal abnormalities such as hypocalcemia, skeletal demineralization, osteopenia and other skeletal abnormalities with continuous maternal administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate for more than 5 to 7 days.^1-10 Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate injection should be used during pregnancy only if clearly needed. If this drug is used during pregnancy, the woman should be apprised of the potential harm to the fetus.

Nonteratogenic Effects

When administered by continuous intravenous infusion (especially for more than 24 hours preceding delivery) to control convulsions in a toxemic woman, the newborn may show signs of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) toxicity, including neuromuscular or respiratory depression (See OVERDOSAGE ).

Labor and Delivery

Continuous administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate is an unapproved treatment for preterm labor. The safety and efficacy of such use have not been established. The administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate outside of its approved indication in pregnant women should be by trained obstetrical personnel in a hospital setting with appropriate obstetrical care facilities.

Nursing Mothers

Since Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) is distributed into milk during parenteral Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate administration, the drug should be used with caution in nursing women.

Geriatrics

Geriatric patients often require reduced dosage because of impaired renal function. In patients with severe impairment, dosage should not exceed 20 grams in 48 hours. Serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) should be monitored in such patients.

ADVERSE REACTIONS

The adverse effects of parenterally administered Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) usually are the result of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) intoxication. These include flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and central nervous system depression proceeding to respiratory paralysis. Hypocalcemia with signs of tetany secondary to Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate therapy for eclampsia has been reported.

OVERDOSAGE

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) intoxication is manifested by a sharp drop in blood pressure and respiratory paralysis. Disappearance of the patellar reflex is a useful clinical sign to detect the onset of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) intoxication. In the event of overdosage, artificial ventilation must be provided until a calcium salt can be injected intravenously to antagonize the effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)).

For Treatment of Overdose

Artificial respiration is often required. Intravenous calcium, 10 to 20 mL of a 5% solution (diluted if desirable with isotonic sodium chloride for injection) is used to counteract effects of hypermagnesemia. Subcutaneous physostigmine, 0.5 to 1 mg may be helpful.

Hypermagnesemia in the newborn may require resuscitation and assisted ventilation via endotracheal intubation or intermittent positive pressure ventilation as well as intravenous calcium.

DOSAGE AND ADMINISTRATION

Dosage of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate must be carefully adjusted according to individual requirements and response, and administration of the drug should be discontinued as soon as the desired effect is obtained.

Both intravenous and intramuscular administration are appropriate. Intramuscular administration of the undiluted 50% solution results in therapeutic plasma levels in 60 minutes, whereas intravenous doses will provide a therapeutic level almost immediately. The rate of intravenous injection should generally not exceed 150 mg/minute (1.5 mL of a 10% concentration or its equivalent), except in severe eclampsia with seizures. Continuous maternal administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate in pregnancy beyond 5 to 7 days can cause fetal abnormalities.

Solutions for intravenous infusion must be diluted to a concentration of 20% or less prior to administration. The diluents commonly used are 5% Dextrose Injection, USP and 0.9% Sodium Chloride Injection, USP. Deep intramuscular injection of the undiluted (50%) solution is appropriate for adults, but the solution should be diluted to a 20% or less concentration prior to such injection in children.

In Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) Deficiency

In the treatment of mild Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) deficiency, the usual adult dose is 1 gram, equivalent to 8.12 mEq of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) (2 mL of the 50% solution) injected intramuscularly every six hours for four doses (equivalent to a total of 32.5 mEq of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) per 24 hours). For severe hypomagnesemia, as much as 250 mg (approximately 2 mEq) per kg of body weight (0.5 mL of the 50% solution) may be given intramuscularly within a period of four hours if necessary. Alternatively, 5 grams, (approximately 40 mEq) can be added to one liter of 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP for slow intravenous infusion over a three-hour period. In the treatment of deficiency states, caution must be observed to prevent exceeding the renal excretory capacity.

In Hyperalimentation

In total parenteral nutrition, maintenance requirements for Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) are not precisely known. The maintenance dose used in adults ranges from 8 to 24 mEq (1 gram to 3 grams) daily; for infants, the range is 2 to 10 mEq (0.25 gram to 1.25 grams) daily.

In Pre-eclampsia or Eclampsia

In severe pre-eclampsia or eclampsia, the total initial dose is 10 grams to 14 grams of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate. Intravenously, a dose of 4 grams to 5 grams in 250 mL of 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP may be infused. Simultaneously, intramuscular doses of up to 10 grams (5 grams or 10 mL of the undiluted 50% solution in each buttock) are given. Alternatively, the initial intravenous dose of 4 grams may be given by diluting the 50% solution to a 10 or 20% concentration; the diluted fluid (40 mL of a 10% solution or 20 mL of a 20% solution) may then be injected intravenously over a period of three to four minutes. Subsequently, 4 grams to 5 grams (8 to 10 mL of the 50% solution) are injected intramuscularly into alternate buttocks every four hours as needed, depending on the continuing presence of the patellar reflex and adequate respiratory function. Alternatively, after the initial intravenous dose, some clinicians administer 1 gram to 2 grams/hour by constant intravenous infusion. Therapy should continue until paroxysms cease. A serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) level of 6 mg/100 mL is considered optimal for control of seizures. A total daily (24 hr) dose of 30 grams to 40 grams should not be exceeded. In the presence of severe renal insufficiency, the maximum dosage of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate is 20 grams/48 hours and frequent serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) concentrations must be obtained. Continuous use of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate in pregnancy beyond 5 to 7 days can cause fetal abnormalities.

Other Uses

In counteracting the muscle-stimulating effects of barium poisoning, the usual dose of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate is 1 gram to 2 grams given intravenously.

For controlling seizures associated with epilepsy, glomerulonephritis or hypothyroidism, the usual adult dose is 1 gram administered intramuscularly or intravenously.

In paroxysmal atrial tachycardia, Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) should be used only if simpler measures have failed and there is no evidence of myocardial damage. The usual dose is 3 grams to 4 grams (30 to 40 mL of a 10% solution) administered intravenously over 30 seconds with extreme caution.

For reduction of cerebral edema, 2.5 grams (25 mL of a 10% solution) is given intravenously.

Incompatibilities

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate in solution may result in a precipitate formation when mixed with solutions containing:

Alcohol (in high Heavy Metals

concentrations) Hydrocortisone sodium

Alkali carbonates and succinate

bicarbonates Phosphates

Alkali hydroxides Polymixin B sulfate

Arsenates Procaine hydrochloride

Barium Salicylates

Calcium Strontium

Clindamycin phosphate Tartrates

The potential incompatibility will often be influenced by the changes in the concentration of reactants and the pH of the solutions.

It has been reported that Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) may reduce the antibiotic activity of streptomycin, tetracycline and tobramycin when given together.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

HOW SUPPLIED

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) Sulfate Injection, USP is supplied in single-dose containers as follows:

NDC No.

Container

Total

Amount

Concentration

mEq

Mg⁺⁺/mL

0409-1754-10

Ansyr

Plastic Syringe

5 g/10 mL

50%

4 mEq/mL

Do not administer unless solution is clear and container is undamaged. Discard unused portion.

Store at 20 to 25°C (68 to 77°F).

REFERENCES

Yokoyama K, Takahashi N, Yada Y. Prolonged maternal Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) administration and bone metabolism in neonates. Early Hum Dev. 2010;86(3):187-91. Epub 2010 Mar 12.
Wedig KE, Kogan J, Schorry EK et al. Skeletal demineralization and fractures caused by fetal Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) toxicity. J. Perinatol. 2006; 26(6):371-4.
Nassar AH, Sakhel K, Maarouf H, et al. Adverse maternal and neonatal outcome of prolonged course of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate tocolysis. Acta Obstet Gynecol Scan. 2006;85(9):1099-103.
Malaeb SN, Rassi A, Haddad MC. Bone mineralization in newborns whose mothers received Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulphate for tocolysis of premature labor. Pediatr Radiol. 2004;34(5):384-6. Epub 2004 Feb 18.
Matsuda Y, Maeda Y, Ito M, et al. Effect of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate treatment on neonatal bone abnormalities. Gynecol Obstet Invest. 1997;44(2):82-8.
Schanler RJ, Smith LG, Burns PA. Effects of long-term maternal intravenous Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate therapy on neonatal calcium metabolism and bone mineral content. Gynecol Obstet Invest. 1997;43(4):236-41.
Santi MD, Henry GW, Douglas GL. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate treatment of preterm labor as a cause of abnormal neonatal bone mineralization. J Pediatr Orthrop. 1994;14(2):249-53.
Holcomb WL, Shackelford GD, Petrie RH. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) tocolysis and neonatal bone abnormalities; a controlled study. Obstet Gynecol. 1991; 78(4):611-4.
Cumming WA, Thomas VJ. Hypermagnesemia: a cause of abnormal metaphyses in the neonate. Am J Roentgenol. 1989; 152(5):1071-2.
Lamm CL, Norton KL, Murphy RJ. Congenital rickets associated with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate infusion for tocolysis. J Pediatr. 1988; 113(6):1078-82.
McGuinness GA, Weinstein MM, Cruikshank DP, et al. Effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate treatment on perinatal calcium metabolism. II. Neonatal responses. Obstet Gynecol. 1980; 56(5): 595-600.
Riaz M, Porat R, Brodsky NL, et al. The effects of maternal Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) sulfate treatment on newborns: a prospective controlled study. J. Perinatol. 1998;18(6 pt 1):449-54.

Hospira, Inc., Lake Forest, IL 60045 USA

LAB-1024-1.0

April 2017

Hospira Logo

50% Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) Sulfate 5 g/10 mL (500 mg/mL)

Rx only

NDC 0409-1754-10

10 mL Single-dose syringe

50% Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Citrate)) Sulfate Injection, USP

5 g/10 mL (500 mg/mL) (4 mEq Mg++/mL)

MUST BE DILUTED FOR INTRAVENOUS USE.

For Intravenous or Intramuscular Use. Sterile. 4.06 mOsmol/mL (calc.).

Contains no more than 75 mcg/L of aluminum.

Hospira, Inc., Lake Forest, IL 60045 USA

Hospira

RL-6891

Magnesium (Magnesium Oxide):

Description
Clinical pharmacology
Indications and usage
Contraindications
Warnings
Precautions
Adverse reactions
Overdosage
Dosage and administration
How supplied
References
Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) reviews

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) Sulfate

Injection, USP

Ansyr Plastic Syringe

Rx only

Hospira Logo

DESCRIPTION

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) Sulfate Injection, USP is a sterile solution of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate heptahydrate in Water for Injection, USP administered by the intravenous or intramuscular routes as an electrolyte replenisher or anticonvulsant. Must be diluted before intravenous use. May contain sulfuric acid and/or sodium hydroxide for pH adjustment. The pH is 5.5 to 7.0. The 50% concentration has an osmolarity of 4.06 mOsmol/mL (calc.).

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) Sulfate, USP heptahydrate is chemically designated MgSO₄ - 7H₂O with molecular weight of 246.48 and occurs as colorless crystals or white powder freely soluble in water.

CLINICAL PHARMACOLOGY

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) (Mg⁺⁺) is an important cofactor for enzymatic reactions and plays an important role in neurochemical transmission and muscular excitability.

As a nutritional adjunct in hyperalimentation, the precise mechanism of action for Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) is uncertain. Early symptoms of hypomagnesemia (less than 1.5 mEq/liter) may develop as early as three to four days or within weeks.

Predominant deficiency effects are neurological, e.g., muscle irritability, clonic twitching and tremors. Hypocalcemia and hypokalemia often follow low serum levels of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)). While there are large stores of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) present intracellularly and in the bones of adults, these stores often are not mobilized sufficiently to maintain plasma levels. Parenteral Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) therapy repairs the plasma deficit and causes deficiency symptoms and signs to cease.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) prevents or controls convulsions by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated at the end plate by the motor nerve impulse. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) is said to have a depressant effect on the central nervous system (CNS), but it does not adversely affect the woman, fetus or neonate when used as directed in eclampsia or pre-eclampsia. Normal plasma Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) levels range from 1.5 to 2.5 mEq/liter.

As plasma Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) rises above 4 mEq/liter, the deep tendon reflexes are first decreased and then disappear as the plasma level approaches 10 mEq/liter. At this level respiratory paralysis may occur. Heart block also may occur at this or lower plasma levels of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)). Serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) concentrations in excess of 12 mEq/L may be fatal.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) acts peripherally to produce vasodilation. With low doses only flushing and sweating occur, but larger doses cause lowering of blood pressure. The central and peripheral effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) poisoning are antagonized to some extent by intravenous administration of calcium.

Pharmacokinetics

With intravenous administration the onset of anticonvulsant action is immediate and lasts about 30 minutes. Following intramuscular administration the onset of action occurs in about one hour and persists for three to four hours. Effective anticonvulsant serum levels range from 2.5 to 7.5 mEq/liter. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) is excreted solely by the kidneys at a rate proportional to the plasma concentration and glomerular filtration.

INDICATIONS AND USAGE

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) Sulfate Injection, USP is suitable for replacement therapy in Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) deficiency, especially in acute hypomagnesemia accompanied by signs of tetany similar to those observed in hypocalcemia. In such cases, the serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) (Mg⁺⁺) level is usually below the lower limit of normal (1.5 to 2.5 mEq/liter) and the serum calcium (Ca⁺⁺) level is normal (4.3 to 5.3 mEq/liter) or elevated.

In total parenteral nutrition (TPN), Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate may be added to the nutrient admixture to correct or prevent hypomagnesemia which can arise during the course of therapy.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) Sulfate Injection, USP is also indicated for the prevention and control of seizures (convulsions) in pre-eclampsia and eclampsia, respectively.

CONTRAINDICATIONS

Parenteral administration of the drug is contraindicated in patients with heart block or myocardial damage.

WARNINGS

FETAL HARM: Continuous administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate beyond 5 to 7 days to pregnant women can lead to hypocalcemia and bone abnormalities in the developing fetus. These bone abnormalities include skeletal demineralization and osteopenia. In addition, cases of neonatal fracture have been reported. The shortest duration of treatment that can lead to fetal harm is not known. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate should be used during pregnancy only if clearly needed. If Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate is given for treatment of preterm labor, the woman should be informed that the efficacy and safety of such use have not been established and that use of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate beyond 5 to 7 days may cause fetal abnormalities.

Parenteral use in the presence of renal insufficiency may lead to Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) intoxication. Intravenous use in the eclampsia should be reserved for immediate control of life-threatening convulsions.

PRECAUTIONS

General

Administer with caution if flushing and sweating occurs. When barbiturates, narcotics or other hypnotics (or systemic anesthetics) are to be given in conjunction with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)), their dosage should be adjusted with caution because of additive CNS depressant effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)).

Because Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) is removed from the body solely by the kidneys, the drug should be used with caution in patients with renal impairment. Urine output should be maintained at a level of 100 mL or more during the four hours preceding each dose. Monitoring serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) levels and the patient's clinical status is essential to avoid the consequences of overdosage in toxemia. Clinical indications of a safe dosage regimen include the presence of the patellar reflex (knee jerk) and absence of respiratory depression (approximately 16 breaths or more/minute). When repeated doses of the drug are given parenterally, knee jerk reflexes should be tested before each dose and if they are absent, no additional Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) should be given until they return. Serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) levels usually sufficient to control convulsions range from 3 to 6 mg/100 mL (2.5 to 5 mEq/liter). The strength of the deep tendon reflexes begins to diminish when Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) levels exceed 4 mEq/liter. Reflexes may be absent at 10 mEq magnesium/liter, where respiratory paralysis is a potential hazard. An injectable calcium salt should be immediately available to counteract the potential hazards of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) intoxication in eclampsia.

50% Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) Sulfate Injection, USP must be diluted to a concentration of 20% or less prior to intravenous infusion. Rate of administration should be slow and cautious, to avoid producing hypermagnesemia. The 50% solution also should be diluted to 20% or less for intramuscular injection in infants and children.

Laboratory Tests

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate injection should not be given unless hypomagnesemia has been confirmed and the serum concentration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) is monitored. The normal serum level is 1.5 to 2.5 mEq/L.

Drug Interactions

CNS Depressants - When barbiturates, narcotics or other hypnotics (or systemic anesthetics), or other CNS depressants are to be given in conjunction with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)), their dosage should be adjusted with caution because of additive CNS depressant effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)). CNS depression and peripheral transmission defects produced by Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) may be antagonized by calcium.

Neuromuscular Blocking Agents - Excessive neuromuscular block has occurred in patients receiving parenteral Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate and a neuromuscular blocking agent; these drugs should be administered concomitantly with caution.

Cardiac Glycosides - Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate should be administered with extreme caution in digitalized patients, because serious changes in cardiac conduction which can result in heart block may occur if administration of calcium is required to treat Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) toxicity.

Pregnancy

Teratogenic Effects

Pregnancy Category D (See WARNINGS and PRECAUTIONS )

See WARNINGS and PRECAUTIONS .

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate can cause fetal abnormalities when administered beyond 5 to 7 days to pregnant women. There are retrospective epidemiological studies and case reports documenting fetal abnormalities such as hypocalcemia, skeletal demineralization, osteopenia and other skeletal abnormalities with continuous maternal administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate for more than 5 to 7 days.^1-10 Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate injection should be used during pregnancy only if clearly needed. If this drug is used during pregnancy, the woman should be apprised of the potential harm to the fetus.

Nonteratogenic Effects

When administered by continuous intravenous infusion (especially for more than 24 hours preceding delivery) to control convulsions in a toxemic woman, the newborn may show signs of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) toxicity, including neuromuscular or respiratory depression (See OVERDOSAGE ).

Labor and Delivery

Continuous administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate is an unapproved treatment for preterm labor. The safety and efficacy of such use have not been established. The administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate outside of its approved indication in pregnant women should be by trained obstetrical personnel in a hospital setting with appropriate obstetrical care facilities.

Nursing Mothers

Since Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) is distributed into milk during parenteral Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate administration, the drug should be used with caution in nursing women.

Geriatrics

ADVERSE REACTIONS

The adverse effects of parenterally administered Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) usually are the result of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) intoxication. These include flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and central nervous system depression proceeding to respiratory paralysis. Hypocalcemia with signs of tetany secondary to Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate therapy for eclampsia has been reported.

OVERDOSAGE

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) intoxication is manifested by a sharp drop in blood pressure and respiratory paralysis. Disappearance of the patellar reflex is a useful clinical sign to detect the onset of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) intoxication. In the event of overdosage, artificial ventilation must be provided until a calcium salt can be injected intravenously to antagonize the effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)).

For Treatment of Overdose

Hypermagnesemia in the newborn may require resuscitation and assisted ventilation via endotracheal intubation or intermittent positive pressure ventilation as well as intravenous calcium.

DOSAGE AND ADMINISTRATION

Dosage of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate must be carefully adjusted according to individual requirements and response, and administration of the drug should be discontinued as soon as the desired effect is obtained.

Both intravenous and intramuscular administration are appropriate. Intramuscular administration of the undiluted 50% solution results in therapeutic plasma levels in 60 minutes, whereas intravenous doses will provide a therapeutic level almost immediately. The rate of intravenous injection should generally not exceed 150 mg/minute (1.5 mL of a 10% concentration or its equivalent), except in severe eclampsia with seizures. Continuous maternal administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate in pregnancy beyond 5 to 7 days can cause fetal abnormalities.

In Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) Deficiency

In the treatment of mild Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) deficiency, the usual adult dose is 1 gram, equivalent to 8.12 mEq of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) (2 mL of the 50% solution) injected intramuscularly every six hours for four doses (equivalent to a total of 32.5 mEq of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) per 24 hours). For severe hypomagnesemia, as much as 250 mg (approximately 2 mEq) per kg of body weight (0.5 mL of the 50% solution) may be given intramuscularly within a period of four hours if necessary. Alternatively, 5 grams, (approximately 40 mEq) can be added to one liter of 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP for slow intravenous infusion over a three-hour period. In the treatment of deficiency states, caution must be observed to prevent exceeding the renal excretory capacity.

In Hyperalimentation

In total parenteral nutrition, maintenance requirements for Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) are not precisely known. The maintenance dose used in adults ranges from 8 to 24 mEq (1 gram to 3 grams) daily; for infants, the range is 2 to 10 mEq (0.25 gram to 1.25 grams) daily.

In Pre-eclampsia or Eclampsia

In severe pre-eclampsia or eclampsia, the total initial dose is 10 grams to 14 grams of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate. Intravenously, a dose of 4 grams to 5 grams in 250 mL of 5% Dextrose Injection, USP or 0.9% Sodium Chloride Injection, USP may be infused. Simultaneously, intramuscular doses of up to 10 grams (5 grams or 10 mL of the undiluted 50% solution in each buttock) are given. Alternatively, the initial intravenous dose of 4 grams may be given by diluting the 50% solution to a 10 or 20% concentration; the diluted fluid (40 mL of a 10% solution or 20 mL of a 20% solution) may then be injected intravenously over a period of three to four minutes. Subsequently, 4 grams to 5 grams (8 to 10 mL of the 50% solution) are injected intramuscularly into alternate buttocks every four hours as needed, depending on the continuing presence of the patellar reflex and adequate respiratory function. Alternatively, after the initial intravenous dose, some clinicians administer 1 gram to 2 grams/hour by constant intravenous infusion. Therapy should continue until paroxysms cease. A serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) level of 6 mg/100 mL is considered optimal for control of seizures. A total daily (24 hr) dose of 30 grams to 40 grams should not be exceeded. In the presence of severe renal insufficiency, the maximum dosage of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate is 20 grams/48 hours and frequent serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) concentrations must be obtained. Continuous use of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate in pregnancy beyond 5 to 7 days can cause fetal abnormalities.

Other Uses

In counteracting the muscle-stimulating effects of barium poisoning, the usual dose of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate is 1 gram to 2 grams given intravenously.

For controlling seizures associated with epilepsy, glomerulonephritis or hypothyroidism, the usual adult dose is 1 gram administered intramuscularly or intravenously.

In paroxysmal atrial tachycardia, Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) should be used only if simpler measures have failed and there is no evidence of myocardial damage. The usual dose is 3 grams to 4 grams (30 to 40 mL of a 10% solution) administered intravenously over 30 seconds with extreme caution.

For reduction of cerebral edema, 2.5 grams (25 mL of a 10% solution) is given intravenously.

Incompatibilities

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate in solution may result in a precipitate formation when mixed with solutions containing:

Alcohol (in high Heavy Metals

concentrations) Hydrocortisone sodium

Alkali carbonates and succinate

bicarbonates Phosphates

Alkali hydroxides Polymixin B sulfate

Arsenates Procaine hydrochloride

Barium Salicylates

Calcium Strontium

Clindamycin phosphate Tartrates

The potential incompatibility will often be influenced by the changes in the concentration of reactants and the pH of the solutions.

It has been reported that Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) may reduce the antibiotic activity of streptomycin, tetracycline and tobramycin when given together.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

HOW SUPPLIED

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) Sulfate Injection, USP is supplied in single-dose containers as follows:

NDC No.

Container

Total

Amount

Concentration

mEq

Mg⁺⁺/mL

0409-1754-10

Ansyr

Plastic Syringe

5 g/10 mL

50%

4 mEq/mL

Do not administer unless solution is clear and container is undamaged. Discard unused portion.

Store at 20 to 25°C (68 to 77°F).

REFERENCES

Yokoyama K, Takahashi N, Yada Y. Prolonged maternal Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) administration and bone metabolism in neonates. Early Hum Dev. 2010;86(3):187-91. Epub 2010 Mar 12.
Wedig KE, Kogan J, Schorry EK et al. Skeletal demineralization and fractures caused by fetal Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) toxicity. J. Perinatol. 2006; 26(6):371-4.
Nassar AH, Sakhel K, Maarouf H, et al. Adverse maternal and neonatal outcome of prolonged course of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate tocolysis. Acta Obstet Gynecol Scan. 2006;85(9):1099-103.
Malaeb SN, Rassi A, Haddad MC. Bone mineralization in newborns whose mothers received Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulphate for tocolysis of premature labor. Pediatr Radiol. 2004;34(5):384-6. Epub 2004 Feb 18.
Matsuda Y, Maeda Y, Ito M, et al. Effect of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate treatment on neonatal bone abnormalities. Gynecol Obstet Invest. 1997;44(2):82-8.
Schanler RJ, Smith LG, Burns PA. Effects of long-term maternal intravenous Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate therapy on neonatal calcium metabolism and bone mineral content. Gynecol Obstet Invest. 1997;43(4):236-41.
Santi MD, Henry GW, Douglas GL. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate treatment of preterm labor as a cause of abnormal neonatal bone mineralization. J Pediatr Orthrop. 1994;14(2):249-53.
Holcomb WL, Shackelford GD, Petrie RH. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) tocolysis and neonatal bone abnormalities; a controlled study. Obstet Gynecol. 1991; 78(4):611-4.
Cumming WA, Thomas VJ. Hypermagnesemia: a cause of abnormal metaphyses in the neonate. Am J Roentgenol. 1989; 152(5):1071-2.
Lamm CL, Norton KL, Murphy RJ. Congenital rickets associated with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate infusion for tocolysis. J Pediatr. 1988; 113(6):1078-82.
McGuinness GA, Weinstein MM, Cruikshank DP, et al. Effects of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate treatment on perinatal calcium metabolism. II. Neonatal responses. Obstet Gynecol. 1980; 56(5): 595-600.
Riaz M, Porat R, Brodsky NL, et al. The effects of maternal Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) sulfate treatment on newborns: a prospective controlled study. J. Perinatol. 1998;18(6 pt 1):449-54.

Hospira, Inc., Lake Forest, IL 60045 USA

LAB-1024-1.0

April 2017

Hospira Logo

50% Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) Sulfate 5 g/10 mL (500 mg/mL)

Rx only

NDC 0409-1754-10

10 mL Single-dose syringe

50% Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Magnesium (Magnesium Oxide)) Sulfate Injection, USP

5 g/10 mL (500 mg/mL) (4 mEq Mg++/mL)

MUST BE DILUTED FOR INTRAVENOUS USE.

For Intravenous or Intramuscular Use. Sterile. 4.06 mOsmol/mL (calc.).

Contains no more than 75 mcg/L of aluminum.

Hospira, Inc., Lake Forest, IL 60045 USA

Hospira

RL-6891

Manganese (Manganese Citrate):

Indications and usage
Contraindications
Warnings
Precautions
Adverse reactions
Drug abuse and dependence
Overdosage
Dosage and administration
How supplied
Rl-0104
Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) reviews

INDICATIONS AND USAGE

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) 0.1 mg/mL (Manganese Chloride Injection, USP) is indicated for use as a supplement to intravenous solutions given for total parenteral nutrition (TPN).

Administration helps to maintain Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) serum levels and to prevent depletion of endogenous stores and subsequent deficiency symptoms.

CONTRAINDICATIONS

None known.

WARNINGS

Direct intramuscular or intravenous injection of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) 0.1 mg/mL (Manganese Chloride Injection, USP) is contraindicated as the acidic pH of the solution (pH 2.0) may cause considerable tissue irritation.

Liver and/or biliary tract dysfunction may require omission or reduction of copper and Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) doses because these elements are primarily eliminated in the bile.

WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they require large amounts of calcium and phosphate solutions, which contain aluminum.

PRECAUTIONS

General

Do not use unless solution is clear and seal is intact.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) 0.1 mg/mL (Manganese Chloride Injection, USP) should only be used in conjunction with a pharmacy directed admixture program using aseptic technique in a laminar flow environment; it should be used promptly and in a single operation without any repeated penetrations. Solution contains no preservatives; discard unused portion immediately after admixture procedure is completed.

Laboratory Tests

Serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) levels can be measured periodically at the discretion of the investigator. Because of the low serum concentration normally present, samples will usually be analyzed by a reference laboratory.

Carcinogenesis, Mutagenesis, and Impairment of Fertility

Long-term animal studies to evaluate the carcinogenic potential of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) 0.1 mg/mL (Manganese Chloride Injection, USP) have not been performed, nor have studies been done to assess mutagenesis or impairment of fertility.

Nursing Mothers

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) 0.1 mg/mL (Manganese Chloride Injection, USP) additive is administered to a nursing woman.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Pregnancy Category C.

Animal reproduction studies have not been conducted with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) chloride. It is also not known whether Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) chloride can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) chloride should be given to a pregnant woman only if clearly indicated.

Geriatric Use

An evaluation of current literature revealed no clinical experience identifying differences in response between elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

ADVERSE REACTIONS

None known.

DRUG ABUSE AND DEPENDENCE

None known.

OVERDOSAGE

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) toxicity in TPN patients has not been reported.

DOSAGE AND ADMINISTRATION

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) 0.1 mg/mL (Manganese Chloride Injection, USP) contains 0.1 mg manganese/mL and is administered intravenously only after dilution. The additive should be administered in a volume of fluid not less than 100 mL. For the adult receiving TPN, the suggested additive dosage for Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) is 0.15 to 0.8 mg/day (1.5 to 8 mL/day). For pediatric patients, a dosage of 2 to 10 mcg manganese/kg/day (0.02 to 0.1 mL/kg/day) is recommended.

Periodic monitoring of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) plasma levels is suggested as a guideline for subsequent administration.

Parenteral products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. (See PRECAUTIONS .)

HOW SUPPLIED

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Manganese (Manganese Citrate)) 0.1 mg/mL (Manganese Chloride Injection, USP) is supplied in 10 mL Plastic Vials (NDC No. 0409-4091-01).

Store at 20 to 25°C (68 to 77°F)

Revised: November, 2009

Printed in USA EN-2320

Hospira, Inc., Lake Forest, IL 60045 USA

RL-0104

Potassium (Potassium Citrate):

Description
Clinical pharmacology
Indications and usage
Contraindications
Warnings
Precautions
Adverse reactions
Overdosage
Dosage and administration
How supplied
Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) reviews

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) CHLORIDE EXTENDED RELEASE TABLETS USP 20 mEq K

Rx Only

DESCRIPTION

The Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablets USP, 20 mEq product is an immediately dispersing extended release oral dosage form of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride containing 1500 mg of microencapsulated Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride, USP equivalent to 20 mEq of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) in a tablet.

These formulations are intended to slow the release of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) so that the likelihood of a high localized concentration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride within the gastrointestinal tract is reduced.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablets USP, 20 mEq is an electrolyte replenisher. The chemical name of the active ingredient is Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride, and the structural formula is KCl. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride, USP occurs as a white, granular powder or as colorless crystals. It is odorless and has a saline taste. Its solutions are neutral to litmus. It is freely soluble in water and insoluble in alcohol.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablets USP, 20 mEq is a tablet formulation (not enteric coated or wax matrix) containing individually microencapsulated Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride crystals which disperse upon tablet disintegration. In simulated gastric fluid at 37°C and in the absence of outside agitation, Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablets USP, 20 mEq begin disintegrating into microencapsulated crystals within seconds and completely disintegrates within 1 minute. The microencapsulated crystals are formulated to provide an extended release of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride.

Inactive Ingredients: Colloidal silicon dioxide, crospovidone, diethyl phthalate, ethyl-cellulose, microcrystalline cellulose.

CLINICAL PHARMACOLOGY

The Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) ion is the principal intracellular cation of most body tissues. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) ions participate in a number of essential physiological processes including the maintenance of intracellular tonicity; the transmission of nerve impulses; the contraction of cardiac, skeletal, and smooth muscle; and the maintenance of normal renal function.

The intracellular concentration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) is approximately 150 to 160 mEq per liter. The normal adult plasma concentration is 3.5 to 5 mEq per liter. An active ion transport system maintains this gradient across the plasma membrane.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) is a normal dietary constituent and under steady-state conditions the amount of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) absorbed from the gastrointestinal tract is equal to the amount excreted in the urine. The usual dietary intake of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) is 50 to 100 mEq per day.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) depletion will occur whenever the rate of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) loss through renal excretion and/or loss from the gastrointestinal tract exceeds the rate of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) intake. Such depletion usually develops as a consequence of therapy with diuretics, primary or secondary hyperaldosteronism, diabetic ketoacidosis, or inadequate replacement of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) in patients on prolonged parenteral nutrition. Depletion can develop rapidly with severe diarrhea, especially if associated with vomiting. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) depletion due to these causes is usually accompanied by a concomitant loss of chloride and is manifested by hypokalemia and metabolic alkalosis. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) depletion may produce weakness, fatigue, disturbances or cardiac rhythm (primarily ectopic beats), prominent U-waves in the electrocardiogram, and in advanced cases, flaccid paralysis and/or impaired ability to concentrate urine.

If Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) depletion associated with metabolic alkalosis cannot be managed by correcting the fundamental cause of the deficiency, eg, where the patient requires long-term diuretic therapy, supplemental Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) in the form of high Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) food or Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride may be able to restore normal Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) levels.

In rare circumstances (eg, patients with renal tubular acidosis) Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) depletion may be associated with metabolic acidosis and hyperchloremia. In such patients Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) replacement should be accomplished with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) salts other than the chloride, such as Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) bicarbonate, Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) citrate, Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) acetate, or Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) gluconate.

INDICATIONS AND USAGE

BECAUSE OF REPORTS OF INTESTINAL AND GASTRIC ULCERATION AND BLEEDING WITH CONTROLLED-RELEASE Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) CHLORIDE PREPARATIONS, THESE DRUGS SHOULD BE RESERVED FOR THOSE PATIENTS WHO CANNOT TOLERATE OR REFUSE TO TAKE LIQUID OR EFFERVESCENT Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) PREPARATIONS OR FOR PATIENTS IN WHOM THERE IS A PROBLEM OF COMPLIANCE WITH THESE PREPARATIONS.

1. For the treatment of patients with hypokalemia with or without metabolic alkalosis, in digitalis intoxication, and in patients with hypokalemic familial periodic paralysis. If hypokalemia is the result of diuretic therapy, consideration should be given to the use of a lower dose of diuretic, which may be sufficient without leading to hypokalemia.

2. For the prevention of hypokalemia in patients who would be at particular risk if hypokalemia were to develop, eg, digitalized patients or patients with significant cardiac arrhythmias.

The use of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) salts in patients receiving diuretics for uncomplicated essential hypertension is often unnecessary when such patients have a normal dietary pattern and when low doses of the diuretic are used. Serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) should be checked periodically, however, and if hypokalemia occurs, dietary supplementation with potassium-containing foods may be adequate to control milder cases. In more severe cases, and if dose adjustment of the diuretic is ineffective or unwarranted, supplementation with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) salts may be indicated.

CONTRAINDICATIONS

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) supplements are contraindicated in patients with hyperkalemia since a further increase in serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) concentration in such patients can produce cardiac arrest. Hyperkalemia may complicate any of the following conditions: chronic renal failure, systemic acidosis, such as diabetic acidosis, acute dehydration, extensive tissue breakdown as in severe burns, adrenal insufficiency, or the administration of a potassium-sparing diuretic (eg, spironolactone, triamterene, amiloride) (see OVERDOSAGE ).

Controlled-release formulations of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride have produced esophageal ulceration in certain cardiac patients with esophageal compression due to enlarged left atrium. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) supplementation, when indicated in such patients, should be given as a liquid preparation or as an aqueous (water) suspension of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride (see PRECAUTIONS: Information for Patients , and DOSAGE AND ADMINISTRATION sections).

All solid oral dosage forms of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride are contraindicated in any patient in whom there is structural, pathological (eg, diabetic gastroparesis), or pharmacologic (use of anticholinergic agents or other agents with anticholinergic properties at sufficient doses to exert anticholinergic effects) cause for arrest or delay in tablet passage through the gastrointestinal tract.

WARNINGS

Hyperkalemia (see OVERDOSAGE )

In patients with impaired mechanisms for excreting Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)), the administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) salts can produce hyperkalemia and cardiac arrest. This occurs most commonly in patients given Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) by the intravenous route but may also occur in patients given Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) orally. Potentially fatal hyperkalemia can develop rapidly and be asymptomatic. The use of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) salts in patients with chronic renal disease, or any other condition which impairs Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) excretion, requires particularly careful monitoring of the serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) concentration and appropriate dosage adjustment.

Interaction with Potassium-Sparing Diuretics

Hypokalemia should not be treated by the concomitant administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) salts and a potassium-sparing diuretic (eg, spironolactone, triamterene, or amiloride) since the simultaneous administration of these agents can produce severe hyperkalemia.

Interaction with Angiotensin-Converting Enzyme Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors (eg, captopril, enalapril) will produce some Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) retention by inhibiting aldosterone production. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) supplements should be given to patients receiving ACE inhibitors only with close monitoring.

Gastrointestinal Lesions

Solid oral dosage forms of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride can produce ulcerative and/or stenotic lesions of the gastrointestinal tract. Based on spontaneous adverse reaction reports, enteric-coated preparations of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride are associated with an increased frequency of small bowel lesions (40-50 per 100,000 patient years) compared to sustained release wax matrix formulations (less than one per 100,000 patient years). Because of the lack of extensive marketing experience with microencapsulated products, a comparison between such products and wax matrix or enteric-coated products is not available. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablets USP, 20 mEq is a tablet formulated to provide a controlled rate of release of microencapsulated Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride and thus to minimize the possibility of a high local concentration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) near the gastrointestinal wall.

Prospective trials have been conducted in normal human volunteers in which the upper gastrointestinal tract was evaluated by endoscopic inspection before and after 1 week of solid oral Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride therapy. The ability of this model to predict events occurring in usual clinical practice is unknown. Trials which approximated usual clinical practice did not reveal any clear differences between the wax matrix and microencapsulated dosage forms. In contrast, there was a higher incidence of gastric and duodenal lesions in subjects receiving a high dose of a wax matrix controlled-release formulation under conditions which did not resemble usual or recommended clinical practice (ie, 96 mEq per day in divided doses of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride administered to fasted patients, in the presence of an anticholinergic drug to delay gastric emptying). The upper gastrointestinal lesions observed by endoscopy were asymptomatic and were not accompanied by evidence of bleeding (Hemoccult testing). The relevance of these findings to the usual conditions (ie, non-fasting, no anticholinergic agent, smaller doses) under which controlled-release Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride products are used is uncertain; epidemiologic studies have not identified an elevated risk, compared to microencapsulated products, for upper gastrointestinal lesions in patients receiving wax matrix formulations. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablets USP, 20 mEq should be discontinued immediately and the possibility of ulceration, obstruction, or perforation should be considered if severe vomiting, abdominal pain, distention, or gastrointestinal bleeding occurs.

Metabolic Acidosis

Hypokalemia in patients with metabolic acidosis should be treated with an alkalinizing Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) salt such as Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) bicarbonate, Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) citrate, Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) acetate, or Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) gluconate.

PRECAUTIONS

General

The diagnosis of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) depletion is ordinarily made by demonstrating hypokalemia in a patient with a clinical history suggesting some cause for Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) depletion. In interpreting the serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) level, the physician should bear in mind that acute alkalosis per se can produce hypokalemia in the absence of a deficit in total body Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) while acute acidosis per se can increase the serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) concentration into the normal range even in the presence of a reduced total body Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)). The treatment of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) depletion, particularly in the presence of cardiac disease, renal disease, or acidosis requires careful attention to acid-base balance and appropriate monitoring of serum electrolytes, the electrocardiogram, and the clinical status of the patient.

Information for Patients

Physicians should consider reminding the patient of the following: To take each dose with meals and with a full glass of water or other liquid. To take each dose without crushing, chewing, or sucking the tablets. If those patients are having difficulty swallowing whole tablets, they may try one of the following alternate methods of administration:

Break the tablet in half, and take each half separately with a glass of water.
Prepare an aqueous (water) suspension as follows:
1. Place the whole tablet(s) in approximately 1/2 glass of water (4 fluid ounces).
2. Allow approximately 2 minutes for the tablet(s) to disintegrate.
3. Stir for about half a minute after the tablet(s) has disintegrated.
4. Swirl the suspension and consume the entire contents of the glass immediately by drinking or by the use of a straw.
5. Add another 1 fluid ounce of water, swirl, and consume immediately.
6. Then, add an additional 1 fluid ounce of water, swirl, and consume immediately.

Aqueous suspension of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride that is not taken immediately should be discarded. The use of other liquids for suspending Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablets USP, 20 mEq is not recommended.

To take this medicine following the frequency and amount prescribed by the physician. This is especially important if the patient is also taking diuretics and/or digitalis preparations.

To check with the physician at once if tarry stools or other evidence of gastrointestinal bleeding is noticed.

Laboratory Tests

When blood is drawn for analysis of plasma Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) it is important to recognize that artifactual elevations can occur after improper venipuncture technique or as a result of in vitro hemolysis of the sample.

Drug Interactions

Potassium-sparing diuretics, angiotensin-converting enzyme inhibitors (see WARNINGS ).

Carcinogenesis, Mutagenesis, Impairment of Fertility

Carcinogenicity, mutagenicity, and fertility studies in animals have not been performed. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) is a normal dietary constituent.

Pregnancy Category C

Animal reproduction studies have not been conducted with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablets USP, 20 mEq. It is unlikely that Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) supplementation that does not lead to hyperkalemia would have an adverse effect on the fetus or would affect reproductive capacity.

Nursing Mothers

The normal Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) ion content of human milk is about 13 mEq per liter. Since oral Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) becomes part of the body Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) pool, so long as body Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) is not excessive, the contribution of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride supplementation should have little or no effect on the level in human milk.

Pediatric Use

Safety and effectiveness in pediatric patients have not been established.

Geriatric Use

Clinical studies of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.

This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection; and it may be useful to monitor renal function.

ADVERSE REACTIONS

One of the most severe adverse effects is hyperkalemia (see CONTRAINDICATIONS , WARNINGS , and OVERDOSAGE ). There have also been reports of upper and lower gastrointestinal conditions including obstruction, bleeding, ulceration, and perforation (see CONTRAINDICATIONS and WARNINGS ). The most common adverse reactions to oral Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) salts are nausea, vomiting, flatulence, abdominal pain/discomfort, and diarrhea. These symptoms are due to irritation of the gastrointestinal tract and are best managed by diluting the preparation further, taking the dose with meals or reducing the amount taken at one time.

OVERDOSAGE

The administration of oral Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) salts to persons with normal excretory mechanisms for Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) rarely causes serious hyperkalemia. However, if excretory mechanisms are impaired or if Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) is administered too rapidly intravenously, potentially fatal hyperkalemia can result (see CONTRAINDICATIONS and WARNINGS ). It is important to recognize that hyperkalemia is usually asymptomatic and may be manifested only by an increased serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) concentration (6.5-8.0 mEq/L) and characteristic electrocardiographic changes (peaking of T-waves, loss of P-waves, depression of S-T segment, and prolongation of the QT-interval). Late manifestations include muscle paralysis and cardiovascular collapse from cardiac arrest (9-12 mEq/L).

Treatment measures for hyperkalemia include the following:

Patients should be closely monitored for arrhythmias and electrolyte changes.
Elimination of foods and medications containing Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) and of any agents with potassium-sparing properties such as potassium-sparing diuretics, ARBS, ACE inhibitors, NSAIDS, certain nutritional supplements and many others.
Intravenous calcium gluconate if the patient is at no risk of developing digitalis toxicity.
Intravenous administration of 300 to 500 mL/hr of 10% dextrose solution containing 10-20 units of crystalline insulin per 1,000 mL.
Correction of acidosis, if present, with intravenous sodium bicarbonate.
Use of exchange resins, hemodialysis, or peritoneal dialysis.

In treating hyperkalemia, it should be recalled that in patients who have been stabilized on digitalis, too rapid a lowering of the serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) concentration can produce digitalis toxicity.

The extended release feature means that absorption and toxic effects may be delayed for hours.

Consider standard measures to remove any unabsorbed drug.

DOSAGE AND ADMINISTRATION

The usual dietary intake of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) by the average adult is 50 to 100 mEq per day. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) depletion sufficient to cause hypokalemia usually requires the loss of 200 or more mEq of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) from the total body store.

Dosage must be adjusted to the individual needs of each patient. The dose for the prevention of hypokalemia is typically in the range of 20 mEq per day. Doses of 40-100 mEq per day or more are used for the treatment of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) depletion. Dosage should be divided if more than 20 mEq per day is given such that no more than 20 mEq is given in a single dose.

Each Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablet USP, 20 mEq provides 20 mEq of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride.

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablets USP, 20 mEq should be taken with meals and with a glass of water or other liquid. This product should not be taken on an empty stomach because of its potential for gastric irritation (see WARNINGS ).

Patients having difficulty swallowing whole tablets may try one of the following alternate methods of administration:

Break the tablet in half, and take each half separately with a glass of water.
Prepare an aqueous (water) suspension as follows:
- Place the whole tablet(s) in approximately 1/2 glass of water (4 fluid ounces).
- Allow approximately 2 minutes for the tablet(s) to disintegrate.
- Stir for about half a minute after the tablet(s) has disintegrated.
- Swirl the suspension and consume the entire contents of the glass immediately by drinking or by the use of a straw.
- Add another 1 fluid ounce of water, swirl, and consume immediately.
- Then, add an additional 1 fluid ounce of water, swirl, and consume immediately.

HOW SUPPLIED

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) Chloride Extended Release Tablets USP, 20 mEq are available in bottles of 100 (NDC 62037-999-01), bottles of 500 (NDC 62037-999-05), and bottles of 1000 (NDC 62037-999-10). Potassium Chloride Extended Release Tablets USP, 20 mEq are capsule shaped, white to off-white tablets, with “ABRS-123” imprinted on one side and scored on the other side for flexibility of dosing.

Storage Conditions

Keep tightly closed. Store at controlled room temperature, 20°-25°C (68°-77°F).

Manufactured by:

Eurand, Inc.

Vandalia, OH 45377 USA

Distributed by:

Watson Pharma, Inc.

Rev. Date (01/09) 173714

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Potassium (Potassium Citrate)) chloride 20 Meq

Zinc (Zinc Citrate):

Indications and usage
Contraindications
Warnings
Precautions
Adverse reactions
Drug abuse and dependence
Overdosage
Dosage and administration
How supplied
Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) reviews

INDICATIONS AND USAGE

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) 1 mg/mL (Zinc Chloride Injection, USP) is indicated for use as a supplement to intravenous solutions given for TPN. Administration helps to maintain Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) serum levels and to prevent depletion of endogenous stores, and subsequent deficiency symptoms.

CONTRAINDICATIONS

None known.

WARNINGS

Direct intramuscular or intravenous injection of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) 1 mg/mL (Zinc Chloride Injection, USP) is contraindicated as the acidic pH of the solution (2) may cause considerable tissue irritation.

Severe kidney disease may make it necessary to reduce or omit chromium and Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) doses because these elements are primarily eliminated in the urine.

PRECAUTIONS

General

Do not use unless the solution is clear and the seal is intact.

Zinc 1 mg/mL should only be used in conjunction with a pharmacy directed admixture program using aseptic technique in a laminar flow environment; it should be used promptly and in a single operation without any repeated penetrations. Solution contains no preservatives; discard unused portion immediately after admixture procedure is completed.

Zinc should not be given undiluted by direct injection into a peripheral vein because of the likelihood of infusion phlebitis and the potential for increased excretory loss of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) from a bolus injection. Administration of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) in the absence of copper may cause a decrease in serum copper levels.

Laboratory Tests

Periodic determinations of serum copper as well as Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) are suggested as a guideline for subsequent Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) administration.

Carcinogenesis, Mutagenesis, and Impairment of Fertility

Long-term animal studies to evaluate the carcinogenic potential of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) 1 mg/mL (Zinc Chloride Injection, USP) have not been performed, nor have studies been done to assess mutagenesis or impairment of fertility.

Nursing Mothers

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) 1 mg/mL (Zinc Chloride Injection, USP) is administered to a nursing woman.

Pediatric Use

Pregnancy Category C. Animal reproduction studies have not been conducted with Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D ) chloride. It is also not known whether Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) chloride can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) chloride should be given to a pregnant woman only if clearly needed.

Geriatric Use

ADVERSE REACTIONS

None known.

DRUG ABUSE AND DEPENDENCE

None known.

OVERDOSAGE

Single intravenous doses of 1 to 2 mg zinc/kg body weight have been given to adult leukemic patients without toxic manifestations. However, acute toxicity was reported in an adult when 10 mg Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) was infused over a period of one hour on each of four consecutive days. Profuse sweating, decreased level of consciousness, blurred vision, tachycardia (140/min), and marked hypothermia (94.2° F) on the fourth day were accompanied by a serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) concentration of 207 mcg/dl. Symptoms abated within three hours.

Hyperamylasemia may be a sign of impending Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) overdosage; patients receiving an inadvertent overdose (25 mg zinc/liter of TPN solution, equivalent to 50 to 70 mg zinc/day) developed hyperamylasemia (557 to 1850 Klein units; normal: 130 to 310).

Death resulted from an overdosage in which 1683 mg Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) was delivered intravenously over the course of 60 hours to a 72 year old patient.

Symptoms of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) toxicity included hypotension (80/40 mm Hg), pulmonary edema, diarrhea, vomiting, jaundice, and oliguria, with a serum Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) level of 4184 mcg/dl.

Calcium supplements may confer a protective effect against Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) toxicity.

DOSAGE AND ADMINISTRATION

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) 1 mg/mL (Zinc Chloride Injection, USP) contains 1 mg zinc/mL and is administered intravenously only after dilution. The additive should be diluted prior to administration in a volume of fluid not less than 100 mL. For the metabolically stable adult receiving TPN, the suggested intravenous dosage is 2.5 to 4 mg zinc/day (2.5 to 4 mL/day). An additional 2 mg zinc/day (2 mL/day) is suggested for acute catabolic states. For the stable adult with fluid loss from the small bowel, an additional 12.2 mg zinc/liter of small bowel fluid lost (12.2 mL/liter of small bowel fluid lost), or an additional 17.1 mg zinc/kg of stool or ileostomy output (17.1 mL/kg of stool or ileostomy output) is recommended. Frequent monitoring of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) blood levels is suggested for patients receiving more than the usual maintenance dosage level of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)).

For full term infants and children up to 5 years of age, 100 mcg zinc/kg/day (0.1 mL/kg/day) is recommended. For premature infants (birth weight less than 1500 g) up to 3 kg in body weight, 300 mcg zinc/kg/day (0.3 mL/kg/day) is suggested.

Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.

HOW SUPPLIED

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) 1 mg/mL (Zinc Chloride Injection, USP) is supplied in 10 mL Plastic Vials (List No. 4090).

Store at 20 to 25°C (68 to 77°F).

Revised: October, 2004

HOSPIRA, INC., LAKE FOREST, IL 60045 USA

10 mL Vial

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate))

1 mg/mL

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D (Zinc (Zinc Citrate)) Chloride Inj., USP

Rx only

FOR I.V. USE ONLY AFTER DILUTION.

HOSPIRA, INC., LAKE FOREST, IL 60045 USA

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D pharmaceutical active ingredients containing related brand and generic drugs:

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D available forms, composition, doses:

Tablets; Oral; Calcium (Calcium Citrate) 250 mg; Magnesium (Magnesium Oxide, Magnesium Citrate) 250 mg; Manganese (Manganese Citrate) 1 mg; Potassium (Potassium Citrate) 20 mg; Vitamin D3 100 units; Zinc (Zinc Citrate) 5 mg

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D destination | category:

Human:
Vitamin supplements / mineral supplements
Vitamins and Minerals

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D Anatomical Therapeutic Chemical codes:

A11JB - Vitamins with minerals

Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D pharmaceutical companies:

WN Pharmaceuticals

References

Dailymed."CHOLECALCIFEROL: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
Dailymed."CALCIUM: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailym... (accessed August 28, 2018).
"Potassium". https://pubchem.ncbi.nlm.nih.gov/co... (accessed August 28, 2018).

Frequently asked Questions

Can i drive or operate heavy machine after consuming Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D?

Depending on the reaction of the Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D after taken, if you are feeling dizziness, drowsiness or any weakness as a reaction on your body, Then consider Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D not safe to drive or operate heavy machine after consumption. Meaning that, do not drive or operate heavy duty machines after taking the capsule if the capsule has a strange reaction on your body like dizziness, drowsiness. As prescribed by a pharmacist, it is dangerous to take alcohol while taking medicines as it exposed patients to drowsiness and health risk. Please take note of such effect most especially when taking Primosa capsule. It's advisable to consult your doctor on time for a proper recommendation and medical consultations.

Is Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D addictive or habit forming?

Medicines are not designed with the mind of creating an addiction or abuse on the health of the users. Addictive Medicine is categorically called Controlled substances by the government. For instance, Schedule H or X in India and schedule II-V in the US are controlled substances.

Please consult the medicine instruction manual on how to use and ensure it is not a controlled substance.In conclusion, self medication is a killer to your health. Consult your doctor for a proper prescription, recommendation, and guidiance.

Review

sdrugs.com conducted a study on Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D, and the result of the survey is set out below. It is noteworthy that the product of the survey is based on the perception and impressions of the visitors of the website as well as the views of Calcium; Magnesium; Potassium; Zinc; Manganese; Vitamin D consumers. We, as a result of this, advice that you do not base your therapeutic or medical decisions on this result, but rather consult your certified medical experts for their recommendations.