calcium/vitamin D (OTC)

Brand and Other Names:Caltrate 600+D3, Os-Cal Calcium + D3, more...Os-Cal Extra D3, Os-Cal Ultra
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

calcium/vitamin D

caplet

  • 315mg/250IU
  • 500mg/200IU
  • 500mg/600IU

capsule

  • 600mg/100IU
  • 600mg/400IU
  • 600mg/500IU
  • 600mg/1000IU

tablet

  • 250mg/125IU
  • 200mg/250IU
  • 250mg/200IU
  • 315mg/215IU
  • 500mg/200IU
  • 600mg/200IU
  • 600mg/400IU
  • 600mg/800IU

tablet, chewable

  • 250mg/400IU
  • 500mg/100IU
  • 500mg/200IU
  • 500mg/600IU
  • 600mg/400IU
  • 600mg/800IU

Calcium Supplementation

Daily dietary reference intake

  • Calcium/vitamin D
  • 19-50 years: 1000 mg/600 IU daily
  • ≥51-70 years (males): 1000 mg/600 IU
  • ≥51 years (females): 1200 mg/600 IU
  • ≥70 years (males): 1200 mg/800 IU
  • Pregnancy/lactating: 1000mg/600IU
  • Osteoporosis prevention in adults ≥50 years: Vitamin D intake may need to be increased to 800-1000 mg

Dietary supplement

  • 1-2 tablets/caplets PO BID with or without food (food may increase absorption); consult product informaiton also

Dosing Considerations

Elemental calcium equivalent by weight

  • Calcium carbonate is 40% elemental calcium
  • Calcium citrate is 21% elemental calcium

High risk for vitamin D deficiency

  • Age ≥50 years
  • Dark pigmented skin
  • Limited sun exposure
  • Consistently wearing sunscreen

Administration

Tablet strengths are varied; check content of calcium and vitamin D carefully to assure dosage

Take with food

Data on calcium supplementation in childrem not conclusive

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Interactions

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            Adverse Effects

            Frequency Not Defined

            Calcium

            • Anorexia
            • Constipation
            • Flatulence
            • Nausea
            • Vomiting
            • Hypercalcemia
            • Hypophosphatemia
            • Xerostomia
            • Acid rebound
            • Milk-alkali syndrome

            Vitamin D

            • Hypercalcemia
            • Muscle/bone pain
            • Metallic taste
            • Headache
            • Nausea
            • Vomiting
            • Dry mouth
            • Constipation
            • Arrhythmias
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            Warnings

            Contraindications

            Calcium carbonate

            • Hypersensitivity
            • Hypercalciuria
            • Renal calculi
            • Hypophosphatemia
            • Hypercalcemia
            • Suspected digoxin toxicity

            Vitamin D

            • Hypercalcemia
            • Hypervitaminosis D
            • Ergocalciferol (oral): GI, liver, or biliary disease associated with malabsorption of vitamin D analogs

            Cautions

            Constipation, bloating, and gas may occur

            Achlohydria, which is common in elderly, may impair calcium absorption; use the citrate salt and administer with food in such patients

            Hypercalcemia and hypercalciuria may occur in hypoparathyroid patients receiving high doses of vitamin D

            Use caution in patients with renal failure; frequent monitoring of serum calcium and phosphorus necessary to prevent hypercalcemia

            Calcium supplements may interfere with absorption of some medications and minerals; use caution

            Use caution administering calcium supplements to patients with a history of kidney stones

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            Pregnancy & Lactation

            Pregnancy

            Available data suggests safe use during pregnancy

            Lactation

            Available data suggests safe use during lactation

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Mechanism of Action

            Calcium

            • Used to prevent or treat negative calcium imbalance; as antacids, increases gastric and duodenal bulb pH >4 and increase lower esophageal sphincter tone; in osteoporosis helps prevent or decrease the rate of bone loss; calcium is also involved in normal cardiac function; also treats hyperphosphatemia in patients with chronic kidney disease

            Vitamin D

            • The active metabolite, calcitriol, stimulates calcium and phosphate absorption from the small intestine, promotes renal tubule phosphate resorption, and secretion of calcium from bone to blood

            Absorption

            Bioavailability: 25-35% (calcium carbonate)

            Vitamin D: Fat soluble; requires bile; absorbed in small intestine

            Distribution

            Protein bound: 40-45% (calcium)

            Metabolism

            Vitamin D: Hydroxylated hepatically to calciferol (25-hydroxyvitamin D), then renally to the active metabolite calcitriol (1,25-dihydroxyvitamin D)

            Elimination

            Excretion (calcium): 80% as unabsorbed calcium in feces, 20% urinary via urine

            Excretion (vitamin D): Feces

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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.