calcium/vitamin D (OTC)

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

Interaction Checker

and calcium/vitamin D

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     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (1)

              • baloxavir marboxil

                calcium/vitamin D will decrease the level or effect of baloxavir marboxil by cation binding in GI tract. Avoid or Use Alternate Drug. Baloxavir may bind to polyvalent cations resulting in decreased absorption. Studies in monkeys showed concurrent use with calcium, aluminum, or iron caused significantly decreased plasma levels. Human studies not conducted.

              Monitor Closely (9)

              • cabotegravir

                calcium/vitamin D will decrease the level or effect of cabotegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer polyvalent cation products at least 2 hr before or 4 hr after taking oral cabotegravir.

              • deferiprone

                calcium/vitamin D decreases levels of deferiprone by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Deferiprone may bind polyvalent cations (eg, iron, aluminum, and zinc), separate administration by at least 4 hr between deferiprone and other medications (eg, antacids), or supplements containing these polyvalent cations.

              • delafloxacin

                calcium/vitamin D will decrease the level or effect of delafloxacin by cation binding in GI tract. Modify Therapy/Monitor Closely. Oral delafloxacin form chelates with alkaline earth and transition metal cations. Administer oral delafloxacin at least 2 hr before or 6 hr after these agents.

              • omadacycline

                calcium/vitamin D will decrease the level or effect of omadacycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • rifampin

                calcium/vitamin D will decrease the level or effect of rifampin by Other (see comment). Use Caution/Monitor. Concomitant antacid administration may reduce absorption of rifampin; daily doses of rifampin should be given at least 1 hr before ingestion of antacids

              • rilpivirine

                calcium/vitamin D decreases levels of rilpivirine by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Coadministration of antacids with rilpivirine may cause significant decreases in rilpivirine plasma concentrations because of increased gastric pH. If antacids must be administered, they should given at least 2 hr before or at least 4 hr after rilpivirine.

              • sarecycline

                calcium/vitamin D will decrease the level or effect of sarecycline by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Multivalent cation-containing products may impair absorption of tetracyclines, which may decrease its efficacy. Separate dosing of tetracyclines from these products.

              • sodium sulfate/?magnesium sulfate/potassium chloride

                sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of calcium/vitamin D by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              • sodium sulfate/potassium sulfate/magnesium sulfate

                sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of calcium/vitamin D by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

              Minor (0)

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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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                Images

                BRAND FORM. UNIT PRICE PILL IMAGE
                Os-Cal 500 + D3 oral
                -
                500 mg(1,250mg) -200 unit tablet
                Calcium 500 With D oral
                -
                500 mg(1,250mg) -400 unit tablet
                Calcium 500 With D oral
                -
                500 mg(1,250mg) -400 unit tablet
                Calcium 600 + D(3) oral
                -
                600 mg(1,500mg) -200 unit tablet
                Calcium 600 + D(3) oral
                -
                600 mg(1,500mg) -200 unit tablet
                Calcium 600 + D(3) oral
                -
                600 mg(1,500mg) -200 unit tablet
                Calcium 600 + D(3) oral
                -
                600 mg(1,500mg) -200 unit tablet
                Calcium 600 + D(3) oral
                -
                600 mg(1,500mg) -400 unit tablet
                Calcium 500 + D oral
                -
                500 mg(1,250mg) -200 unit tablet
                Calcium 500 + D oral
                -
                500 mg(1,250mg) -400 unit chewable tablet
                Calcium 500 + D oral
                -
                500 mg(1,250mg) -200 unit tablet
                Calcium 500 + D oral
                -
                500 mg(1,250mg) -200 unit tablet
                Oyster Shell Calcium-Vitamin D3 oral
                -
                500 mg(1,250mg) -400 unit tablet
                Oyster Shell Calcium-Vitamin D3 oral
                -
                500 mg(1,250mg) -200 unit tablet
                Oyster Shell Calcium-Vitamin D3 oral
                -
                250-125 mg-unit tablet
                Oyster Shell Calcium-Vitamin D3 oral
                -
                250-125 mg-unit tablet
                Oyster Shell Calcium-Vitamin D3 oral
                -
                250-125 mg-unit tablet
                Oyster Shell Calcium-Vitamin D3 oral
                -
                500 mg(1,250mg) -200 unit tablet
                calcium carbonate-vitamin D3 oral
                -
                600 mg(1,500mg) -400 unit tablet
                calcium carbonate-vitamin D3 oral
                -
                500 mg(1,250mg) -400 unit chewable tablet
                calcium carbonate-vitamin D3 oral
                -
                250-125 mg-unit tablet
                calcium carbonate-vitamin D3 oral
                -
                250-125 mg-unit tablet
                calcium carbonate-vitamin D3 oral
                -
                250-125 mg-unit tablet
                calcium carbonate-vitamin D3 oral
                -
                600 mg(1,500mg) -200 unit tablet
                calcium carbonate-vitamin D3 oral
                -
                600 mg(1,500mg) -800 unit tablet
                calcium carbonate-vitamin D3 oral
                -
                600 mg(1,500mg) -800 unit tablet
                calcium carbonate-vitamin D3 oral
                -
                600 mg(1,500mg) -400 unit tablet
                calcium carbonate-vitamin D3 oral
                -
                1,000 mg(2,500 mg)-800 unit tablet
                calcium carbonate-vitamin D3 oral
                -
                600 mg(1,500mg) -800 unit tablet
                calcium carbonate-vitamin D3 oral
                -
                500-100 mg-unit chewable tablet
                calcium carbonate-vitamin D3 oral
                -
                600 mg(1,500mg) -800 unit tablet
                calcium carbonate-vitamin D3 oral
                -
                600 mg(1,500mg) -400 unit tablet
                Oysco 500/D oral
                -
                500 mg(1,250mg) -200 unit tablet
                Oyster Shell + D3 oral
                -
                250-125 mg-unit tablet
                Caltrate 600 plus D oral
                -
                600 mg (1,500 mg)-800 unit chewable tablet
                Caltrate with Vitamin D3 oral
                -
                600 mg(1,500mg) -800 unit tablet
                Caltrate with Vitamin D3 oral
                -
                600 mg(1,500mg) -800 unit tablet
                Caltrate with Vitamin D3 oral
                -
                600 mg(1,500mg) -800 unit tablet

                Copyright © 2010 First DataBank, Inc.

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                Patient Handout

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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.