calcium carbonate (OTC)

Brand and Other Names:Tums, Tums Chewy Delights, more...Tums Extra, Tums Freshers, Tums Kids, Tums Regular, Tums Smoothies, Tums Ultra, Children's Pepto, Calci-Chew, Caltrate 600, Oysco 500
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet, chewable

  • 500mg (Tums Regular, Tums Freshers)
  • 750mg (Tums Extra, Tums Kids, Tums Smoothies)
  • 1000mg (Tums Ultra)
  • 1250mg (Calci-Chew, Oysco)
  • 1500mg (Caltrate)
  • 1177mg (Tums Chewy Delights)

Antacid

Take at onset of GI distress

Tums Regular, Tums Freshers (500 mg): Chew 2-4 tablets; not to exceed 15 tabs/24 hr

Tums Smoothies (750 mg): Chew 2-4 tablets; not to exceed 10 tabs/24 hr

Tums Extra (750 mg): Chew 2-4 tablets; not to exceed 9 tabs/24 hr

Tums Ultra (1000 mg): Chew 2-3 tablets; not to exceed 7 tabs/24 hr

Tums Chewy Delights (1177 mg): Chew and swallow 2-3 chews; not to exceed 10 chews/24 hr

Not to exceed 7 g/day

Calcium Supplementation

500 mg to 4 g PO qDay or divided q6-12hr with meals

Recommended Dietary Allowance

19-50 years: 1 g/day PO

Females

  • >51 years: 1.2 g/day PO

Males

  • 51-70 years: 1 g/day PO
  • >71 years: 1.2 g/day PO

Dosing Considerations

Calcium carbonate (elemental calcium equivalent)

Approximately 40% of calcium carbonate is elemental calcium; 1000mg of calcium carbonate = 400 mg of elemental calcium

  • 400 mg (161 mg)
  • 500 mg (200 mg)
  • 750 mg (300 mg)
  • 1000 mg (400 mg)
  • 1250 mg (500 mg)
  • 1500 mg (600 mg)
  • 1177 mg (470 mg)

Hyperphosphatemia (Orphan)

Treatment of hyperphosphatemia in patients with end-stage renal disease

Orphan indication sponsor

  • R & D Laboratories, Inc; 4204 Glencoe Avenue; Marina Del Rey, CA 90292

Dosage Forms & Strengths

tablet, chewable

  • 500mg (Tums Regular, Tums Freshers)
  • 750mg (Tums Extra, Tums Kids, Tums Smoothies)
  • 1000mg (Tums Ultra)
  • 1250mg (Calci-Chew, Oysco)
  • 1500mg (Caltrate)
  • 1177mg (Tums Chewy Delights)

Antacid

Children's Pepto

  • <2 years (<11 kg): Safety and efficacy not established
  • 2-5 years (12-21 kg): 400 mg (1 tablet) PO PRN; not to exceed 3 tablets/day
  • 6-11 years (22-43 kg): 800 mg (2 tablets) PO PRN; not to exceed 6 tablets/day

Tums Kids

  • <2 years (<11 kg): Safety and efficacy not established
  • 2-4 years (11-21 kg): 375 mg (1/2 tablet) PO BID with meal
  • >4 years (22-43 kg): 750 mg (1 tablet) PO TID with meal

Recommended Dietary Allowance

Dosage expressed as elemental calcium

0-6 months: 200 mg/day PO

7-12 months: 260 mg/day PO

1-3 years: 700 mg/day PO

4-8 years: 1000 mg/day PO

9-18 years: 1300 mg/day PO

Dosing Considerations

Calcium carbonate (elemental calcium equivalent)

  • 400 mg (161 mg)
  • 500 mg (200 mg)
  • 750 mg (300 mg)
  • 1000 mg (400 mg)
  • 1250 mg (500 mg)
  • 1500 mg (600 mg)
  • 1177 mg (470 mg)
Next:

Interactions

Interaction Checker

and calcium carbonate

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            Contraindicated (1)

            • ceftriaxone

              ceftriaxone, calcium carbonate. Other (see comment). Contraindicated. Comment: Do not use ANY calcium containing solutions (including Ringer or Harmann solutions) in combination with IV ceftriaxone; risk of potentially fatal particulate precipitation in lungs, kidneys. Separate by at least 48 hrs.

            Serious - Use Alternative (21)

            • atazanavir

              calcium carbonate will decrease the level or effect of atazanavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Atazanavir solubility decreases as pH increases. Reduced plasma concentrations of atazanavir are expected if antacids or buffered medications are coadministered. Administer atazanavir 2 hr before or 1 hr after these medications.

            • baloxavir marboxil

              calcium carbonate 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.

            • dapsone

              calcium carbonate will decrease the level or effect of dapsone by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • dasatinib

              calcium carbonate will decrease the level or effect of dasatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • demeclocycline

              calcium carbonate, demeclocycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • digoxin

              calcium carbonate will increase the level or effect of digoxin by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • doxycycline

              calcium carbonate, doxycycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • eltrombopag

              calcium carbonate decreases levels of eltrombopag by inhibition of GI absorption. Applies only to oral form of both agents. Contraindicated. Separate by at least 4 hours.

            • erdafitinib

              calcium carbonate, erdafitinib. Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid coadministration during initial dosing adjustment period (ie, first 21 days). Increases in serum phosphate levels are a pharmacodynamic effect of FGFR inhibition. Serum phosphate binders may obscure decisions regarding initial dosage increase.

            • indinavir

              calcium carbonate will decrease the level or effect of indinavir by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • infigratinib

              calcium carbonate will decrease the level or effect of infigratinib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer infigratinib 2 hr before and after administration of a locally-acting antacid.

            • ketoconazole

              calcium carbonate will decrease the level or effect of ketoconazole by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • minocycline

              calcium carbonate, minocycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • nimodipine

              calcium carbonate will increase the level or effect of nimodipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • nisoldipine

              calcium carbonate will increase the level or effect of nisoldipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • nitrendipine

              calcium carbonate will increase the level or effect of nitrendipine by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • oxytetracycline

              calcium carbonate, oxytetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            • pazopanib

              calcium carbonate will decrease the level or effect of pazopanib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with drugs that raise gastric pH; may use short-acting antacids in place of PPIs and H2 antagonists, but separate antacid and pazopanib dosing by several hours

            • ponatinib

              calcium carbonate decreases levels of ponatinib by increasing gastric pH. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

            • sotorasib

              calcium carbonate will decrease the level or effect of sotorasib by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. If use with an acid-reducing agent cannot be avoided, administer sotorasib 4 hr before or 10 hr after administration of a locally-acting antacid.

            • tetracycline

              calcium carbonate, tetracycline. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Separate by 2 hours.

            Monitor Closely (135)

            • acalabrutinib

              calcium carbonate decreases levels of acalabrutinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Acalabrutinib solubility decreases with increasing gastric pH. Separate dosing by at least 2 hr between administration of antacids and acalabrutinib.

            • acebutolol

              calcium carbonate decreases effects of acebutolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of acebutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • alendronate

              calcium carbonate decreases levels of alendronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

            • allopurinol

              calcium carbonate decreases levels of allopurinol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • amantadine

              calcium carbonate will increase the level or effect of amantadine by Other (see comment). Modify Therapy/Monitor Closely. Urine pH changes towards alkalinic conditions may lead to an accumulation of amantadine with a possible increase in adverse reactions. Monitor for adverse reactions of amantadine.

            • amlodipine

              calcium carbonate decreases effects of amlodipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • atenolol

              calcium carbonate decreases effects of atenolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of atenolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • azithromycin

              calcium carbonate decreases levels of azithromycin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • bearberry

              calcium carbonate will increase the level or effect of bearberry by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • benazepril

              calcium carbonate decreases effects of benazepril by unspecified interaction mechanism. Use Caution/Monitor.

            • benzphetamine

              calcium carbonate will increase the level or effect of benzphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • betaxolol

              calcium carbonate decreases effects of betaxolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of betaxolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • bictegravir

              calcium carbonate will decrease the level or effect of bictegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Bictegravir can be taken under fasting conditions 2 hr before antacids containing calcium. However, bictegravir and supplements containing calcium can be taken together with food. Routine administration of bictegravir (under fasting conditions) simultaneously with, or 2 hr after, calcium supplements or antacids containing calcium is not recommended.

            • bisoprolol

              calcium carbonate decreases effects of bisoprolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of bisoprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • bosutinib

              calcium carbonate decreases levels of bosutinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Bosutinib displays pH-dependent solubility; may use short-acting antacids with administration separated by 2 hr.

            • budesonide

              calcium carbonate decreases effects of budesonide by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Enteric-coated budesonide dissolves at pH >5.5. Also, dissolution of extended-release budesonide tablets is pH dependent. Coadministration with drugs that increase gastric pH may cause these budesonide products to prematurely dissolve, and possibly affect release properties and absorption of the drug in the duodenum.

            • cabotegravir

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

            • captopril

              calcium carbonate decreases effects of captopril by unspecified interaction mechanism. Use Caution/Monitor. Calcium carbonate may decrease absorption of captopril.

            • carbonyl iron

              calcium carbonate will decrease the level or effect of carbonyl iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • carvedilol

              calcium carbonate decreases effects of carvedilol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of carvedilol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • cefdinir

              calcium carbonate will decrease the level or effect of cefdinir by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • cefditoren

              calcium carbonate will decrease the level or effect of cefditoren by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • cefpodoxime

              calcium carbonate will decrease the level or effect of cefpodoxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • cefuroxime

              calcium carbonate will decrease the level or effect of cefuroxime by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • celecoxib

              calcium carbonate decreases levels of celecoxib by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • celiprolol

              calcium carbonate decreases effects of celiprolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of celiprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • chenodiol

              calcium carbonate decreases levels of chenodiol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • chloroquine

              calcium carbonate will decrease the level or effect of chloroquine by cation binding in GI tract. Use Caution/Monitor. Separate doses by at least 4 hr

            • ciprofloxacin

              calcium carbonate decreases effects of ciprofloxacin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Ciprofloxacin should be administered 2 hr before or 6 hr after calcium salts.

            • clevidipine

              calcium carbonate decreases effects of clevidipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • crizotinib

              calcium carbonate decreases levels of crizotinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that elevate the gastric pH may decrease the solubility of crizotinib and subsequently reduce its bioavailability. However, no formal studies have been conducted. .

            • cyclosporine

              calcium carbonate decreases levels of cyclosporine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • dabrafenib

              calcium carbonate will decrease the level or effect of dabrafenib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Drugs that alter upper GI tract pH (eg, PPIs, H2-blockers, antacids) may decrease dabrafenib solubility and reduce its bioavailability

            • deferiprone

              calcium carbonate 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.

            • deferoxamine

              deferoxamine decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Deferoxamine chelates iron; its affinity for other minerals is unknown.

            • delafloxacin

              calcium carbonate 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.

            • dextroamphetamine

              calcium carbonate will increase the level or effect of dextroamphetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • digoxin

              calcium carbonate increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor.

            • diltiazem

              calcium carbonate decreases effects of diltiazem by pharmacodynamic antagonism. Use Caution/Monitor.

            • dolutegravir

              calcium carbonate will decrease the level or effect of dolutegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Administer dolutegravir 2 hr (dolutegravir or abacavir/dolutegravir/lamivudine) or 4 hr (dolutegravir/rilpivirine) before or 6 hr after taking medications containing polyvalent cations.

            • elvitegravir

              calcium carbonate will decrease the level or effect of elvitegravir by cation binding in GI tract. Modify Therapy/Monitor Closely. Elvitegravir plasma concentrations are lower with antacids due to the formation of ionic complexes in the GI tract and not due to changes in gastric pH; separate dose from antacid by at least 2 hr

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              calcium carbonate decreases levels of elvitegravir/cobicistat/emtricitabine/tenofovir DF by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration from antacids by 2 hr.

            • enalapril

              calcium carbonate decreases effects of enalapril by unspecified interaction mechanism. Use Caution/Monitor.

            • ephedrine

              calcium carbonate will increase the level or effect of ephedrine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • erythromycin base

              calcium carbonate increases levels of erythromycin base by unknown mechanism. Use Caution/Monitor.

            • erythromycin ethylsuccinate

              calcium carbonate increases levels of erythromycin ethylsuccinate by unknown mechanism. Use Caution/Monitor.

            • erythromycin lactobionate

              calcium carbonate increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

            • erythromycin stearate

              calcium carbonate increases levels of erythromycin stearate by unknown mechanism. Use Caution/Monitor.

            • esmolol

              calcium carbonate decreases effects of esmolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of esmolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • estramustine

              calcium carbonate decreases levels of estramustine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Patients should take estramustine with water at least 1h before or 2h after meals.

            • etidronate

              calcium carbonate decreases levels of etidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

            • felodipine

              calcium carbonate decreases effects of felodipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • ferric maltol

              calcium carbonate will decrease the level or effect of ferric maltol by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ferrous fumarate

              calcium carbonate will decrease the level or effect of ferrous fumarate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ferrous gluconate

              calcium carbonate will decrease the level or effect of ferrous gluconate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • flecainide

              calcium carbonate will increase the level or effect of flecainide by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • fosamprenavir

              calcium carbonate will decrease the level or effect of fosamprenavir by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • fosinopril

              calcium carbonate decreases effects of fosinopril by unspecified interaction mechanism. Use Caution/Monitor.

            • gabapentin

              calcium carbonate decreases levels of gabapentin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • gabapentin enacarbil

              calcium carbonate decreases levels of gabapentin enacarbil by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • gefitinib

              calcium carbonate decreases levels of gefitinib by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor. Separate gefitinib and antacid doses by at least 6 hr.

            • gemifloxacin

              calcium carbonate, gemifloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • glipizide

              calcium carbonate will increase the level or effect of glipizide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • glyburide

              calcium carbonate will increase the level or effect of glyburide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • ibandronate

              calcium carbonate decreases levels of ibandronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

            • imidapril

              calcium carbonate decreases effects of imidapril by unspecified interaction mechanism. Use Caution/Monitor.

            • iron dextran complex

              calcium carbonate will decrease the level or effect of iron dextran complex by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • iron sucrose

              calcium carbonate will decrease the level or effect of iron sucrose by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • isoniazid

              calcium carbonate decreases levels of isoniazid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • isradipine

              calcium carbonate decreases effects of isradipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • itraconazole

              calcium carbonate will decrease the level or effect of itraconazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Administer acid neutralizing medicines at least 2 hours before or 2 hours after itraconazole.

            • ketoconazole

              calcium carbonate decreases levels of ketoconazole by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • labetalol

              calcium carbonate decreases effects of labetalol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of labetalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • lactulose

              calcium carbonate decreases effects of lactulose by pharmacodynamic antagonism. Use Caution/Monitor.

            • lanthanum carbonate

              lanthanum carbonate, calcium carbonate. cation binding in GI tract. Use Caution/Monitor. Administer antacid at least 2 hours before or after lanthanum. .

            • ledipasvir/sofosbuvir

              calcium carbonate decreases levels of ledipasvir/sofosbuvir by Other (see comment). Use Caution/Monitor. Comment: Ledipasvir solubility decreases as pH increases; drugs that increase gastric pH are expected to decrease levels of ledipasvir; separate antacid and ledipasivr/sofosbuvir administration by 4 hr.

            • levofloxacin

              calcium carbonate, levofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • levothyroxine

              calcium carbonate decreases levels of levothyroxine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • lisdexamfetamine

              calcium carbonate will increase the level or effect of lisdexamfetamine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • lisinopril

              calcium carbonate decreases effects of lisinopril by unspecified interaction mechanism. Use Caution/Monitor.

            • memantine

              calcium carbonate will increase the level or effect of memantine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • methscopolamine

              calcium carbonate decreases levels of methscopolamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

            • methylphenidate

              calcium carbonate decreases effects of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Since the characteristics of methylphenidate extended release capsules (Ritalin LA) are pH dependent, coadministration of antacids or acid suppressants could alter the release of methylphenidate. Consider separating the administration of the antacid and the methylphenidate extended-release capsules may be avoided.

            • metoprolol

              calcium carbonate decreases effects of metoprolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of metoprolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • mexiletine

              calcium carbonate will increase the level or effect of mexiletine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor.

            • moexipril

              calcium carbonate decreases effects of moexipril by unspecified interaction mechanism. Use Caution/Monitor.

            • moxifloxacin

              calcium carbonate, moxifloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • mycophenolate

              calcium carbonate will decrease the level or effect of mycophenolate by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • nadolol

              calcium carbonate decreases effects of nadolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of nadolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • nebivolol

              calcium carbonate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • neratinib

              calcium carbonate will decrease the level or effect of neratinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate antacid and neratinib dosing by 3 hr.

            • nicardipine

              calcium carbonate decreases effects of nicardipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • nifedipine

              calcium carbonate decreases effects of nifedipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • nilotinib

              calcium carbonate decreases levels of nilotinib by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Avoid this interaction by administering antacids 2 hr after or 2 hr before nilotinib.

            • nisoldipine

              calcium carbonate decreases effects of nisoldipine by pharmacodynamic antagonism. Use Caution/Monitor.

            • nitrofurantoin

              calcium carbonate decreases levels of nitrofurantoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • ofloxacin

              calcium carbonate, ofloxacin. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • omadacycline

              calcium carbonate 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.

            • pamidronate

              calcium carbonate decreases levels of pamidronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

            • pancrelipase

              calcium carbonate decreases effects of pancrelipase by pharmacodynamic antagonism. Use Caution/Monitor. Antacids may negate beneficial effects of enzymes.

            • penbutolol

              calcium carbonate decreases effects of penbutolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of penbutolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • penicillamine

              calcium carbonate decreases levels of penicillamine by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • perindopril

              calcium carbonate decreases effects of perindopril by unspecified interaction mechanism. Use Caution/Monitor.

            • pexidartinib

              calcium carbonate will decrease the level or effect of pexidartinib by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Separate pexidartinib by 2 hr before or after taking a locally-acting antacid.

            • pindolol

              calcium carbonate decreases effects of pindolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of pindolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • polysaccharide iron

              calcium carbonate will decrease the level or effect of polysaccharide iron by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • posaconazole

              calcium carbonate will decrease the level or effect of posaconazole by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • potassium phosphates, IV

              calcium carbonate decreases effects of potassium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Calcium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

            • propranolol

              calcium carbonate decreases effects of propranolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of propranolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • quinapril

              calcium carbonate decreases effects of quinapril by unspecified interaction mechanism. Use Caution/Monitor.

            • quinidine

              calcium carbonate will increase the level or effect of quinidine by passive renal tubular reabsorption - basic urine. Use Caution/Monitor. Elevated quinidine plasma levels, possibly with cardiac conduction disturbances and arrhythmias, may occur.

            • ramipril

              calcium carbonate decreases effects of ramipril by unspecified interaction mechanism. Use Caution/Monitor.

            • rifampin

              calcium carbonate 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 carbonate 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 be given at least 2 hr before or at least 4 hr after rilpivirine. For the combination product dolutegravir/rilpivirine, antacids should be given at least 4 hr before or at least 6 hr afterwards.

            • riociguat

              calcium carbonate decreases levels of riociguat by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate administration by at least 1 hour.

            • risedronate

              calcium carbonate decreases levels of risedronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

            • rose hips

              calcium carbonate will decrease the level or effect of rose hips by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • rosuvastatin

              calcium carbonate decreases levels of rosuvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • sarecycline

              calcium carbonate 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 phosphates, IV

              calcium carbonate decreases effects of sodium phosphates, IV by cation binding in GI tract. Modify Therapy/Monitor Closely. Calcium decreases serum phosphate concentration by binding dietary phosphate. Use alternatives if available.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of calcium carbonate 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 carbonate 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.

            • sofosbuvir/velpatasvir

              calcium carbonate will decrease the level or effect of sofosbuvir/velpatasvir by increasing gastric pH. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Velpatasvir solubility decreases as gastric pH increases (practically insoluble at pH >5). Separate administration of sofosbuvir/velpatasvir from antacids by at least 4 hr.

            • sotalol

              calcium carbonate decreases effects of sotalol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of sotalol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • squill

              calcium carbonate increases toxicity of squill by unspecified interaction mechanism. Use Caution/Monitor.

            • strontium ranelate

              calcium carbonate decreases levels of strontium ranelate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Applies to oral form of calcium. Separate by 2 hr.

            • tiludronate

              calcium carbonate decreases levels of tiludronate by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

            • timolol

              calcium carbonate decreases effects of timolol by unspecified interaction mechanism. Use Caution/Monitor.

              calcium carbonate decreases levels of timolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

            • tolbutamide

              calcium carbonate will increase the level or effect of tolbutamide by increasing gastric pH. Applies only to oral form of both agents. Use Caution/Monitor.

            • trandolapril

              calcium carbonate decreases effects of trandolapril by unspecified interaction mechanism. Use Caution/Monitor.

            • ursodiol

              calcium carbonate decreases effects of ursodiol by pharmacodynamic antagonism. Use Caution/Monitor.

            • verapamil

              calcium carbonate decreases effects of verapamil by pharmacodynamic antagonism. Use Caution/Monitor.

            • vismodegib

              calcium carbonate will decrease the level or effect of vismodegib by Other (see comment). Use Caution/Monitor. Drugs that increase gastric pH alter vismodegib solubility and therefore reduce bioavailability; effect on efficacy unknown

            • vitamin D

              vitamin D, calcium carbonate. Other (see comment). Use Caution/Monitor. Comment: The concurrent use of vitamin D with calcium salts is generally beneficial; in some patients this combination may result in hypercalcemia.

            • zoledronic acid

              calcium carbonate decreases levels of zoledronic acid by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 30 minutes.

            Minor (64)

            • amikacin

              amikacin decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • amiloride

              amiloride decreases levels of calcium carbonate by increasing renal clearance. Minor/Significance Unknown.

            • aspirin

              calcium carbonate, aspirin. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • aspirin rectal

              calcium carbonate, aspirin rectal. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • aspirin/citric acid/sodium bicarbonate

              calcium carbonate, aspirin/citric acid/sodium bicarbonate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • balsalazide

              calcium carbonate, balsalazide. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • bendroflumethiazide

              bendroflumethiazide increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

            • blessed thistle

              blessed thistle decreases effects of calcium carbonate by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction.

            • budesonide

              budesonide decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • bumetanide

              bumetanide decreases levels of calcium carbonate by increasing renal clearance. Minor/Significance Unknown.

            • caffeine

              caffeine decreases levels of calcium carbonate by increasing renal clearance. Minor/Significance Unknown.

            • calcitriol topical

              calcitriol topical increases levels of calcium carbonate by pharmacodynamic synergism. Minor/Significance Unknown. Topical calcitriol may lead to hypercalcemia.

            • carbonyl iron

              calcium carbonate decreases levels of carbonyl iron by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              carbonyl iron increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • chlorothiazide

              chlorothiazide increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

            • chlorthalidone

              chlorthalidone increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

            • choline magnesium trisalicylate

              calcium carbonate, choline magnesium trisalicylate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • chromium

              calcium carbonate decreases levels of chromium by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hours.

            • cortisone

              cortisone decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • cyclopenthiazide

              cyclopenthiazide increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

            • deflazacort

              deflazacort decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • devil's claw

              devil's claw decreases effects of calcium carbonate by pharmacodynamic antagonism. Minor/Significance Unknown.

            • dexamethasone

              dexamethasone decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • diflunisal

              calcium carbonate, diflunisal. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • drospirenone

              drospirenone decreases levels of calcium carbonate by increasing renal clearance. Minor/Significance Unknown.

            • ethacrynic acid

              ethacrynic acid decreases levels of calcium carbonate by increasing renal clearance. Minor/Significance Unknown.

            • ferric maltol

              ferric maltol increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              calcium carbonate decreases levels of ferric maltol by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • ferrous fumarate

              calcium carbonate decreases levels of ferrous fumarate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              ferrous fumarate increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • ferrous gluconate

              ferrous gluconate increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              calcium carbonate decreases levels of ferrous gluconate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • ferrous sulfate

              ferrous sulfate increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • fludrocortisone

              fludrocortisone decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • furosemide

              furosemide decreases levels of calcium carbonate by increasing renal clearance. Minor/Significance Unknown.

            • gentamicin

              gentamicin decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • hydrochlorothiazide

              hydrochlorothiazide increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

            • hydrocortisone

              hydrocortisone decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • indapamide

              indapamide increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

            • iron dextran complex

              calcium carbonate decreases levels of iron dextran complex by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              iron dextran complex increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • iron sucrose

              calcium carbonate decreases levels of iron sucrose by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              iron sucrose increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • isoniazid

              isoniazid decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • isotretinoin

              isotretinoin increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • lily of the valley

              calcium carbonate increases effects of lily of the valley by unspecified interaction mechanism. Minor/Significance Unknown.

            • manganese

              calcium carbonate, manganese. Either decreases levels of the other by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Separate by 2 hours.

            • mesalamine

              calcium carbonate, mesalamine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • methyclothiazide

              methyclothiazide increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

            • methylprednisolone

              methylprednisolone decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • metolazone

              metolazone increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis, hypercalcemia.

            • neomycin PO

              neomycin PO decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • paromomycin

              paromomycin decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • polysaccharide iron

              calcium carbonate decreases levels of polysaccharide iron by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              polysaccharide iron increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • prednisolone

              prednisolone decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • prednisone

              prednisone decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • rose hips

              calcium carbonate decreases levels of rose hips by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

              rose hips increases levels of calcium carbonate by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • salicylates (non-asa)

              calcium carbonate, salicylates (non-asa). Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • salsalate

              calcium carbonate, salsalate. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • shark cartilage

              calcium carbonate, shark cartilage. pharmacodynamic synergism. Minor/Significance Unknown. May lead to hypercalcemia (theoretical).

            • sodium polystyrene sulfonate

              sodium polystyrene sulfonate increases levels of calcium carbonate by decreasing renal clearance. Minor/Significance Unknown. Risk of alkalosis.

            • spironolactone

              spironolactone decreases levels of calcium carbonate by increasing renal clearance. Minor/Significance Unknown.

            • streptomycin

              streptomycin decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • sulfasalazine

              calcium carbonate, sulfasalazine. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

            • teriparatide

              teriparatide increases levels of calcium carbonate by pharmacodynamic synergism. Minor/Significance Unknown.

            • tobramycin

              tobramycin decreases levels of calcium carbonate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • torsemide

              torsemide decreases levels of calcium carbonate by increasing renal clearance. Minor/Significance Unknown.

            • triamcinolone acetonide injectable suspension

              triamcinolone acetonide injectable suspension decreases levels of calcium carbonate by increasing elimination. Minor/Significance Unknown.

            • triamterene

              triamterene decreases levels of calcium carbonate by increasing renal clearance. Minor/Significance Unknown.

            • willow bark

              calcium carbonate, willow bark. Mechanism: passive renal tubular reabsorption due to increased pH. Minor/Significance Unknown. Salicylate levels increased at moderate doses; salicylate levels decreased at large doses (d/t increased renal excretion of unchanged salicylic acid).

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            Adverse Effects

            Frequency Not Defined

            Anorexia

            Constipation

            Flatulence

            Nausea

            Vomiting

            Hypercalcemia

            Hypophosphatemia

            Milk-alkali syndrome

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            Warnings

            Contraindications

            Hypersensitivity

            Hypercalciuria

            Renal calculi

            Hypophosphatemia

            Hypercalcemia

            Suspected digoxin toxicity

            Cautions

            Shake suspension well; chew tablets thoroughly

            Bloating, gas, and constipation may occur with therapy

            Hypercalcemia may occur from long-term use, which may exacerbate nephrolithiasis or cause generalized soft tissue and vascular calcification; may also increase mortality in patients with chronic kidney disease

            Drug administration impaired by achlorhydria, common in the elderly; consider using an alternate salt form of calcium

            Hypercalciuria and hypercalcemia may occur in patients with hypoparathyroid disease, receiving high doses of vitamin D

            Kidney stones reported with use; exercise caution in patients with history

            Use caution in patients with renal insufficiency; patients more susceptible toe effects of excess calcium

            Advise patients to limit intake of oxalate-rich foods (soy; green, leafy vegetables; animal protein) to avoid reduced absorption through Ca-oxalate formation

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Safe; crosses the placenta; appears in breast milk

            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

            Antacid: Neutralizes gastric acidity

            Dietary supplement: Prevents or treats negative Ca balance; oral Ca supplements may protect against renal calculi formation by chelating with oxalate in gut and preventing its absorption

            Phosphate binder: Binds with dietary phosphate to form insoluble calcium phosphate, which is excreted in feces

            Absorption

            Bioavailability: 25-35%; food increases absorption 10-30%; antacid action dependent on gastric emptying time

            Peak plasma time: 20-60 min (fasting state); up to 3 hr (ingested 1 hr after meals)

            Distribution

            Protein bound: 45%

            Elimination

            Renal clearance: 50-300 mg/day

            Excretion: Feces, as unabsorbed calcium (80%); urine (20%)

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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Alcalak oral
            -
            168 mg calcium (420 mg) chewable tablet
            Oyster Shell Calcium 500 oral
            -
            500 mg calcium (1,250 mg) tablet
            Oyster Shell Calcium 500 oral
            -
            500 mg calcium (1,250 mg) tablet
            Oyster Shell Calcium 500 oral
            -
            500 mg calcium (1,250 mg) tablet
            Oyster Shell Calcium 500 oral
            -
            500 mg calcium (1,250 mg) tablet
            Antacid Extra-Strength oral
            -
            300 mg (750 mg) chewable tablet
            Antacid Extra-Strength oral
            -
            300 mg (750 mg) chewable tablet
            Antacid Extra-Strength oral
            -
            300 mg (750 mg) chewable tablet
            Antacid Extra-Strength oral
            -
            300 mg (750 mg) chewable tablet
            Antacid Extra-Strength oral
            -
            300 mg (750 mg) chewable tablet
            Antacid Extra-Strength oral
            -
            300 mg (750 mg) chewable tablet
            Antacid Extra-Strength oral
            -
            168 mg calcium (420 mg) chewable tablet
            Antacid Extra-Strength oral
            -
            300 mg (750 mg) chewable tablet
            Tums Ultra oral
            -
            400 mg calcium (1,000 mg) chewable tablet
            Tums Ultra oral
            -
            400 mg calcium (1,000 mg) chewable tablet
            Gaviscon oral
            -
            80-14.2 mg chewable tablet
            Gaviscon oral
            -
            95-358 mg/15 mL suspension
            Tums oral
            -
            200 mg calcium (500 mg) chewable tablet
            Tums oral
            -
            200 mg calcium (500 mg) chewable tablet
            Tums oral
            -
            300 mg (750 mg) chewable tablet
            Tums oral
            -
            200 mg calcium (500 mg) chewable tablet
            Antacid Ultra Strength oral
            -
            400 mg calcium (1,000 mg) chewable tablet
            Antacid Ultra Strength oral
            -
            400 mg calcium (1,000 mg) chewable tablet
            Antacid Ultra Strength oral
            -
            400 mg calcium (1,000 mg) chewable tablet
            Children's Pepto oral
            -
            160 mg calcium (400 mg) chewable tablet
            Cal-Gest Antacid oral
            -
            200 mg calcium (500 mg) chewable tablet
            Calcium Antacid oral
            -
            200 mg calcium (500 mg) chewable tablet
            Calcium Antacid oral
            -
            320 mg calcium (750 mg) chewable tablet
            Calcium Antacid oral
            -
            400 mg calcium (1,000 mg) chewable tablet
            Calcium Antacid oral
            -
            200 mg calcium (500 mg) chewable tablet
            Calcium Antacid oral
            -
            300 mg (750 mg) chewable tablet
            Calcium Antacid oral
            -
            320 mg calcium (750 mg) chewable tablet
            Calcium Antacid oral
            -
            200 mg calcium (500 mg) chewable tablet
            calcium carbonate oral
            -
            500 mg/5 mL (1,250 mg/5 mL) suspension
            calcium carbonate oral
            -
            500 mg calcium (1,250 mg) tablet
            calcium carbonate oral
            -
            500 mg calcium (1,250 mg) tablet
            calcium carbonate oral
            -
            260 mg calcium (648 mg) tablet
            calcium carbonate oral
            -
            500 mg calcium (1,250 mg) tablet
            calcium carbonate oral
            -
            320 mg calcium (750 mg) chewable tablet
            calcium carbonate oral
            -
            600 mg calcium (1,500 mg) tablet
            calcium carbonate oral
            -
            500 mg calcium (1,250 mg) chewable tablet
            calcium carbonate oral
            -
            500 mg calcium (1,250 mg) tablet
            calcium carbonate oral
            -
            500 mg calcium (1,250 mg) chewable tablet
            calcium carbonate oral
            -
            600 mg calcium (1,500 mg) tablet
            calcium carbonate oral
            -
            600 mg calcium (1,500 mg) tablet
            calcium carbonate oral
            -
            600 mg calcium (1,500 mg) tablet
            Tums Extra Strength Smoothies oral
            -
            300 mg (750 mg) chewable tablet
            Tums Extra Strength Smoothies oral
            -
            300 mg (750 mg) chewable tablet
            Calcium 600 oral
            -
            600 mg calcium (1,500 mg) tablet
            Calcium 600 oral
            -
            600 mg calcium (1,500 mg) tablet
            Calcium 600 oral
            -
            600 mg calcium (1,500 mg) tablet
            Antacid (calcium carbonate) oral
            -
            200 mg calcium (500 mg) chewable tablet
            Antacid (calcium carbonate) oral
            -
            200 mg calcium (500 mg) chewable tablet
            Tums E-X oral
            -
            300 mg (750 mg) chewable tablet
            Tums E-X oral
            -
            300 mg (750 mg) chewable tablet
            Tums E-X oral
            -
            300 mg (750 mg) chewable tablet
            Antacid Extra Strength (calcium carbonate) oral
            -
            300 mg (750 mg) chewable tablet
            Antacid Extra Strength (calcium carbonate) oral
            -
            300 mg (750 mg) chewable tablet
            Antacid Calcium oral
            -
            215 mg calcium (500 mg) chewable tablet
            Tums Freshers oral
            -
            200 mg calcium (500 mg) chewable tablet
            Tums Freshers oral
            -
            200 mg calcium (500 mg) chewable tablet

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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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.