Calcium carbonate + Colecalciferol - instructions for use, dose, side effects, contraindications

Combination calcium carbonate and kolkaltsiferola regulates the exchange of calcium and phosphorus in the body (in bones, teeth, nails, hair, muscles).

Reduces resorption (resorption) and increases bone density, making up for the lack of calcium and vitamin D₃ in the body, it is necessary for the mineralization of teeth.

Calcium is involved in the regulation of nerve conduction,muscle contractions and is a component of the blood coagulation system. Adequate calcium intake is especially important during growth, during pregnancy and lactation.

Vitamin D₃ increases the absorption of calcium in the intestine.

The use of calcium and vitamin D₃ prevents the increase in the production of parathyroid hormone, which is a stimulator of increased bone resorption (leaching calcium from the bones).

Pharmacokinetics:

Usually the amount of calcium that is absorbed from the digestive tract is about 30% of the dose, colcalciferol it is easily absorbed from the small intestine (about 80% of the dose taken).

99% of calcium in the body is concentrated in the rigid structure of bones and teeth. The remaining 1% is in the intra- and extracellular fluids. About 50% of the total calcium content in the blood is in a physiologically active ionized form, of which about 10% is complexed with citrate, phosphate or other anions, the remaining 40% is bound to proteins, primarily albumin. Kolekaltsiferol and its metabolites circulate in the blood in a bound state with a specific globulin. Kolekaltsiferol metabolized in the liver by hydroxylation to 25-hydroxycolecalciferol. Then it is converted into the active form in the kidneys - 1,25-hydroxycolecularciferol. 1,25-hydroxycolecularciferol is a metabolite responsible for increasing calcium absorption. Unchanged colcalciferol is deposited in fat and muscle tissue.

Calcium is excreted through the intestines, kidneys and sweat glands. Renal excretion depends on the glomerular filtration and tubular reabsorption of calcium. Kolekaltsiferol is excreted by the kidneys and through the intestine.

Indications:

Prevention and complex therapy of osteoporosis and its complications (fractures of bones); prevention and treatment of calcium and / or vitamin D deficiency₃.

ICD-10

IV.E50-E64.E55.9 Vitamin D deficiency, unspecified

IV.E50-E64.E58 Alimentary calcium deficiency

XIII.M80-M85.M80 Osteoporosis with pathological fracture

XIII.M80-M85.M81 Osteoporosis without pathological fracture

XIII.M80-M85.M81.0 Postmenopausal osteoporosis

XIII.M80-M85.M81.1 Osteoporosis after removal of ovaries

XIII.M80-M85.M81.2 Osteoporosis caused by immobility

XIII.M80-M85.M81.4 Medicinal osteoporosis

XIII.M80-M85.M81.5 Idiopathic osteoporosis

XIII.M80-M85.M81.8 Other osteoporosis

XIII.M80-M85.M81.9 Osteoporosis, unspecified

XIII.M80-M85.M82.8 * Osteoporosis in other diseases classified elsewhere

Contraindications:

Hypercalcemia (including as a result of hyperparathyroidism of primary or secondary), hypercalciuria, nephrolithiasis, hypervitaminosis D, sarcoidosis, pulmonary tuberculosis (active form), severe renal failure.

Carefully:

Renal failure, benign granulomatosis, pregnancy, breast-feeding, cardiac glycosides and thiazide diuretics, children's age (under 12 years).

Pregnancy and lactation:

Calcium and vitamin D₃apply in pregnancy to make up for their deficiency in the body.

In pregnancy, the daily dose of the drug should not exceed 1500 mg of calcium and 600 IU of vitamin D₃.

Hypercalcemia against an overdose during pregnancy can have an adverse effect on the developing fetus.

The drug is used during lactation.

Calcium and vitamin D₃ can penetrate into breast milk, so you need to consider the intake of calcium and vitamin D from other sources in the mother and child.

The category of FDA recommendations is not defined.

Dosing and Administration:

Inside. Daily dose of calcium carbonate 1500 mg (equivalent to 1000 mg of calcium), colcalciferol 20 μg (800 IU vitamin D₃), in the morning and in the evening, mainly during meals, or individual dosage depending on the clinical picture.

Side effects:

Dysfunction of the gastrointestinal tract (constipation, diarrhea, flatulence, abdominal pain); hypercalcemia; hypercalciuria; allergic reactions (itching, rashes, urticaria).

Overdose:

Symptoms: manifestations of hypercalcemia - anorexia, thirst, polyuria, muscle weakness, nausea, vomiting, constipation, abdominal pain, fatigue, bone pain, mental disorders, nephrocalcinosis, urolithiasis and in severe cases - cardiac arrhythmias. With prolonged use of excessive doses (over 2500 mg of calcium) - kidney damage, calcification of soft tissues.

In case of symptoms of overdose, the patient should stop taking calcium and vitamin D, as well as thiazide diuretics and cardiac glycosides, and consult a doctor.

Treatment: gastric lavage, replenishment of fluid loss, the use of loop diuretics (eg, furosemide), glucocorticosteroids, calcitonin, bisphosphonates.It is necessary to control the content of electrolytes in blood plasma, the function of the kidneys and diuresis. In severe cases, it is necessary to measure central venous pressure and ECG monitoring.

Interaction:

Hypercalcemia can potentiate the toxic effects of cardiac glycosides when used concomitantly with calcium and vitamin D. It is necessary to monitor the ECG and calcium levels in the blood serum.

Calcium preparations can reduce the absorption of tetracyclines from the digestive tract. Therefore, tetracycline drugs should be taken at least 2 hours before or 4-6 hours after taking the drug.

To prevent the absorption of bisphosphonate preparations, they should be taken at least 1 hour before taking the drug.

Glucocorticosteroids reduce the absorption of calcium, so treatment with them may require an increase in the dose of calcium carbonate + colcalciferol.

With the simultaneous use of thiazide diuretics, the risk of hypercalcemia increases as they increase tubular calcium reabsorption. With the simultaneous use of thiazide diuretics should regularly monitor the calcium content in the serum.

Calcium reduces the effectiveness of levothyroxine, reducing its absorption. The time interval between levothyroxine and calcium carbonate + colcalciferol should be not less than 4 hours.

Absorption of antibiotics of the quinolone group decreases with simultaneous use with calcium preparations. Therefore, the antibiotics of the quinolone group should be taken 2 hours before or 6 hours after taking calcium carbonate + colcalciferol.

The intake of food products containing oxalates (sorrel, rhubarb, spinach) and phytidine (cereals), reduces the absorption of calcium, so do not take calcium carbonate + colcalciferol within 2 hours after eating sorrel, rhubarb, spinach, croup.

Special instructions:

With prolonged admission, the serum calcium and serum creatinine should be monitored, especially in the elderly, with the use of cardiac glycosides and thiazide diuretics and in patients prone to urolithiasis. In case of calcium intake, exceeding 7.5 mmol per day (300 mg per day), it is necessary to reduce the dose or stop taking.

In patients with renal insufficiency, it is necessary to monitor the content of calcium and serum phosphate, take into account the risk of calcification of soft tissues. Calcium and vitamin D₃ should be used with caution in immobilized patients with osteoporosis in connection with the risk of hypercalcemia.

Combination of 400 IU of vitamin D₃ + 500 mg of calcium is superior to taking individual components, a combination of 200 IU of vitamin D₃ + 500 mg of calcium carbonate is comparable in effectiveness with a combination of 125 IU of vitamin D₃ + 600 mg of calcium.

During pregnancy, the daily dose should not exceed 1500 mg Ca²⁺ and 600 IU of vitamin D₃. Overdose during pregnancy can lead to disruption of the child's mental and physical development.

In the elderly, the need for Ca²⁺ is 1.5 grams per day, in vitamin D₃ - 0,5-1000 IU per day.

Instructions

Calcium carbonate + Colecalciferol (Calcii carbonas + Colecalciferolum)