Calcium carbonate oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of calcium carbonate.
1250mg of calcium carbonate is equivalent to 500mg or 12.5mmol of elemental calcium.
Drugs List
Therapeutic Indications
Uses
Calcium deficiency
Osteoporosis - adjunct to treatment
Renal failure (adjunctive treatment)
Treatment of osteomalacia
Dosage
Adults
Calcium deficiency states, including malabsorption
2.5g to 6.25g of calcium carbonate daily (1g to 2.5g of elemental calcium daily).
The dose should be adjusted to the individual needs of the patient.
Treatment of osteoporosis
Up to 3.75g of calcium carbonate daily (1.5g of elemental calcium daily).
In patients with adequate dietary calcium intake, 500mg of elemental calcium per day may be administered.
Therapeutic supplementation
Up to 3.75g of calcium carbonate daily (1.5g of elemental calcium daily).
Phosphate Binder
Dose as required by the individual patient, depending on the serum phosphate level.
Children
Calcium deficiency states, including malabsorption and rickets
1.25g to 3.75g of calcium carbonate daily (500mg to 1.5g of elemental calcium daily).
The dose should be adjusted to the individual needs of the patient.
The following alternative dosage schedule may be suitable:
Children aged 12 to 18 years: 10mmol of calcium four times per day, titrated to response.
Children aged 5 to 12 years: 0.2mmol/kg of calcium four times a day, titrated to response.
Children aged 1 month to 4 years: 0.25mmol/kg of calcium four times a day, titrated to response.
Phosphate Binder
Dose as required by the individual patient, depending on serum phosphate level.
The following alternative dosage schedule may be suitable:
Children aged 12 years to 18 years: 1.25g calcium carbonate three to four times daily prior to or with meals, titrated to response.
Children aged 6 years to 12 years: 600mg calcium carbonate three to four times daily prior to or with meals, titrated to response.
Children aged 1 year to 6 years: 300mg calcium carbonate three to four times daily prior to or with meals, titrated to response.
Children aged 1 month to 1 year: 120mg calcium carbonate three to four times daily with feeds, titrated to response.
Neonates
Calcium deficiency (unlicensed)
0.25mmol/kg of calcium four times per day, titrated to response.
Contraindications
Hypervitaminosis D
Hyperparathyroidism
Multiple myeloma
Nephrolithiasis
Osteolytic neoplasm
Prolonged immobilisation with hypercalciuria and/or hypercalcaemia
Severe hypercalcaemia
Severe hypercalciuria
Severe renal impairment
Skeletal metastasis
Precautions and Warnings
Glucose-galactose malabsorption syndrome
Hereditary fructose intolerance
History of nephrolithiasis
Hypercalciuria > 0.12 to 0.15 mmol/kg/24 hours in children
Hypercalciuria > 7.5mmol/24 hours in adults
Renal impairment
Sarcoidosis
Reduce dose in patients with creatinine clearance below 30ml/min
Allow for calcium and vitamin D intake from other sources
Not all presentations are licensed for all indications
Some brands contain Sunset Yellow (E110) - can trigger allergic reactions
Some forms contain isomalt: unsuitable in hereditary fructose intolerance
Some formulations contain glucose
Some formulations contain propylene glycol
Monitor renal function during prolonged/high dose therapy
Monitor serum and urinary calcium in patients with renal impairment
Monitor serum and urinary calcium in patients with sarcoidosis
Monitor serum calcium levels on prolonged use
Monitor serum phosphate levels in patients with renal impairment
Monitor urinary calcium in mild hypercalciuria
Monitor urinary calcium in patients on prolonged therapy
Monitor urinary calcium in patients with a history of renal stones
Reduce dose or discontinue if urinary calcium exceeds 7.5mmol/24 hours
Discontinue if renal function deteriorates
Advise to avoid iron, zinc and strontium 2 hours before or after dose
Pregnancy and Lactation
Pregnancy
Calcium supplements are generally considered safe during pregnancy. They have been used widely during pregnancy for many years without apparent adverse effects.
During pregnancy, requirements for calcium are increased. Daily intake should however not exceed 1500 mg calcium.
Lactation
Calcium supplements are generally considered safe during breastfeeding.
Calcium carbonate has been used widely during breastfeeding for many years without apparent adverse effects.
Side Effects
Abdominal pain
Alkalosis
Allergic reaction
Angioedema
Asthma
Constipation
Decreased appetite
Diarrhoea
Dyspepsia
Eructation
Flatulence
Gastric pain
Headache
Hypercalcaemia
Hypercalciuria
Hypersensitivity reactions
Laryngeal oedema
Milk-alkali syndrome
Nausea
Pruritus
Rash
Renal impairment
Tiredness
Urticaria
Vomiting
Weakness
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: September 2014
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Summary of Product Characteristics: Adcal 1500mg Chewable Tablets. ProStrakan Ltd. Revised February 2014.
Summary of Product Characteristics: Calcium 500mg Effervescent Tablets. Accord UK Ltd. Revised September 2019.
Summary of Product Characteristics: Calcichew 500mg Chewable Tablets. Takeda UK Limited. Revised June 2016.
Summary of Product Characteristics: Calcichew Forte Chewable Tablets. Takeda UK Limited. Revised June 2016.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 16 July 2021
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
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