| CALCIUM CARBONATe
Apo-Cal , BioCal, Calcite-500, Calsan , Cal-Sup, Caltrate , Chooz, Dicarbosil, Equilet, Mallamint, Mega-Cal, Nu-Cal, Os-Cal, Oystercal, Titralac, Tums
CALCIUM PHOSPHATE TRIBASIC (TRICALCIUM PHOSPHATE)
Classifications: fluid and electrolytic replacement solution; antacid; Therapeutic: fluid and electrolytic replacement solution; antacid
Prototype: Calcium gluconate
Pregnancy Category: B for calcium acetate; other salts not rated
Calcium carbonate: 125 mg, 250 mg, 650 mg, 750 mg, 1.25 g, 1.5 g tablets;
Calcium acetate: 667 mg tablets;
Calcium citrate: 950 mg, 2376 mg tablets;
Calcium phosphate tribasic: 1565.2 mg tablets
Calcium carbonate is a rapid-acting antacid with high neutralizing capacity and relatively prolonged duration of action.
Decreases gastric acidity, thereby inhibiting proteolytic action of pepsin on gastric mucosa. All forms of calcium salts
are used for calcium replacement therapy.
Effectively relieves symptoms of acid indigestion and useful as a calcium supplement.
Relief of transient symptoms of hyperacidity as in acid indigestion, heartburn, peptic esophagitis, and hiatal hernia. Also
used as calcium supplement when calcium intake may be inadequate and in treatment of mild calcium deficiency states. Control
of hyperphosphatemia in chronic renal failure (calcium acetate).
For treatment of hyperphosphatemia in patients with chronic renal failure and to lower BP in selected patients with hypertension.
Hypercalcemia and hypercalciuria (e.g., hyperparathyroidism, vitamin D overdosage, decalcifying tumors, bone metastases),
calcium loss due to immobilization, severe renal failure, renal calculi, GI hemorrhage or obstruction, dehydration, digitalis
toxicity; hypochloremic alkalosis, ventricular fibrillation, cardiac disease, pregnancy (category B).
Decreased bowel motility (e.g., with anticholinergics, antidiarrheals, antispasmodics), the older adult.
Route & Dosage
All doses are in terms of elemental calcium: 1 g calcium carbonate = 400 mg (20 mEq, 40%) elemental calcium; 1 g calcium acetate = 250 mg (12.6 mEq, 25%) elemental
calcium; 1 g calcium citrate = 210 mg (12 mEq, 21%) elemental calcium; 1 g tricalcium phosphate = 390 mg (19.3 mEq,
39%) elemental calcium ; calcium lactate = 130 mg (6.5 mEq, 13%) elemental calcium
Supplement for Osteoporosis
Adult: PO 12 g b.i.d. or t.i.d.
Adult: PO 0.52 g 46 times/d
Adult: PO Calcium acetate 24 tablets with each meal
Supplement for Mild Hypercalcemia
Child: PO 500 mg/kg/d in divided doses (lactate)
- When used as antacid, give 1 h after meals and at bedtime. When used as calcium supplement, give 11 ? h after meals,
unless otherwise directed by physician.
- Chewable tablet should be chewed well before swallowing or allowed to dissolve completely in mouth, followed with water.
Powder form may be mixed with water.
- Ensure that sustained-release form of drug is not chewed or crushed. It must be swallowed whole.
Adverse Effects (≥1%)GI: Constipation
or laxative effect, acid rebound, nausea, eructation, flatulence,
vomiting, fecal concretions. Metabolic:
Hypercalcemia with alkalosis, metastatic calcinosis, hypercalciuria, hypomagnesemia, hypophosphatemia (when phosphate intake
is low). CNS:
Mood and mental changes. Urogenital:
May enhance inotropic and toxic effects of digoxin; magnesium
may compete for GI absorption; decreases absorption of tetracyclines
of dose absorbed from small intestine. Distribution:
Crosses placenta. Elimination:
Primarily in feces; small amounts in urine, pancreatic juice, saliva, breast milk.
Assessment & Drug Effects
- Note number and consistency of stools. If constipation is a problem, physician may prescribe alternate or combination therapy
with a magnesium antacid or advise patient to take a laxative or stool softener as necessary.
- Lab tests: Determine serum and urine calcium weekly in patients receiving prolonged therapy and in patients with renal dysfunction.
- Record amelioration of symptoms of hypocalcemia (see Signs & Symptoms, Appendix F).
- Observe for S&S of hypercalcemia in patients receiving frequent or high doses, or who have impaired renal function (see
Patient & Family Education
- Do not continue this medication beyond 12 wk, since it may cause acid rebound, which generally occurs after repeated
use for 1 or 2 wk and leads to chronic use. It is potentially dangerous to self-medicate. Do not take antacids longer than
2 wk without medical supervision.
- Avoid taking calcium carbonate with cereals or other foods high in oxalates. Oxalates combine with calcium carbonate to form
insoluble, nonabsorbable compounds.
- Do not use calcium carbonate repeatedly with foods high in vitamin D (such as milk) or sodium bicarbonate, as it may cause
milk-alkali syndrome: hypercalcemia, distaste for food, headache, confusion, nausea, vomiting, abdominal pain, metabolic
alkalosis, hypercalciuria, polyuria, soft tissue calcification (calcinosis), hyperphosphatemia and renal insufficiency.
Predisposing factors include renal dysfunction, dehydration, electrolyte imbalance, and hypertension.