Yes

Antacid; Antidote; Calcium Salt; Electrolyte Supplement, Oral

As an antacid, and treatment and prevention of calcium deficiency or hyperphosphatemia (eg, osteoporosis, osteomalacia, mild/moderate renal insufficiency, hypoparathyroidism, postmenopausal osteoporosis, rickets); has been used to bind phosphate

C

Clinical effects on the fetus: No data available; available evidence suggests safe use during pregnancy and breast-feeding

Breast-feeding/lactation: No data available

Hypercalcemia, renal calculi, hypophosphatemia

Calcium carbonate absorption is impaired in achlorhydria (common in elderly - use alternate salt, administer with food); administration is followed by increased gastric acid secretion within 2 hours of administration; while hypercalcemia and hypercalciuria may result when therapeutic replacement amounts are given for prolonged periods, they are most likely to occur in hypoparathyroid patients receiving high doses of vitamin D

Well tolerated; 1% to 10%:

Endocrine & metabolic: Hypophosphatemia, hypercalcemia

Gastrointestinal: Constipation, laxative effect, acid rebound, nausea, vomiting, anorexia, abdominal pain, xerostomia, flatulence

Miscellaneous: Milk alkali syndrome with very high, chronic dosing and/or renal failure (headache, nausea, irritability, and weakness or alkalosis, hypercalcemia, renal impairment)

Acute single ingestions of calcium salts may produce mild gastrointestinal distress, but hypercalcemia or other toxic manifestations are extremely unlikely

Treatment is supportive

Decreased effect:

Large intakes of dietary fiber may decrease calcium absorption due to a decreased GI transit time and the formation of fiber-calcium complexes

Admixture incompatibilities include carbonates, phosphates, sulfates, tartrates

As dietary supplements to prevent or treat negative calcium balance (eg, osteoporosis), the calcium in calcium salts moderates nerve and muscle performance and allows normal cardiac function; also used to treat hyperphosphatemia in patients with advanced renal insufficiency by combining with dietary phosphate to form insoluble calcium phosphate, which is excreted in feces; calcium salts as antacids neutralize gastric acidity resulting in increased gastric an duodenal bulb pH; they additionally inhibit proteolytic activity of peptic if the pH is increased >4 and increase lower esophageal sphincter tone.

Absorption: From the GI tract requires vitamin D; minimal absorption unless chronic, high doses are given; calcium is absorbed in soluble, ionized form; solubility of calcium is increased in an acid environment

Distribution: Crosses the placenta; appears in breast milk

Elimination: Mainly in feces as unabsorbed calcium with 20% eliminated by the kidneys

Oral (dosage is in terms of elemental calcium):

0-6 months: 210 mg/day

7-12 months: 270 mg/day

1-3 years: 500 mg/day

4-8 years: 800 mg/day

Adults, male/female:

9-18 years: 1300 mg/day

19-50 years: 1000 mg/day

>51 years: 1200 mg/day

Female: Pregnancy:

less than or equal to 18 years: 1300 mg/day

>19 years: 1000 mg/day

Female: Lactating:

less than or equal to 18 years: 1300 mg/day

>19 years: 1000 mg/day

Hypocalcemia (dose depends on clinical condition and serum calcium level): Dose expressed in mg of elemental calcium

Neonates: 50-150 mg/kg/day in 4-6 divided doses; not to exceed 1 g/day

Children: 45-65 mg/kg/day in 4 divided doses

Adults: 1-2 g or more/day in 3-4 divided doses

Adults:

Dietary supplementation: 500 mg to 2 g divided 2-4 times/day

Antacid: 2 tablets or 10 mL every 2 hours, up to 12 times/day

Adults >51 years of age: Osteoporosis: 1200 mg/day

Dosing adjustment in renal impairment: Cl_cr <25 mL/minute: Dosage adjustments may be necessary depending on the serum calcium levels

Should be administered 1-3 hours after meals; may decrease iron absorption so should be administered 1-2 hours before or after iron supplementation; should not be administered with bran, foods high in oxalates or whole grain cereals which may decrease calcium absorption

Serum calcium: 8.4-10.2 mg/dL: Monitor plasma calcium levels if using calcium salts as electrolyte supplements for deficiency

Due to a poor correlation between the serum ionized calcium (free) and total serum calcium, particularly in states of low albumin or acid/base imbalances, direct measurement of ionized calcium is recommended

In low albumin states, the corrected total serum calcium may be estimated by: Corrected total calcium = total serum calcium + 0.8 (4.0 - measured serum albumin)

calcium (S); magnesium

May rarely produce irritability

None reported

No information available to require special precautions

No effects or complications reported

Shake suspension well; chew tablets thoroughly; take with large quantities of water or juice; do not take calcium supplements within 1-2 hours of taking other medicine by mouth or eating large amounts of fiber-rich foods; do not take other antacids or calcium supplements or drink large amounts of alcohol or caffeine-containing beverages; if the maximum dosage of antacids is required for >2 weeks, consult your physician

Monitor serum calcium levels

Elemental calcium listed in brackets

Calci-Mix™: 1250 mg [500 mg]

Florical®: 364 mg [145.6 mg] with sodium fluoride 8.3 mg

Liquid (Tums® Extra Strength): 1000 mg/5 mL (360 mL)

Lozenge (Mylanta® Soothing Antacids): 600 mg [240 mg]

Powder (Cal Carb-HD®): 6.5 g/packet [2.6 g]

Suspension, oral: 1250 mg/5 mL [500 mg]

Tablet: 650 mg [260 mg], 1500 mg [600 mg]

Calciday-667®: 667 mg [267 mg]

Os-Cal® 500, Oyst-Cal 500, Oystercal® 500: 1250 mg [500 mg]

Cal-Plus®, Caltrate® 600, Gencalc® 600, Nephro-Calci®: 1500 mg [600 mg]

Chewable:

Alka-Mints®: 850 mg [340 mg]

Amitone®: 350 mg [140 mg]

Caltrate, Jr.®: 750 mg [300 mg]

Calci-Chew™, Os-Cal®: 750 mg [300 mg]

Chooz®, Dicarbosil®, Equilet®, Tums®: 500 mg [200 mg]

Mallamint®: 420 mg [168 mg]

Rolaids® Calcium Rich: 550 mg [220 mg]

Tums® E-X Extra Strength: 750 mg [300 mg]

Tums® Ultra®: 1000 mg [400 mg]

Florical®: 364 mg [145.6 mg] with sodium fluoride 8.3 mg

Bauwens SF, Drinka PJ, Boh LE, "Pathogenesis and Management of Primary Osteoporosis," Clin Pharm, 1986, 5:639-59.

Heaney RP, Recker RR, and Saville PD, "Menopausal Changes in Calcium Balance Performance," J Lab Clin Med, 1978, 92(6):953-63.

NIH Consensus Conference, "Optimal Calcium Intake," JAMA, 1994, 272(24):1942-8.

Recker RR, "Calcium Absorption and Achlorhydria," N Engl J Med, 1985, 313(2):70-3.