Calcium Citrate

Calcium citrate is used to prevent or treat low blood calcium levels in people who do not get enough calcium from their diets. It may be used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased activity of the parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). It may also be used in certain patients to make sure they are getting enough calcium (e.g., women who are pregnant, nursing, or postmenopausal, people taking certain medications such as phenytoin, phenobarbital, or prednisone).

Calcium plays a very important role in the body. It is necessary for normal functioning of nerves, cells, muscle, and bone. If there is not enough calcium in the blood, then the body will take calcium from bones, thereby weakening bones. Having the right amount of calcium is important for building and keeping strong bones.

Calcium citrate is available under the following different brand names: Cal-Cee and Cal-C-Cap.

Dosage Forms and Strengths

Tablet/capsule

• 150mg
• 200mg
• 250mg
• 950mg
• 1040mg

Granules

• 760mg/3.5g

Dosage Considerations – Should be Given as Follows:

Recommended Daily Allowance (RDA) (Elemental Calcium)

• Age less than 50 years: 1 g/day
• Over 50 years females: 1.2 g/day
• Over 50 years males: 1 g/day
• Over 70 years males: 1.2 g/day
• Children under 6 months old: 200 mg/day
• Children 6-12 months old: 260 mg/day
• Children 1-3 years old: 700 mg/day
• Children 4-8 years old: 1000 mg/day
• Children 9-18 years old: 1300 mg/day

Hypocalcemia Prevention

• Adults: 1 g/day in divided doses

Hypocalcemia, Pediatric

• Neonates: 50-150 mg/kg/day divided every 4-6 hours orally; dose expressed as elemental calcium; no more than 1g/day
• Children: 45-65 mg/kg/day divided every 6 hours orally; dose expressed as elemental calcium

Primary Osteoporosis Prevention

• 1-1.5 g/day in divided doses

Other Information

• 211 mg elemental calcium (Ca) per gram of calcium citrate
• Most commercial products also contain Vitamin D

Other Indications and Uses

• Oral calcium (Ca) supplements may protect against renal calculi formation by chelating with oxalate in gut and preventing its absorption

Side effects of Calcium Citrate include:

• Low blood pressure (hypotension)
• Headache
• Constipation
• Diarrhea
• Gas (flatulence)
• Belching
• Nausea
• Vomiting
• Low blood phosphates (hypophosphatemia)
• Low blood magnesium (hypomagnesemia)
• High blood calcium (hypercalcemia)
  • Coma
  • Coma
  • Confusion
  • Delirium
  • Headache
  • Lethargy
  • Loss of appetite
  • Milk-alkali syndrome (very high, chronic dosing)
  • Nausea/Vomiting

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

• Severe interactions of Calcium Citrate include:
  • ceftriaxone
• Serious interactions of Calcium Citrate include:
  • demeclocycline
  • dolutegravir
  • doxycycline
  • eltrombopag
  • lymecycline
  • minocycline
  • oxytetracycline
  • tetracycline
• Calcium Citrate has moderate interactions with at least 50 different drugs.
• Calcium Citrate has mild interactions with at least 52 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

Contraindications

Effects of Drug Abuse

Short-Term Effects

Long-Term Effects

Cautions

Pregnancy and Lactation

• This medication contains calcium citrate. Do not take Cal-Cee or Cal-C-Cap if you are allergic to calcium citrate or any ingredients contained in this drug.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.
  • Documented hypersensitivity, hypercalciuria, renal calculi, hypophosphatemia, hypercalcemia, ventricular fibrillation
  • Milk-alkali syndrome (very high, chronic dosing)
  • See "What Are Side Effects Associated with Using Calcium Citrate?"
  • Milk-alkali syndrome (very high, chronic dosing)
  • See "What Are Side Effects Associated with Using Calcium Citrate?"
  • Hypercalcemia and hypercalciuria may result from long-term use.
  • Advise patients to limit intake of oxalate-rich foods (soy, green leafy vegetables, animal protein) to avoid reduced absorption through Ca-oxalate formation.
  • Use calcium citrate with caution during pregnancy if benefits outweigh risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
  • Calcium citrate is considered safe for use while breastfeeding. It appears in breast milk.