calcium carbonate/vitamin D3 (Caltrate 600+D3, Os-Cal Calcium + D3, Os-Cal Extra D3, Os-Cal Ultra)
Classes: Calcium Salts; Vitamins, Fat-Soluble
Dosing and uses of Caltrate, Os-Cal (calcium carbonate/vitamin D3)
Adult dosage forms and strengths
calcium carbonate/vitamin D&sub3;
tablet
- 500mg/200 IU (Os-Cal Calcium + D&sub3;)
- 500mg/600 IU (Os-Cal Extra D&sub3;)
- 600mg/500 IU (Os-Cal Ultra)
- 600mg/800 IU (Caltrate + D&sub3;)
Calcium Supplementation
NIH recommended daily intake
- Elemental calcium and vitamin D
- 19-50 years: 1000 mg/200 IU daily
- ≥51-70 years (females): 1200 mg/400 IU
- ≥51 years (males): 1000 mg/400 IU
- ≥70 years (females): 1200 mg/600 IU
- Osteoporosis prevention in adults ≥50 years: Vitamin D intake may need to be increased to 800-1000 mg/day
Dosing Considerations
Calcium carbonate (elemental calcium equivalent)
- 500 mg (200 mg)
- 600 mg (240 mg)
High risk for vitamin D deficiency
- Age ≥50 yr
- African Americans and others with dark pigmented skin
- Individuals with limited sun exposure
- Individuals who consistently wearing sunscreen SPF ≥8
Administration
Tablet strengths are varied; check content of calcium and vitamin D carefully to assure dosage
Take with food
Pediatric dosage forms and strengths
calcium carbonate/vitamin D&sub3;
tablet
- 500mg/200 IU (Os-Cal Calcium + D&sub3;)
Calcium Supplementation
NIH recommended daily intake
- Elemental calcium and vitamin D
- Adolescents (9-18 years): 1300 mg/200 IU
Dosing Considerations
Calcium carbonate (elemental calcium equivalent)
- 500 mg (200 mg)
- 600 mg (240 mg)
Administration
Tablet strengths are varied; check content of calcium and vitamin D carefully to assure dosage
Take with food
Caltrate, Os-Cal (calcium carbonate/vitamin D3) adverse (side) effects
Frequency not defined
Calcium carbonate
- Anorexia
- Constipation
- Flatulence
- Nausea
- Vomiting
- Hypercalcemia
- Hypophosphatemia
- Xerostomia
- Acid rebound
- Milk-alkali syndrome
Vitamin d
- Hypercalcemia
- Muscle/bone pain
- Metallic taste
- Headache
- Nausea
- Vomiting
- Dry mouth
- Constipation
- Arrhythmias
Warnings
Contraindications
Calcium carbonate
- Hypersensitivity
- Hypercalciuria
- Renal calculi
- Hypophosphatemia
- Hypercalcemia
- Suspected digoxin toxicity
Vitamin d
- Hypercalcemia
- Hypervitaminosis D
- Ergocalciferol (oral) GI, liver, or biliary disease associated with malabsorption of vitamin D analogs
Cautions
Calcium carbonate
- Caution with history of kidney stones
Vitamin d
- Ergocalciferol: renal impairment (strong caution); heart disease, kidney stones, arteriosclerosis
- Discontinue if patient becomes hypercalcemic
- Concurrent cardiac glycosides
Pregnancy and lactation
Pregnancy category: C (calcium carbonate)
Lactation: Distributed in human breast milk
Supplement calcium and vitamin D during pregnancy and lactation according to recommended daily allowance
Pregnant or breastfeeding patients should seek advice of health professional before using OTC drugs
Pregnancy categories
A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA: Information not available.
Pharmacology of Caltrate, Os-Cal (calcium carbonate/vitamin D3)
Mechanism of action
Prevents or treats negative Ca balance
Absorption
Bioavailability: 25-35% (calcium carbonate)
Distribution
Protein bound: 45% (calcium carbonate)
Metabolism
Vitamin D is metabolized in the liver
Elimination
Excretion (calcium carbonate): 80% as unabsorbed calcium in feces, 20% urinary via urine
Excretion (vitamin D): Urine
