calcium carbonate (Tums Chewy Delights, Tums Extra, Tums Freshers, Tums Kids, Tums Regular, Tums Smoothies, Tums Ultra, Children's Pepto): Dosing and Uses

Dosing and uses of Tums (calcium carbonate)

• Adult
• Pediatric

Adult dosage forms and strengths

tablet, chewable

• 500mg (Tums Regular, Tums Freshers)
• 750mg (Tums Extra, Tums Kids, Tums Smoothies)
• 1000mg (Tums Ultra)
• 1177mg (Tums Chewy Delights)

Antacid

Take at onset of GI distress

Tums Regular, Tums Freshers (500 mg): Chew 2-4 tablets; not to exceed 15 tabs/24 hr

Tums Smoothies (750 mg): Chew 2-4 tablets; not to exceed 10 tabs/24 hr

Tums Extra (750 mg): Chew 2-4 tablets; not to exceed 9 tabs/24 hr

Tums Ultra (1000 mg): Chew 2-3 tablets; not to exceed 7 tabs/24 hr

Tums Chewy Delights (1177 mg): Chew and swallow 2-3 chews; not to exceed 10 chews/24 hr

Not to exceed 7 g/day

Calcium Supplementation

1-1.2 g PO qDay or divided q6-12hr with meals

Recommended Dietary Allowance

19-50 years: 1 g/day PO

Females

• >51 years: 1.2 g/day PO

Males

• 51-70 years: 1 g/day PO
• >71 years: 1.2 g/day PO

Dosing Considerations

Calcium carbonate (elemental calcium equivalent)

• 400 mg (161 mg)
• 500 mg (200 mg)
• 750 mg (300 mg)
• 1000 mg (400 mg)
• 1177 mg (470 mg)

Hyperphosphatemia (Orphan)

Treatment of hyperphosphatemia in patients with end-stage renal disease

Orphan indication sponsor

• R & D Laboratories, Inc; 4204 Glencoe Avenue; Marina Del Rey, CA 90292

Pediatric dosage forms and strengths

tablet, chewable

• 400mg (Children's Pepto)
• 500mg (Tums Regular, Tums Freshers)
• 750mg (Tums Extra, Tums Kids, Tums Smoothies)
• 1000mg (Tums Ultra)
• 1177mg (Tums Chewy Delights)

Antacid

Children's Pepto

• <2 years (<11 kg): Safety and efficacy not established
• 2-5 years (12-21 kg): 400 mg (1 tablet) PO PRN; not to exceed 3 tablets/day
• 6-11 years (22-43 kg): 800 mg (2 tablets) PO PRN; not to exceed 6 tablets/day

Tums Kids

• <2 years (<11 kg): Safety and efficacy not established
• 2-4 years (11-21 kg): 375 mg (1/2 tablet) PO BID with meal
• >4 years (22-43 kg): 750 mg (1 tablet) PO TID with meal

Recommended Dietary Allowance

Dosage expressed as elemental calcium

0-6 months: 200 mg/day PO

7-12 months: 260 mg/day PO

1-3 years: 700 mg/day PO

4-8 years: 1000 mg/day PO

9-18 years: 1300 mg/day PO

Dosing Considerations

Calcium carbonate (elemental calcium equivalent)

• 400 mg (161 mg)
• 500 mg (200 mg)
• 750 mg (300 mg)
• 1000 mg (400 mg)
• 1177 mg (470 mg)

Tums (calcium carbonate) adverse (side) effects

Frequency not defined

Anorexia

Constipation

Flatulence

Nausea

Vomiting

Hypercalcemia

Hypophosphatemia

Milk-alkali syndrome

Warnings

Contraindications

Hypersensitivity

Hypercalciuria

Renal calculi

Hypophosphatemia

Hypercalcemia

Suspected digoxin toxicity

Cautions

Shake suspension well; chew tablets thoroughly

Absorption impaired in achlorhydria

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

Pregnancy and lactation

Pregnancy category: C

Lactation: Safe; crosses the placenta; appears in breast milk

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 Tums (calcium carbonate)

Mechanism of action

Antacid: Neutralizes gastric acidity

Dietary supplement: Prevents or treats negative Ca balance; oral Ca supplements may protect against renal calculi formation by chelating with oxalate in gut and preventing its absorption

Phosphate binder: Binds with dietary phosphate to form insoluble calcium phosphate, which is excreted in feces

Absorption

Bioavailability: 25-35%; food increases absorption 10-30%; antacid action dependent on gastric emptying time

Peak plasma time: 20-60 min (fasting state); up to 3 hr (ingested 1 hr after meals)

Distribution

Protein bound: 45%

Elimination

Renal clearance: 50-300 mg/day

Excretion: Feces, as unabsorbed calcium (80%); urine (20%)