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Tablet $0.03

Calcium Carbonate

Editor: AP Updated Class: Electrolyte

ADMINISTRATION ROUTES:

PO

ALTERNATIVE NAMES:

Calci-Tab, Caltrate, Calcium-Sandoz

ICU INDICATIONS:

  1. Calcium supplementation

PRESENTATION AND ADMINISTRATION:

PO:

Calci-Tab 500 (500 mg elemental calcium), Calci-Tab 600 (600 mg elemental calcium), Caltrate tablets (600 mg elemental calcium), Calci-Tab Effervescent (1 gm elemental calcium), Calcium Sandoz (5.23 gm of calcium lactate-gluconate, 0.8 gm of calcium carbonate)

DOSAGE:

PO:

500 mg-1800 mg of elemental calcium per day

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

Not applicable

CLINICAL PHARMACOLOGY:

Calcium

CONTRAINDICATIONS:

  1. Hypercalcaemia,

  2. Digitalis toxicity.

  3. Hyperphosphataemia (do not administer calcium if the Calcium + Phosphate is >5.5; this is an indication for dialysis)

WARNINGS:

Nil

PRECAUTIONS:

General:

Elderly, fluid restriction, decreased GI motility, GI obstruction, dehydration

Laboratory Tests:

No tests in addition to standard ICU tests are required

Drug/Laboratory Test Interactions:

False Increase:

Chloride, benzodiazepine (false positive)

False Decrease:

Magnesium, lipase.

IMPORTANT DRUG INTERACTIONS IN ICU:

Calcium channel blockers:

Calcium administration may inhibit calcium channel blocker activity.

Doxycycline, tetracycline:

Co-therapy with a tetracycline and calcium carbonate can reduce the serum concentrations and efficacy of tetracyclines.

Quinolones:

Reduced bioavailability of quinolone antibiotics.

Thiazides:

Large doses of calcium with thiazides may lead to milk-alkali syndrome

ADVERSE REACTIONS:

Cardiovascular:

Bradycardia, cardiac arrest, dysrhythmias, heart block, haemorrhage, hypotension, rebound hypertension, shortened QT interval.

Gastrointestinal:

Anorexia, constipation, diarrhoea, flatulence, nausea, obstruction, rebound hyperacidity, vomiting.

Genitourinary:

Renal dysfunction, renal failure, renal stones.

Metabolic:

Hypercalcaemia (drowsiness, lethargy, muscle weakness, headache, constipation, coma, anorexia, nausea, vomiting, polyuria, thirst), metabolic alkalosis, milk-alkali syndrome (nausea, vomiting, disorientation, headache)