Calcium Carbonate/Calcium Lactogluconate/Vitamin D

this Calcium Carbonate is useful for the temporary relief of occasional indigestion and heartburn. Frequent, daily or nightly symptoms usually mean a more serious problem. Antacids by themselves do not correct these problems. The medications that are now available to treat acid problems are generally superior to antacids.

The second and more important use of calcium carbonate is as a source of calcium, necessary for bones and teeth and to prevent osteoporosis. A quart of milk contains about 1500 mg of calcium which is about what you need. Otherwise this or a similar calcium preparation can be taken.

This medicine is indicated in all conditions where there is a disturbance of calcium metabolism due to impaired 1-α hydroxylation such as when there is reduced renal function. The main indications are:

a) Renal osteodystrophy

b) Hyperparathyroidism (with bone disease)

c) Hypoparathyroidism

d) Neonatal hypocalcaemia

e) Nutritional and malabsorptive rickets and osteomalacia

f) Pseudo-deficiency (D-dependent) rickets and osteomalacia

g) Hypophosphataemic vitamin D resistant rickets and osteomalacia

Antacids are taken by mouth to relieve heartburn, sour stomach, or acid indigestion. They work by neutralizing excess stomach acid. Some Calcium Carbonate combinations also contain simethicone, which may relieve the symptoms of excess gas. Antacids alone or in combination with simethicone may also be used to treat the symptoms of stomach or duodenal ulcers.

With larger doses than those used for the Calcium Carbonate effect, magnesium hydroxide (magnesia) and magnesium oxide antacids produce a laxative effect. The information that follows applies only to their use as an Calcium Carbonate.

Some antacids, like aluminum carbonate and aluminum hydroxide, may be prescribed with a low-phosphate diet to treat hyperphosphatemia (too much phosphate in the blood). Aluminum carbonate and aluminum hydroxide may also be used with a low-phosphate diet to prevent the formation of some kinds of kidney stones. Aluminum hydroxide may also be used for other conditions as determined by your doctor.

These medicines are available without a prescription. However, your doctor may have special instructions on the proper use and dose of these medicines for your medical problem.

Vitamins are compounds that you must have for growth and health. They are needed in small amounts only and are available in the foods that you eat. Vitamin D is necessary for strong bones and teeth.

Lack of vitamin D may lead to a condition called rickets, especially in children, in which bones and teeth are weak. In adults it may cause a condition called osteomalacia, in which calcium is lost from bones so that they become weak. Your doctor may treat these problems by prescribing vitamin D for you. Vitamin D is also sometimes used to treat other diseases in which calcium is not used properly by the body.

Ergocalciferol is the form of vitamin D used in vitamin supplements.

Some conditions may increase your need for vitamin D. These include:

• Alcoholism
• Intestine diseases
• Kidney disease
• Liver disease
• Overactivity of the parathyroid glands with kidney failure
• Pancreas disease
• Surgical removal of stomach

In addition, individuals and breast-fed infants who lack exposure to sunlight, as well as dark-skinned individuals, may be more likely to have a vitamin D deficiency. Increased need for vitamin D should be determined by your health care professional.

Alfacalcidol, calcifediol, calcitriol, and dihydrotachysterol are forms of vitamin D used to treat hypocalcemia (not enough calcium in the blood). Alfacalcidol, calcifediol, and calcitriol are also used to treat certain types of bone disease that may occur with kidney disease in patients who are undergoing kidney dialysis.

Claims that vitamin D is effective for treatment of arthritis and prevention of nearsightedness or nerve problems have not been proven. Some psoriasis patients may benefit from vitamin D supplements; however, controlled studies have not been performed.

Injectable vitamin D is given by or under the supervision of a health care professional. Some strengths of ergocalciferol and all strengths of alfacalcidol, calcifediol, calcitriol, and dihydrotachysterol are available only with your doctor's prescription. Other strengths of ergocalciferol are available without a prescription. However, it may be a good idea to check with your health care professional before taking vitamin D on your own. Taking large amounts over long periods may cause serious unwanted effects.

Usual Adult Dose for Osteoporosis:

2500 to 7500 mg/day orally in 2 to 4 divided doses.

Usual Adult Dose for Hypocalcemia:

900 to 2500 mg/day orally in 2 to 4 divided doses. This dose may be adjusted as needed to achieve a normal serum calcium level.

Usual Adult Dose for Dyspepsia:

300 to 8000 mg/day orally in 2 to 4 divided doses. This dose may be increased as needed and tolerated to decrease symptoms of stomach upset.

Maximum Dose: 5,500 to 7980 mg (depending on product used). Not to exceed maximum daily dosage for a period of greater than 2 weeks unless directed by a physician.

Usual Adult Dose for Duodenal Ulcer:

1250 to 3750 mg/day in 2 to 4 divided doses. This dose may be increased as needed and tolerated to decrease the abdominal discomfort. The major limiting factor to the chronic use of calcium carbonate is gastric hypersecretion and acid rebound.

Usual Adult Dose for Gastric Ulcer:

1250 to 3750 mg/day in 2 to 4 divided doses. This dose may be increased as needed and tolerated to decrease the abdominal discomfort. The major limiting factor to the chronic use of calcium carbonate is gastric hypersecretion and acid rebound.

Usual Adult Dose for Erosive Esophagitis:

1250 to 3750 mg/day orally in 2 to 4 divided doses. The potential for acid rebound could be detrimental. However, antacids have been frequently used in the management of erosive esophagitis and may be beneficial in decreasing the acidity of gastric contents.

Maximum Dose: 5,500 to 7980 mg (depending on product used). Not to exceed maximum daily dosage for a period of greater than 2 weeks unless directed by a physician.

Usual Adult Dose for Gastroesophageal Reflux Disease:

1250 to 3750 mg/day orally in 2 to 4 divided doses. The potential for acid rebound could be detrimental. However, antacids have been frequently used in the management of erosive esophagitis and may be beneficial in decreasing the acidity of gastric contents.

Maximum Dose: 5,500 to 7980 mg (depending on product used). Not to exceed maximum daily dosage for a period of greater than 2 weeks unless directed by a physician.

Usual Pediatric Dose for Hypocalcemia:

Neonatal:

Hypocalcemia (dose depends on clinical condition and serum calcium level): Dose expressed in mg of elemental calcium: 50 to 150 mg/kg/day in 4 to 6 divided doses; not to exceed 1 g/day

Usual

Dosage:

Calcium Carbonate:

Children 2 to 5 years: Childrens Pepto, Mylanta (R) Childrens: 1 tablet (400 mg calcium carbonate) as symptoms occur; not to exceed 3 tablets/day

Children 6 to 11 years: Childrens Pepto, Mylanta (R) Childrens: 2 tablets (800 mg calcium carbonate) as symptoms occur; not to exceed 6 tablets/day

Children 11 years and older:

Tums (R), Tums (R) E-X: 2 to 4 tablets chewed as symptoms occur; not to exceed 15 tablets [Tums (R)] or 10 tablets [Tums (R) E-X] per day

Tums (R) Ultra: 2 to 3 tablets chewed as symptoms occur; not to exceed 7 tablets per day

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

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

Treatment of hyperphosphatemia in end-stage renal failure: Children and Adults: Dose expressed in mg of calcium carbonate: 1 g with each meal; increase as needed; range: 4 to 7 g/day

Hydrofluoric acid (HF) burns (HF concentration less than 20%):

Topical: Various topical calcium preparations have been used anecdotally for treatment of dermal exposure to HF solutions; calcium carbonate at concentrations ranging from 2.5% to 33% has been used; a topical calcium carbonate preparation must be compounded.

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule,

Oral:

D3-50: 1.25 MG (50000 UT) [dairy free, egg free, fish derivative free, gluten free, kosher certified, no artificial color(s), nut free, soy free, sugar free, wheat free, yeast free]

Vitamin D: 1.25 MG (50000 UT) [contains fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow), soybean oil]

Vitamin D: 250 MCG (10000 UT) [contains fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake, gelatin (bovine)]

Vitamin D: 625 MCG (25000 UT) [contains soybean oil]

Dialyvite Vitamin D 5000: 125 MCG (5000 UT)

Pronutrients Vitamin D3: 25 MCG (1000 UT) [contains soybean oil]

Weekly-D: 1.25 MG (50000 UT) [contains fd&c red #40]

Generic: 1.25 MG (50000 UT), 250 MCG (10000 UT)

Capsule,

Oral [preservative free]:

Vitamin D: 125 MCG (5000 UT) [dairy free, dye free, egg free, gluten free, no artificial color(s), nut free, soy free, sugar free, wheat free, yeast free]

D3-50: 1.25 MG (50000 UT) [dairy free, egg free, fish derivative free, gluten free, kosher certified, no artificial color(s), nut free, soy free, sugar free, wheat free, yeast free]

Generic: 10,000 units, 125 MCG (5000 UT), 25 MCG (1000 UT), 50 MCG (2000 UT)

Liquid,

Oral:

Aqueous Vitamin D: 10 mcg/mL (50 mL) [gluten free, lactose free, sugar free; contains corn oil, methylparaben, polysorbate 80]

Bio-D-Mulsion: 10 mcg/0.03 mL (30 mL [DSC]) [contains sesame oil]

Bio-D-Mulsion Forte: 50 mcg/0.03 mL (30 mL [DSC]) [contains sesame oil]

BProtected Pedia D-Vite: 10 mcg/mL (50 mL) [alcohol free, sugar free; contains polysorbate 80, propylene glycol, sodium benzoate; cherry flavor]

Vitamin D: 10 mcg/mL (50 mL) [gluten free, lactose free, sugar free; contains polysorbate 80]

D-Vita: 10 mcg/mL (50 mL [DSC]) [alcohol free, gluten free, lactose free, sugar free; contains polysorbate 80, propylene glycol, sodium benzoate; fruit flavor]

D-Vite Pediatric: 10 mcg/mL (50 mL) [alcohol free, gluten free, lactose free, no artificial color(s), sugar free; contains disodium edta, polysorbate 80, propylene glycol, saccharin sodium, sodium benzoate]

D3 Vitamin: 10 mcg/mL (50 mL) [contains polysorbate 80, sodium benzoate]

Generic: 10 mcg/mL (50 mL, 52 mL)

Liquid,

Oral [preservative free]:

Generic: 125 mcg/mL (52 mL)

Liquid, Sublingual:

Generic: 5000 units/mL (60 mL)

Tablet,

Oral:

Delta D3: 10 MCG (400 UNIT) [gelatin free, gluten free, lactose free, no artificial color(s), no artificial flavor(s), starch free, sugar free, yeast free]

Dialyvite Vitamin D3 Max: 1.25 MG (50000 UT) [scored]

Vitamin D3 Super Strength: 50 MCG (2000 UT) [gluten free]

Vitamin D3 Ultra Potency: 1.25 MG (50000 UT)

Generic: 10 MCG (400 UNIT), 125 MCG (5000 UT), 20 MCG (800 UNIT), 25 MCG (1000 UT), 50 MCG (2000 UT), 75 MCG (3000 UT)

Tablet,

Oral [preservative free]:

Generic: 5000 units, 10 MCG (400 UNIT), 25 MCG (1000 UT), 50 MCG (2000 UT)

Tablet Chewable,

Oral:

Generic: 10 MCG (400 UNIT)

Tablet Chewable,

Oral [preservative free]:

Generic: 50 MCG (2000 UT)

Dosing: Adult

Note: 1 mcg = 40 units

Hypoparathyroidism (off-label use): Note: Active vitamin D preparations (ie, alfacalcidol, calcitriol) in conjunction with calcium supplementation are recommended therapy. Addition of cholecalciferol (or ergocalciferol) may be considered for supplemental therapy (Endocrine Society [Brandi 2016]).

Osteoporosis, prevention (off-label use): Adults ≥50 years of age:

Oral: 800 to 1,000 units/day is recommended, through dietary sources and/or supplementation if needed (NOF [Cosman 2014]).

Vitamin D insufficiency/deficiency treatment (off-label use): Note: Repletion strategies may vary depending on desired target serum 25(OH)D levels as well as the clinical status of the patient. The optimal serum 25(OH)D level is controversial; the Institute of Medicine recommends a 25(OH)D level >20 ng/mL as sufficient in nearly all persons (IOM 2011), whereas others have suggested targeting a level of ~30 ng/mL to minimize the risk of fractures, particularly in patients with osteoporosis (AACE [Camacho 2016]; NOF [Cosman 2014]). However, some data suggest levels >40 ng/mL (median level in one trial: ~48 ng/mL) are associated with increased risk of falls in postmenopausal women (Sanders 2010; Smith 2017).

Therefore, some experts recommend a range of 20 to 40 ng/mL as a reasonable target in most patients (Dawson-Hughes 2018). In patients with normal absorption, for every 100 units/day of cholecalciferol, the serum 25(OH)D level is expected to increase by ~0.7 to 1 ng/mL after a few weeks (ASPEN [McKeever 2017]; Dawson-Hughes 2018). The dose-response declines as the 25(OH)D concentration increases above 40 ng/mL (100 nmol/L) (Dawson-Hughes 2018). The following recommendations are based primarily on expert opinion and clinical experience:

Initial dosing (according to baseline serum 25(OH)D level):

Serum 25(OH)D 20 to 30 ng/mL: Initial: Supplementation dosing:

Oral: 600 to 800 units once daily; a repeat serum 25(OH)D level is not required (Dawson-Hughes 2018) or 1,000 to 2,000 units once daily; may consider a repeat serum 25(OH)D level in ~3 months to determine if the target level has been achieved (Khan 2010).

Serum 25(OH)D 10 to <20 ng/mL: Initial:

Supplementation dosing:

Oral: 800 to 1,000 units once daily (Dawson-Hughes 2018)

OR

Therapeutic dosing (ie, high-dose cholecalciferol):

Oral: 50,000 units once

Serum 25(OH)D <10 ng/mL or in patients with deficiency symptoms: Initial: Therapeutic dosing (ie, high-dose cholecalciferol):

Oral: 50,000 units once

Maintenance dosing: Maintenance dosing is highly patient specific and dependent on target 25(OH)D level, and may range from: 600 to 800 units/day (Dawson-Hughes 2018) to 1,000 to 2,000 units/day (AACE [Camacho 2016]; NOF [Cosman 2014]).

Special populations (obese patients, patients on medications known to affect vitamin D metabolism, patients with malabsorption syndromes or gastrectomy): Higher doses or longer durations may be necessary for adequate repletion (AACE [Camacho 2016]; Dawson-Hughes 2018).

Vitamin D deficiency/insufficiency in patients with chronic kidney disease (off-label use):

Oral:

Note: In patients without severe and progressive hyperparathyroidism, including chronic kidney disease stages G3 to G5 and dialysis or transplant patients, KDIGO guidelines recommend correcting vitamin D deficiency and insufficiency with treatment strategies recommended for the general population using cholecalciferol (or ergocalciferol) while avoiding hypercalcemia and ensuring phosphate levels are in the normal range. An individualized monitoring approach to direct treatment is also recommended (KDIGO 2009; KDIGO 2017). In patients in whom serum parathyroid hormone levels are progressively rising and remain persistently elevated despite correction of modifiable factors (eg, hyperphosphatemia, vitamin D deficiency), calcitriol or vitamin D analogs are suggested instead of cholecalciferol (or ergocalciferol) (KDOQI commentary [Uhlig 2010]).

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Vitamin D deficiency, prevention (eg, Rickets prevention): (AAP [Folsom 2017]; AAP [Wagner 2008]; Munns 2016):

Oral:

Breast-fed infants (fully or partially):

Oral: 400 units/day beginning in the first few days of life. Continue supplementation until infant is weaned to ≥1,000 mL/day or 1 qt/day of vitamin D-fortified formula or whole milk (after 12 months of age)

Formula-fed infants ingesting <1,000 mL of vitamin D-fortified formula:

Oral: 400 units/day

Children and Adolescents without adequate intake:

Oral: 400 to 600 units/day.

Vitamin D deficiency, treatment:

Oral:

Infants:

Oral: 2,000 units daily for 6 weeks to achieve a serum 25(OH)D level >20 ng/mL; followed by a maintenance dose of 400 to 1,000 units daily. Note: For patients at high risk of fractures a serum 25(OH)D level >30 ng/mL has been suggested (AAP [Golden 2014]).

Children and Adolescents:

Oral: 2,000 units daily for 6 to 8 weeks to achieve serum 25(OH)D level >20 ng/mL; followed by a maintenance dose of 600 to 1,000 units daily. Note: For patients at high risk of fractures a serum 25(OH)D level >30 ng/mL has been suggested (AAP [Golden 2014]).

Vitamin D deficiency in cystic fibrosis, prevention and treatment:

Oral:

CF guidelines (Tangricha [CF Foundation] 2012):

Recommended initial daily intake to maintain serum 25(OH)D level ≥30 ng/mL:

Infants:

Oral: 400 to 500 units/day

Children ≤10 years:

Oral: 800 to 1,000 units/day

Children >10 years and Adolescents:

Oral: 800 to 2,000 units/day

Dosing adjustment for serum 25(OH)D level between 20 to 30 ng/mL and patient adherence established (Step 1 increase):

Infants:

Oral: 800 to 1,000 units/day

Children ≤10 years:

Oral: 1,600 to 3,000 units/day

Children >10 years and Adolescents:

Oral: 1,600 to 6,000 units/day

Dosing adjustment for serum 25(OH)D level <20 ng/mL or persistently between 20 to 30 ng/mL and patient adherence established (Step 2 increase):

Infants: Increase up to a maximum 2,000 units/day

Children ≤10 years: Increase to a maximum of 4,000 units/day

Children >10 years and Adolescents: Increase to a maximum of 10,000 units/day

Alternate dosing (Hall 2010):

Initial dose: Serum 25(OH)D level ≤30 ng/mL

Infants:

Oral: 8,000 units/

Children and Adolescents:

Oral: 800 units/day

Medium-dose regimen: Serum 25(OH)D level remains ≤30 ng/mL and patient compliance established

Infants and Children <5 years:

Oral: 12,000 units/week for 12 weeks

Children ≥5 years and Adolescents:

Oral: 50,000 units/week for 12 weeks

High-dose regimen: Repeat 25(OH)D level remains ≤30 ng/mL and patient compliance established

Infants and Children <5 years:

Oral: 12,000 units twice weekly for 12 weeks

Children ≥5 years and Adolescents:

Oral: 50,000 units twice weekly for 12 weeks

Vitamin D insufficiency or deficiency associated with CKD (stages 2 to 5, 5D), treatment; serum 25 hydroxyvitamin D [25(OH)D] level ≤30 ng/mL (KDOQI Guidelines 2009):

Oral:

Serum 25(OH)D level 16 to 30 ng/mL: Infants, Children, and Adolescents: 2,000 units/day for 3 months or 50,000 units every month for 3 months

Serum 25(OH)D level 5 to 15 ng/mL: Infants, Children, and Adolescents: 4,000 units/day for 12 weeks or 50,000 units every other week for 12 weeks

Serum 25(OH)D level <5 ng/mL: Infants, Children, and Adolescents: 8,000 units/day for 4 weeks then 4,000 units/day for 2 months for total therapy of 3 months or 50,000 units/week for 4 weeks followed by 50,000 units 2 times/month for a total therapy of 3 months

Maintenance dose [once repletion accomplished; serum 25(OH)D level >30 ng/mL]: Infants, Children, and Adolescents: 200 to 1,000 units/day

Nutritional rickets, treatment: Limited data available (Munns 2016): Administer in combination with calcium supplementation:

Daily therapy (preferred):

Infants:

Oral: 2,000 units daily for ≥3 months, followed by maintenance dose of 400 units daily

Children:

Oral: 3,000 to 6,000 units daily for ≥3 months, followed by maintenance dose of 600 units daily

Adolescents:

Oral: 6,000 units daily for ≥3 months, followed by maintenance dose of 600 units daily

Single-dose therapy:

Infants ≥3 months:

Oral: 50,000 units once, or in divided doses over several days; after 3 months, initiate maintenance dose of 400 units daily

Children:

Oral: 150,000 units once, or in divided doses over several days; after 3 months, initiate maintenance dose of 600 units daily

Adolescents:

Oral: 300,000 units once, or in divided doses over several days; after 3 months, initiate maintenance dose of 600 units daily

See also:
What is the most important information I should know about Calcium Carbonate?

Known hypersensitivity reaction to any of the ingredients of Calcium Carbonate.

See also:
What is the most important information I should know about Vitamin D?

OTC labeling: Replesta products only: When used for self-medication, do not use if you have hypercalcemia, primary hyperparathyroidism, sarcoidosis, hypervitaminosis D, Williams syndrome, or are pregnant.

Documentation of allergenic cross-reactivity for vitamin D is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Use Calcium Carbonate as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take Calcium Carbonate by mouth with or without food.
• Many medicines (eg, used for blood clots, immune system suppression, infection, iron supplementation, low blood platelets, osteoporosis, thyroid problems) should not be taken at the same time as Calcium Carbonate; their effectiveness may be decreased. Ask your doctor or pharmacist if your dose of Calcium Carbonate should be separated from your dose of any of your other medicines.
• If you miss a dose of Calcium Carbonate, take it as soon as you remember. Continue to take it as directed by your doctor or on the package label.

Ask your health care provider any questions you may have about how to use Calcium Carbonate.

This medication 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.

How to use Calcium Carbonate

Take this medication by mouth with food. If your product contains calcium citrate, then it may be taken with or without food. Follow all directions on the product package, or take as directed by your doctor. For best absorption, if your daily dose is more than 600 milligrams, then divide your dose and space it throughout the day. If you are uncertain about any of the information, consult your doctor or pharmacist.

If you are using the chewable product, chew it well before swallowing.

If you are using the effervescent tablet, allow the tablet to fully dissolve in a glass of water before drinking it. Do not chew or swallow the tablet whole.

If you are using the liquid product or powder, measure the medication with a dose-measuring spoon or device to make sure you get the correct dose. Do not use a household spoon. If the liquid product is a suspension, shake the bottle well before each dose.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

If your doctor has recommended that you follow a special diet, it is very important to follow the diet to get the most benefit from this medication and to prevent serious side effects. Do not take other supplements/vitamins unless ordered by your doctor.

If you think you may have a serious medical problem, seek immediate medical attention.

Vitamin D (ergocalciferol-D2, cholecalciferol-D3, alfacalcidol) is a fat-soluble vitamin that helps your body absorb calcium and phosphorus. Having the right amount of vitamin D, calcium, and phosphorus is important for building and keeping strong bones. Vitamin D is used to treat and prevent bone disorders (such as rickets, osteomalacia). Vitamin D is made by the body when skin is exposed to sunlight. Sunscreen, protective clothing, limited exposure to sunlight, dark skin, and age may prevent getting enough vitamin D from the sun.

Vitamin D with calcium is used to treat or prevent bone loss (osteoporosis). Vitamin D is also used with other medications to treat low levels of calcium or phosphate caused by certain disorders (such as hypoparathyroidism, pseudohypoparathyroidism, familial hypophosphatemia). It may be used in kidney disease to keep calcium levels normal and allow normal bone growth. Vitamin D drops (or other supplements) are given to breast-fed infants because breast milk usually has low levels of vitamin D.

How to use Vitamin D

Take vitamin D by mouth as directed. Vitamin D is best absorbed when taken after a meal but may be taken with or without food. Alfacalcidol is usually taken with food. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.

If your doctor has prescribed this medication, take as directed by your doctor. Your dosage is based on your medical condition, amount of sun exposure, diet, age, and response to treatment.

Measure the liquid medication with the dropper provided, or use a medication-measuring spoon/device to make sure you have the correct dose. If you are taking the chewable tablet or wafers, chew the medication thoroughly before swallowing. Do not swallow whole wafers.

Certain medications (bile acid sequestrants such as cholestyramine/colestipol, mineral oil, orlistat) can decrease the absorption of vitamin D. Take your doses of these medications as far as possible from your doses of vitamin D (at least 2 hours apart, longer if possible). It may be easiest to take vitamin D at bedtime if you are also taking these other medications. Ask your doctor or pharmacist how long you should wait between doses and for help finding a dosing schedule that will work with all your medications.

Take this medication regularly to get the most benefit from it. To help you remember, take it at the same time each day if you are taking it once a day. If you are taking this medication only once a week, remember to take it on the same day each week. It may help to mark your calendar with a reminder.

If your doctor has recommended that you follow a special diet (such as a diet high in calcium), it is very important to follow the diet to get the most benefit from this medication and to prevent serious side effects. Do not take other supplements/vitamins unless ordered by your doctor.

If you think you may have a serious medical problem, get medical help right away.

See also:
What other drugs will affect Calcium Carbonate?

An interaction generally means that one drug may increase or decrease the effect of another drug. Also, the more medications a person takes, the more likely there will be a drug interaction. Antacids do interact with or prevent the absorption of many medications. As a general rule it is best to separate Calcium Carbonate use and any other medications by at least 1 hour. When antacids are only taken occasionally, this seldom presents a serious problem. Since there are so many good medications to reduce stomach acid, some of them over-the-counter, it is unusual to require frequent Calcium Carbonate use during the day and night.

Interactions with this Calcium Carbonate may occur with the following:

* flecainide (Tambocor)

* phenytoin type drugs (Dilantin, Mesantoin, Peganone, Cerebyx)

* iron (Feosol, ferrous sulfate, Nu-Iron)

* quinidine (Quinidex, Quinaglute)

* aspirin, salicylates

* tetracycline (Sumycin, Tetracyn)

See also:
What other drugs will affect Vitamin D?

Aluminum Hydroxide: Vitamin D Analogs may increase the serum concentration of Aluminum Hydroxide. Specifically, the absorption of aluminum may be increased, leading to increased serum aluminum concentrations. Avoid combination

Bile Acid Sequestrants: May decrease the serum concentration of Vitamin D Analogs. More specifically, bile acid sequestrants may impair absorption of Vitamin D Analogs. Management: Avoid concomitant administration of vitamin D analogs and bile acid sequestrants (eg, cholestyramine). Separate administration of these agents by several hours to minimize the potential risk of interaction. Monitor plasma calcium concentrations. Consider therapy modification

Calcium Salts: May enhance the adverse/toxic effect of Vitamin D Analogs. Monitor therapy

Cardiac Glycosides: Vitamin D Analogs may enhance the arrhythmogenic effect of Cardiac Glycosides. Monitor therapy

Danazol: May enhance the hypercalcemic effect of Vitamin D Analogs. Monitor therapy

Erdafitinib: Serum Phosphate Level-Altering Agents may diminish the therapeutic effect of Erdafitinib. Management: Avoid coadministration of serum phosphate level-altering agents with erdafitinib before initial dose increase period based on serum phosphate levels (Days 14 to 21). Consider therapy modification

Mineral Oil: May decrease the serum concentration of Vitamin D Analogs. More specifically, mineral oil may interfere with the absorption of Vitamin D Analogs. Management: Avoid concomitant, oral administration of mineral oil and vitamin D analogs. Consider separating the administration of these agents by several hours to minimize the risk of interaction. Monitor plasma calcium concentrations. Consider therapy modification

Multivitamins/Fluoride (with ADE): May enhance the adverse/toxic effect of Vitamin D Analogs. Avoid combination

Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Vitamin D Analogs. Avoid combination

Orlistat: May decrease the serum concentration of Vitamin D Analogs. More specifically, orlistat may impair absorption of Vitamin D Analogs. Management: Monitor clinical response (including serum calcium) to oral vitamin D analogs closely if used with orlistat. If this combination must be used, consider giving the vitamin D analog at least 2 hrs before or after orlistat. Consider therapy modification

Sucralfate: Vitamin D Analogs may increase the serum concentration of Sucralfate. Specifically, the absorption of aluminum from sucralfate may be increased, leading to an increase in the serum aluminum concentration. Avoid combination

Thiazide and Thiazide-Like Diuretics: May enhance the hypercalcemic effect of Vitamin D Analogs. Monitor therapy

Vitamin D Analogs: May enhance the adverse/toxic effect of other Vitamin D Analogs. Avoid combination

See also:
What are the possible side effects of Calcium Carbonate?

Applies to calcium carbonate: tablets

Other dosage forms:

• chewable tablets

Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Constipation.

Seek medical attention right away if any of these SEVERE side effects occur while taking calcium carbonate (the active ingredient contained in Calcium Carbonate)

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); confusion; increased urination; loss of appetite; mental or mood changes; nausea; severe or persistent constipation or stomach pain; weakness; vomiting.

See also:
What are the possible side effects of Vitamin D?

Vitamin D at normal doses usually has no side effects. If you have any unusual effects, contact your doctor or pharmacist promptly.

If your doctor has directed you to take this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Too much vitamin D can cause harmful high calcium levels. Tell your doctor right away if any of these signs of high vitamin D/calcium levels occur: nausea/vomiting, constipation, loss of appetite, increased thirst, increased urination, mental/mood changes, unusual tiredness.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Each Calcium Carbonate milk powd contains: Energy Density 1 kCal/mL. Energy Distribution: Protein: Fat: CHO 13:37:50, Protein 32.5 g/L, CHO 125.7 g/L, Fat 42 g/L, Na 500 mg/L, K 1,250 mg/L, Mg 200 mg/L, P 500 mg/L, osmolality 300 mOsmol/kg H₂O.

Each Calcium Carbonate oral liqd (ready-to-drink) contains: Energy Density 1 kCal/mL. Energy Distribution: Protein: Fat: CHO 14:32:54, Protein 35 g/L, CHO 135 g/L, Fat 36 g/L, Na 1,000 mg/L, K 1,200 mg/L, Mg 280 mg/L, P 870 mg/L, osmolality 330 mOsmol/kg H₂O.

Calcium Carbonate is specifically formulated for the dietary management of malnutrition and other medical conditions with increased nutritional needs that cannot be met through diet modification alone.

Special Features: Calcium Carbonate is isotonic (low osmolality); 100% complex carbohydrate; 20% of fat as MCT; lactose-free; unflavoured.