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Citracal Max

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Citracal Max

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Method of action: Vitamins

Treatment option:

Medically reviewed

Marina Burgos

Last updated on 22/12/2025

This page provides general, reference-level information compiled from official medical sources. It is not a substitute for professional medical advice, diagnosis, or treatment. For decisions about your health, please consult a qualified healthcare professional.

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Overview of Citracal Max

Citracal Max is a combination product classified as a Dietary Supplement and Mineral and Vitamin Supplement used to provide essential support for bone health.


Quick Facts

Property Description
Active Ingredients Calcium Citrate, Dihydrotachysterol
Form Oral Tablet
Pharmacological Class Mineral and Vitamin Supplement, Bone Health Agent
General Purpose Support for Bone Mineral Density
Origin Synthetic Mineral Salt and Synthetic Vitamin D Analogue

What Type of Product is Citracal Max? (Classification and Form)

Citracal Max is categorized as a Bone Health Agent and is broadly placed within the pharmacological classification of a Parathyroid Hormone Regulating Agent, due to its influence on calcium metabolism. This indicates that the product's function is centered on regulating the body's natural processes for managing calcium. This preparation is a specialized type of mineral supplement, specifically a non-prescription Oral Tablet intended for Oral administration. Unlike simple, single-ingredient supplements, the product’s identity is defined by its strategic blend of two distinct active entities working synergistically to enhance nutritional support. The formulation is clinically recognized for providing superior bioavailability compared to simpler calcium forms.


Active Ingredients: Composition, Class, and Origin

The core composition of Citracal Max features the two Active Ingredients: Calcium Citrate and Dihydrotachysterol. Calcium Citrate is a Synthetic Mineral Salt—a highly bioavailable form of the essential mineral Calcium—while Dihydrotachysterol is a synthesized Vitamin D Analogue structurally similar to Vitamin D. This preparation functions as a nutritional support agent for calcium. These two components define the formula as a strategic Combination Product.

The key distinction in this composition lies in the use of Calcium Citrate, which is widely accepted as being highly soluble and efficiently absorbed, and the inclusion of Dihydrotachysterol. The Vitamin D Analogue is incorporated specifically to actively promote the body's machinery responsible for Intestinal Calcium Absorption and overall mineral management. The general purpose of this formulation is to support Bone Mineral Density by ensuring both the supply of the mineral and the physiological efficiency of its uptake.

Regulatory References

  1. FDA Drug Label Information
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What side effects are possible with Citracal Max?

Possible Side Effects and Safety Information

The safety profile for calcium citrate and Vitamin D, the active components in Citracal Max, is derived from official regulatory documentation and outlines known adverse reactions and necessary safety precautions.

Adverse Reactions

The most commonly documented side effects are typically non-serious and involve the Gastrointestinal System.

Classification Examples of Reactions
Rare Constipation, gas (flatulence), nausea, abdominal pain, diarrhea, itching, rash.
Uncommon Hypercalcaemia (high blood calcium levels), Hypercalciuria (high calcium in urine).
Not Known Severe hypersensitivity reactions (allergic swelling), Milk-alkali syndrome.

Serious Adverse Reactions

Although rare, Hypercalcaemia (excessive blood calcium) is the primary clinically significant safety concern. Chronic, high-dose ingestion may lead to rare but serious complications, including Milk-Alkali Syndrome (Burnett Syndrome) or the development of kidney stones (Nephrolithiasis), particularly in susceptible individuals. Signs of severe allergic reaction, such as swelling of the face or throat, are considered serious.

Safety Restrictions and Limitations

Specific conditions officially state that this supplement should not be used, as documented in regulatory information. These Contraindications include pre-existing high calcium levels in the blood or urine, severe impairment of kidney function, and a history of kidney stones or Vitamin D overdose (Hypervitaminosis D).

Use requires caution and often involves monitoring in certain populations, such as immobilized patients or individuals with pre-existing mild-to-moderate kidney impairment. This monitoring often involves periodic checks of blood and urinary calcium levels to mitigate the risk of adverse events associated with calcium overload.

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Overdose and Emergency Response

Overdose and When to Seek Help

The official overdose profile for this combination product is defined by the consequences of excessive Vitamin D analogue (Dihydrotachysterol) intake, which leads to abnormally high blood calcium levels (hypercalcemia). This information is derived from authoritative government regulatory documents.

Manifestation Category Officially Documented Findings
Early Manifestations Loss of appetite (anorexia), nausea, vomiting, dry mouth, increased thirst (polydipsia), increased urination (polyuria), headache, and unusual weakness.
Severe Outcomes Cardiac arrhythmias, hypertension, mental confusion, seizures, coma, and potential renal insufficiency. Chronic, unmanaged hypercalcemia may lead to metastatic soft-tissue calcification.

Immediate Regulatory Action

Immediate medical attention is formally required upon suspicion of overdosage. Regulatory guidance explicitly states to contact a poison control center or emergency room at once.

Severe hypercalcemia necessitates urgent medical intervention due to the risk of life-threatening complications, including cardiac and neurological events. Patients with existing renal impairment are documented to be at an increased risk for severe hypercalcemia.

Management is supportive and officially involves immediate discontinuation of the product, aggressive hydration with intravenous fluids, and frequent monitoring of serum calcium levels.

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Therapeutic Uses of Citracal Max

Main Uses and Benefits of Citracal Max

Citracal Maximum Plus is generally used in situations involving certain distressing symptoms related to systemic mineral imbalance. This product is applied across domains where additional symptomatic support is needed, and is considered relevant for managing conditions where supplemental nutrient intake may be helpful.

Targeted Support for Bone and Stability

This supplement contributes to supporting bone structure and stability. The intake of calcium is relevant to supporting bone stability. It is relevant in contexts where additional symptomatic support for bone density is needed, helping to ease the overall symptom burden. It is relevant for managing conditions marked by periods of increased physiological stress where supportive symptom management is appropriate.

“This supplement supports the patient during difficult episodes, helping to maintain a sense of stability when symptoms become more noticeable.”

Addressing Symptom Groups of Mineral Deficiency

Citracal Max is applied across domains to address symptom clusters related to systemic imbalance. It is considered relevant for easing symptoms that may become more disruptive during flare-ups or when conditions are marked by temporary physiological imbalance. This approach supports general well-being during symptomatic phases.

Quick Fact:
Used for: Symptomatic domains related to mineral imbalance
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Eligibility and Restrictions for Use

Who can and cannot use Citracal Max? (Official Eligibility)

Official eligibility for this product is based on regulatory standards for combination mineral and Vitamin D supplements, defining populations for whom use is prohibited or restricted.

Classification Rule from Regulatory Data
Absolute Contraindications Use is prohibited in patients with pre-existing Hypercalcemia (high blood calcium levels) or Hypervitaminosis D (Vitamin D toxicity). Use is also contraindicated in individuals with a known allergy or hypersensitivity to any of the product's ingredients.
Conditional/Restricted Use Professional consultation is required for patients with kidney stones, existing kidney disease, or a parathyroid gland disorder, as these conditions affect the body's ability to manage calcium. Individuals with Sarcoidosis or certain cardiac conditions are also classified for conditional use.
Age-Related Eligibility General eligibility is established for Adults and Children 12 years of age and older. Use in younger children is not typically specified in over-the-counter labeling and must be guided by a healthcare professional.
Pregnancy/Lactation Status Use during pregnancy and breastfeeding is categorized as restricted and requires mandatory consultation with a physician due to the potential for the ingredients to distribute to the fetus or infant.
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What should I know about interactions with other medicines?

Interactions with other medicines and products

Citracal Max, which contains calcium citrate and Vitamin D, can interact with various prescription and non-prescription medicines. The primary interaction mechanism is the ability of calcium to bind with certain drugs in the gastrointestinal tract, which can reduce the absorption and effectiveness of those medications.

Time-separation of doses is a critical strategy to manage these interactions. It is often necessary to take certain interacting medicines two to six hours apart from this calcium supplement.

Medicines and Classes of Concern:

  • Antibiotics: Calcium can decrease the absorption of certain classes, including fluoroquinolones (e.g., ciprofloxacin) and tetracyclines, reducing their effectiveness against infection.
  • Thyroid Hormones: Absorption of levothyroxine, a common thyroid medication, can be reduced, potentially leading to inadequate hormone levels.
  • Bisphosphonates: The absorption of oral bisphosphonates (e.g., alendronate), used to treat osteoporosis, may be impaired.
  • Diuretics: Thiazide diuretics (e.g., hydrochlorothiazide) can decrease the excretion of calcium by the kidneys. Concomitant use with the supplement may increase the risk of developing excessive calcium levels in the blood (hypercalcemia).
  • Digoxin: Taking high doses of calcium or Vitamin D may increase the risk of heart rhythm problems in individuals taking digoxin, a cardiac medication.
  • Anticonvulsants: Certain seizure medications, such as phenytoin, can affect the body's metabolism of Vitamin D, potentially requiring adjustments.
  • Iron Supplements and Certain HIV Integrase Inhibitors (e.g., dolutegravir): Calcium may reduce the absorption of these agents, requiring a substantial separation in dosing time.

Patients should avoid taking other non-prescription supplements containing calcium, Vitamin D, phosphorus, or magnesium, including antacids, unless specifically advised, due to the risk of excessive mineral intake.

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Mechanism of Action

The Pharmacodynamic Mechanism of Citracal Max

Citracal Max functions by elevating the systemic concentration of the calcium ion (Ca^2+) and modulating its homeostatic pathways via cholecalciferol (Vitamin D3). Calcium citrate dissociates in the gastrointestinal lumen, releasing Ca^2+ for passive diffusion and active transport across the enterocytes of the small intestine. This process increases the concentration of circulating Ca^2+ in the plasma and extracellular fluid, with a subsequent distribution to the bone matrix, where Ca^2+ integrates into the hydroxyapatite structure to contribute to the mineral phase.

Cholecalciferol is an inactive sterol that undergoes sequential hydroxylation in the liver and kidney, catalyzed by the enzymes CYP2R1 and CYP27B1, respectively, to yield the active hormone, calcitriol (1,25(OH)2D3). Calcitriol acts as an agonist for the nuclear Vitamin D Receptor (VDR), forming a heterodimer with the Retinoid X Receptor (RXR). This complex translocates to the nucleus and binds to Vitamin D Response Elements (VDREs) on target genes, primarily in the intestine. This genomic mechanism upregulates the transcription of proteins involved in Ca^2+ absorption, including the TRPV6 calcium channel and the calbindin-D9k transport protein, thereby enhancing the overall intestinal flux of Ca^2+ into the circulation. The combined action provides Ca^2+ substrate for skeletal tissue integration and modulates systemic calcium balance, influencing the release of parathyroid hormone (PTH) via its agonism at the extracellular calcium-sensing receptor (CaSR) on parathyroid cells, which is part of the systemic feedback loop.

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Dosage and Administration Information

Administration Overview

Citracal Max is an oral calcium supplement typically taken with or without food. Because it contains calcium citrate, it does not require stomach acid for absorption, offering flexibility in timing compared to other forms of calcium.

Optimization of Absorption

The body has a limited capacity to absorb calcium at one time. For individuals requiring higher daily amounts, the total intake is often divided into smaller portions throughout the day to maximize bioavailability.

Usage Considerations

  • Hydration: It is common practice to take the supplement with a full glass of water.
  • Consistency: Maintaining a regular schedule helps ensure a steady intake of the mineral.
  • Formulation Types: This supplement may be available in different formats, such as tablets or caplets. The choice of format may depend on individual preference for swallowing ease.

Interaction Awareness

Calcium can influence the absorption of various other substances, including certain minerals and specific types of medication. To prevent these interactions, the timing of this supplement is often adjusted so that it is not taken simultaneously with other products.

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Recent Clinical Evidence

Research into the components of this supplement, Calcium Citrate and Dihydrotachysterol, has explored several contexts, focusing primarily on bone health and mineral balance. High-level study designs, such as Randomized Controlled Trials (RCTs), have been used to examine calcium and Vitamin D supplementation in older adults. Researchers monitored outcomes related to Bone Mineral Density (BMD) at the hip and spine, as well as changes in the rate of fractures over study periods typically lasting one to three years. Trials report measured differences in BMD levels between groups receiving the supplementation and those who did not, contributing to the broader evidence landscape for bone support.

The Dihydrotachysterol component has also been evaluated in specialized research related to systemic mineral imbalance. Studies explored its use in populations with chronic conditions like hypoparathyroidism or impaired mineral processing, examining outcomes related to achieving and maintaining stable serum calcium concentrations. The analogue was studied in the context of mineral balance, particularly in populations where kidney function was reduced. However, much of this foundational evidence is historical, and comparative evidence is lacking for how this specific analogue performs against newer vitamin D analogues in contemporary, large-scale studies.

For most applications, long-term effects are not fully established, and there is limited information regarding the durability of observed effects after supplementation is stopped. Furthermore, research on the effects of the specific Calcium Citrate and Dihydrotachysterol combination remains less extensive than general calcium and Vitamin D research, contributing to the overall uncertainty in the evidence base.

Key Studies & References

  1. Dihydrotachysterol Drug Label Information (DailyMed)
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Frequently Asked Questions (FAQ)

Common questions about Citracal Max (FAQ)


Q: Can elderly patients use Citracal Max?

A: The product is generally intended for use by adults, which includes the elderly population. Official guidance notes that conditions sometimes necessitate professional monitoring of calcium levels, as age-related factors like reduced kidney function can affect the body's ability to manage calcium.


Q: Is Citracal Max safe to take long-term?

A: Calcium and Vitamin D supplements are designated for long-term daily use to support sustained bone health. However, official safety documentation warns that chronic ingestion of high doses carries a rare risk of severe complications, including high blood calcium levels (hypercalcemia) and kidney stones.


Q: Can individuals with a history of heart problems take Citracal Max?

A: Official documentation indicates that the use of this supplement is conditional for patients with heart disease or cardiac arrhythmias. High doses, especially when combined with certain heart medications like cardiac glycosides (e.g., Digoxin), may increase the risk of heart rhythm problems.


Q: Is there a specific patient population that sees the most benefit from Citracal Max?

A: The supplement is indicated for individuals whose diets provide inadequate amounts of calcium and vitamin D. It is often used in the dietary management of low blood calcium and to support the reduction of risk related to bone loss (osteoporosis), especially in postmenopausal women.


Q: How does the citrate form of calcium in Citracal Max differ from carbonate?

A: The calcium citrate form is known to be efficiently absorbed in the body and does not require stomach acid for its uptake. This feature differentiates it from forms like calcium carbonate, which regulatory documents state must be taken with food to ensure adequate absorption.


Q: What happens if a person who should not take Citracal Max uses it?

A: Contraindications are conditions under which the product should not be used, such as pre-existing hypercalcemia or Vitamin D toxicity. Regulatory documents state that ignoring these restrictions risks exacerbating excessive calcium levels, which can lead to severe adverse effects including kidney stones or soft tissue calcification.


Q: Is the vitamin D in Citracal Max D2 or D3?

A: The product contains Dihydrotachysterol, which is a synthetic Vitamin D analogue. This analogue functions similarly to activated Vitamin D3 (cholecalciferol) but differs structurally and may not require the same activation step in the kidneys.


Q: What is the main difference between Citracal Max and a standard calcium supplement?

A: The formulation is distinguished by two primary components: the highly soluble calcium citrate and a specialized Vitamin D analogue (Dihydrotachysterol). This combination is often described as having high solubility and efficient absorption when compared to simpler calcium forms.


Q: How quickly does Citracal Max start working for its intended purpose?

A: The supplement’s goal of supporting bone mineral density and long-term mineral balance is achieved gradually over time with consistent use. Regulatory pharmacokinetics data on the Dihydrotachysterol analogue indicate a known rapid onset of action (peak effects within hours) compared to standard Vitamin D.


Q: If I accidentally take an extra tablet of Citracal Max, what happens?

A: Official information on overdose for high calcium/Vitamin D intake lists possible symptoms such as nausea, vomiting, headache, or increased thirst. In cases of suspected excessive intake, official guidelines indicate that emergency medical attention is required.


Q: Does Citracal Max contain any common allergens like gluten or soy?

A: The official product label lists the active ingredients and various inactive ingredients, such as binding and coating agents. While the label does not contain a mandatory specific allergen statement regarding gluten or soy, the full list of inactive ingredients is provided on the package.


Q: Why do official materials mention Citracal Max is for 'dietary management'?

A: This product is classified as a dietary supplement. This classification indicates that its function is to provide dietary support or nutritional supplementation to address inadequate intake, as opposed to being classified as a prescription drug intended to treat a specific disease.


Q: What ingredients besides the main ones are listed in Citracal Max?

A: In addition to the active ingredients (Calcium Citrate and Dihydrotachysterol), the regulatory label details various inactive ingredients. These often include pharmaceutical excipients like Croscarmellose Sodium and Polyethylene Glycol, which act as binding or coating agents, and coloring agents such as Titanium Dioxide.


Q: How does Citracal Max affect blood work results?

A: The supplement is intended to elevate serum calcium levels in the bloodstream. Chronic high-dose usage, or use in susceptible individuals, can result in elevated blood calcium (hypercalcemia). Official warnings note that this sometimes necessitates the periodic monitoring of serum calcium and phosphate concentrations.


Q: Is Citracal Max typically recommended alongside other therapies?

A: Calcium and Vitamin D supplementation is commonly used as an adjunct (or addition) to primary prescription therapies for conditions that affect bone health, such as osteoporosis. It may also be used in clinical practice alongside other therapies like phosphate binders for mineral management in certain chronic conditions.


Q: Are there common signs that Citracal Max is working?

A: The primary objective of the supplement is to increase bone mineral density and maintain systemic calcium balance. Regulatory information indicates these effects are typically measured via clinical tools, such as bone density scans or periodic monitoring of blood mineral levels, rather than immediate, observable patient signs.


Q: Does Citracal Max have any reported interactions with caffeine or alcohol?

A: Official information on related calcium products notes that chronic, excessive alcohol consumption can negatively affect bone health. While specific caffeine interactions are not always prominently listed, regulatory guidance suggests reviewing the product label for specific beverage warnings.


Q: Do people who take stomach acid reducers generally have better results with Citracal Max?

A: Regulatory information indicates that the calcium citrate formulation is often the preferred supplement for individuals taking stomach acid reducers. This is because calcium citrate does not require the presence of stomach acid to achieve adequate absorption.


Q: Are there any known drug-food interactions for Citracal Max?

A: Regulatory documents mention that certain food components may interfere with absorption. Specifically, high-fiber grains or specific minerals can potentially affect the uptake of calcium or the Dihydrotachysterol component. The official label provides details regarding specific food or beverage warnings.


Q: Can athletes or highly active people use Citracal Max?

A: The components of the product are relevant to active populations. Regulatory bodies emphasize the essential role of calcium in numerous bodily functions, including nerve function and muscle contraction, which are processes vital to maintaining the health of active individuals.

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How should Citracal Max be stored and disposed of?

Official Storage and Disposal Requirements

The storage and disposal guidelines for Citracal Max are based on standard regulatory mandates for over-the-counter supplements, ensuring product stability and environmental protection.

Storage Component Requirement
Temperature Store at controlled room temperature, typically 20 C to 25 C (68 F to 77 F).
Protection Keep the product protected from excessive heat, humidity, and moisture.
Container Integrity The product must be kept in its original container with the cap tightly closed.
Child Safety Store strictly out of the reach and sight of children.
Disposal Prioritize drug take-back programs or authorized collectors for unused or expired product.
Environmental Rule Disposal by flushing down the toilet or pouring down the drain is strictly prohibited.

Attention! Always consult to a doctor or pharmacist before using pills or medicines.

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