Calcium carbonate is a calcium supplement that is used in deficiency states and as an adjunct in the prevention and treatment of osteoporosis. Vitamin D3 is a fat-soluble sterol, it aids in the regulation of calcium and phosphate homeostasis and bone mineralisation.

Absorption
Calcium carbonate: About 15-25% gets absorbed in the GI tract. Converted to calcium chloride by gastric acid. Vitamin D: Well-absorbed in the GI tract in the presence of bile.

Metabolism
Vitamin D: Undergoes hydroxylation in the liver and kidney to form the active metabolite, 1,25-dihydrocolecalciferol.

Excretion
Vitamin D and metabolites are mainly excreted in the bile and faeces.

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Constipation, flatulence, nausea, abdominal pain and diarrhoea. Pruritus, rash and urticaria.

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Impaired calcium absorption in achlorhydria which is common in elderly. Increased risk of hypercalcaemia and hypercalciuria in hypoparathyroid patients receiving high doses of vitamin D. Caution when using in patients with history of kidney stones. Renal impairment; frequent monitoring of serum calcium and phosphorus is recommended.

May affect the absorption of tetracycline when used together. Concurrent use with systemic corticosteroids may reduce calcium absorption. Thiazide diuretics may decrease urinary excretion of calcium. Concurrent use with ion-exchange resins may reduce GI absorption of vitamin D. Hypercalcaemia may increase the toxicity of cardiac glycosides during treatment with calcium and vitamin D, monitor ECG and serum calcium levels. Bisphosphonate or sodium fluoride should be given at least 3 hours before calcium-containing preparations.

Food Interaction
Foods that are rich in oxalic acid (e.g. spinach and rhubarb) and phytic acid (e.g. whole cereals) may reduce calcium absorption by formation of insoluble calcium salts, thus calcium products should not be taken within 2 hr of eating such foods.

Oral
Supplementation of calcium and vitamin D3
Adult: As effervescent tablet containing calcium carbonate 1500 mg and vitamin D3 10 mcg: 1 tablet bid, to be dissolved in a glass of water and taken immediately. Dosing regimen may vary with brands and dosage forms.

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Patients with hypercalcaemia and/or hypercalciuria. Nephrolithiasis, hypervitaminosis D, hypophosphataemia.

Oral
Store below 25°C.

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