Calcium Citrate + Calcitriol

Indications

Calcium Citrate + Calcitriol is used for: Calcium and vitamin D3 supplement, Osteoporosis, Post-menopausal osteoporosis, Secondary Hyperparathyroidism, Hypocalcaemia, Osteomalacia, Rickets, Renal osteodystrophy

Adult Dose

Adult: PO: 1-2 tablet twice daily.

Child Dose

Renal Dose

Administration

Contra Indications

Patients with hypercalcaemia, hypercalciuria or hypophosphatemia. Nephrolithiasis, hypervitaminosis D.

Precautions

Impaired calcium absorption in achlorhydria is common in the elderly. Increased risk of hypercalcemia and hypercalciuria in hypoparathyroid patients on high doses of vitamin D. History of kidney stones. Renal impairment. This medication should be used with caution in the following conditions malabsorption syndrome, heart disease, certain immune system disorders (sarcoidosis), liver disease, and certain bowel diseases (Crohn's disease).

Pregnancy-Lactation

Pregnancy category C.

Interactions

Reduced absorption of tetracyclines, quinolones and oral biphosphates with concurrent calcium use. Calcium absorption may be reduced by corticosteroids. Increased risk of hypercalcemia and metabolic alkalosis with thiazide diuretics. High blood calcium level may increase the effect of caridac glycosides. Reduced erlotinib efficacy with calcium. Increased risk of hypercalaemia with paricalcitol. Enzyme-inducing antiepileptics increases the metabolism of Vit D. Potentially Fatal: Fatal encephalopathy can occur in patients with renal failure when given calcium citrate and aluminium products concurrently due to marked rise in aluminium levelCalcium salt can be used in the prevention and treatment of calcium deficiency states or negative calcium balance. It is also used as an adjunct in the prevention and treatment of osteoporosis.

Adverse Effects

Side effects of Calcium Citrate + Calcitriol : Calcium Anorexia, Constipation, Flatulence, Nausea, Vomiting, Hypercalcemia, Hypophosphatemia, Xerostomia, Acid rebound, Milk-alkali syndrome, Coma, Confusion, Delirium, Headache, Lethargy. Calcitrol: Abdominal pain,Apathy,BUN and creatinine increased,Cardiac arrhythmia,Constipation,Dry mouth,Dehydration,Growth suppression,Headache,Hyperthermia,Hypercalcemia,Hypercholesteremia,Hypermagnesemia,Hyperphosphatemia,Hypertension,Libido decreased,Metallic taste,Muscle or bone pain,Nocturia,Pruritus,Psychosis,Somnolence,Weakness

Mechanism of Action

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. Calcium citrate is well absorbed on an empty stomach and does not constipate. Calcium citrate is less dependent on stomach acid for absorption. Calcitriol is the most active known form of vitamin D 3 in stimulating intestinal calcium transport. It is normally formed in the kidneys from its immediate precursor, 25-hydroxycholecalciferol. In physiological amounts it augments the intestinal absorption of calcium and phosphate and plays a significant part in the regulation of bone mineralization. The defective production of calcitriol in chronic renal failure contributes to the abnormalities of mineral metabolism found in that disorder. The biological effects of calcitriol are mediated by the vitamin D receptor, a nuclear hormone receptor expressed in most cell types and functioning as a ligand-activated transcription factor that binds to DNA sites to modify the expression of target genes. Oral administration of Calcitriol to patients with chronic renal failure compensates for impaired endogenous production of calcitriol which is decreased when the glomerular filtration rate falls below 30 ml/min. Consequently, intestinal malabsorption of calcium and phosphate and the resulting hypocalcemia are improved, thereby reversing the signs and symptoms of bone disease. In patients with established post-menopausal osteoporosis, Calcitriol increases calcium absorption, elevates circulating levels of calcitriol and reduces vertebral fracture frequency.