Usage
This combination medication is primarily prescribed to address nutritional deficiencies, particularly in conditions like osteomalacia, osteoporosis, rickets, and hypocalcemia. It’s also recommended during pregnancy and lactation to support both maternal and fetal health. It acts as a nutritional supplement.
Alternate Names
There are no officially recognized alternate names for this specific combination. However, the individual components are sometimes referred to by other names:
- Calcitriol: 1,25-dihydroxyvitamin D3
- Vitamin B6: Pyridoxine
- Methylcobalamin: Mecobalamin, Vitamin B12
- Folic Acid: Vitamin B9, Folate
Brand names for products containing this combination vary widely. Some examples include “Calorex-M”, “Coecoral Plus”, “Sarvacal Plus”, “Aditis Plus”, and “Airacal-M”.
How It Works
This combination works through the synergistic action of its components:
- Calcium Carbonate: Provides a supplemental source of calcium, essential for bone mineralization, muscle function, and nerve transmission.
- Calcitriol: The active form of vitamin D3, facilitates calcium and phosphorus absorption in the intestine, regulates calcium homeostasis, and contributes to bone health and cellular growth.
- Folic Acid: Essential for DNA synthesis, cell division, and red blood cell formation. It’s crucial for fetal development and preventing neural tube defects.
- Methylcobalamin: An active form of vitamin B12, plays a vital role in nerve function, red blood cell production, DNA synthesis, and bone metabolism.
- Vitamin B6: Involved in protein, fat, and carbohydrate metabolism, red blood cell formation, and neurotransmitter synthesis. Supports collagen formation and may alleviate pregnancy-related nausea.
Pharmacokinetics: Calcium carbonate absorption is influenced by vitamin D and various dietary factors. Calcitriol undergoes hepatic metabolism. Folic acid is absorbed in the small intestine. Methylcobalamin is absorbed via passive diffusion and active transport. Vitamin B6 is readily absorbed and metabolized in the liver. Elimination pathways vary for each component, involving both renal and hepatic routes.
Dosage
Dosage varies depending on the specific formulation and the patient’s individual needs. It’s crucial to consult a physician and refer to the specific product labeling.
Standard Dosage
Children: Dosage should be determined by a pediatrician, considering the child’s age, weight, and specific health conditions.
Special Cases:
- Elderly Patients: Dose adjustment may be necessary based on renal function.
- Patients with Renal Impairment: Dose reduction is usually required.
- Patients with Hepatic Dysfunction: Caution is advised, and monitoring is essential.
- Patients with Comorbid Conditions: Dosage must be adjusted based on coexisting medical conditions.
Clinical Use Cases
Dosage in specific clinical scenarios should be determined by the attending physician, considering the patient’s condition and response to therapy. There is no fixed dosage for use cases such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dosage adjustments are based on patient-specific factors, including renal and hepatic function, other medical conditions, and concomitant medications.
Side Effects
Common Side Effects:
Nausea, stomach upset, diarrhea, constipation, loss of appetite.
Rare but Serious Side Effects:
Hypercalcemia, allergic reactions, sensory neuropathy (with high doses of vitamin B6).
Long-Term Effects:
Potential for renal calculi with chronic excessive calcium intake. Sensory neuropathy with prolonged high doses of vitamin B6.
Adverse Drug Reactions (ADR):
Severe allergic reactions (rare), hypercalcemic crisis.
Contraindications
Hypersensitivity to any component, hypercalcemia, hypervitaminosis D, severe renal impairment, untreated vitamin B12 deficiency anemia, certain types of anemia.
Drug Interactions
Antacids, certain antibiotics, bisphosphonates, levothyroxine, anticonvulsants, folate antagonists (methotrexate), proton pump inhibitors, H2 blockers, drugs affecting bile acid metabolism, some diabetes medications.
Pregnancy and Breastfeeding
Generally considered safe at recommended doses during pregnancy and breastfeeding. However, consultation with a physician is essential. High doses of vitamin B6 during pregnancy can potentially cause seizures in newborns.
Drug Profile Summary
- Mechanism of Action: Synergistic action of components to address nutritional deficiencies, support bone health, and promote overall well-being.
- Side Effects: Nausea, stomach upset, diarrhea, constipation, hypercalcemia (rare).
- Contraindications: Hypersensitivity, hypercalcemia, hypervitaminosis D, severe renal impairment.
- Drug Interactions: Antacids, antibiotics, bisphosphonates, levothyroxine, anticonvulsants.
- Pregnancy & Breastfeeding: Consult a physician.
- Dosage: Varies; consult a physician.
- Monitoring Parameters: Serum calcium, vitamin D levels, renal function tests.
Popular Combinations
This combination itself is a commonly used formulation. Individual components may be combined with other medications as needed.
Precautions
Pre-screening for allergies and relevant medical conditions (renal/hepatic disease, etc.). Caution in patients with a history of renal calculi. Monitor serum calcium and vitamin D levels, especially during initial therapy. Avoid excessive alcohol intake.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for this combination?
A: Dosage varies significantly depending on the specific product and patient needs. Consult a physician for guidance.
Q2: Can this combination be used during pregnancy?
A: Generally considered safe, but physician consultation is crucial.
Q3: What are the common side effects?
A: Nausea, stomach upset, and diarrhea are common side effects.
Q4: Are there any serious side effects?
A: Rarely, hypercalcemia and allergic reactions may occur.
Q5: What are the contraindications for this combination?
A: Hypersensitivity, hypercalcemia, hypervitaminosis D, severe renal impairment.
Q6: Does this combination interact with other medications?
A: Yes, it can interact with antacids, antibiotics, bisphosphonates, and other medications.
Q7: What are the monitoring parameters for this combination?
A: Serum calcium, vitamin D levels, and renal function tests should be monitored.
Q8: What precautions should be taken while using this combination?
A: Patients with pre-existing medical conditions should consult their doctor. Pregnant and breastfeeding women should also seek medical advice. Avoid concomitant use with antacids, and limit alcohol consumption.
Q9: How should this combination be stored?
A: Store at room temperature away from moisture and direct sunlight.
Q10: Can this combination be used in children?
A: Dosage in children should be determined by a pediatrician.
