Usage
This combination medication is primarily prescribed as a nutritional supplement to address deficiencies in vitamin D, calcium, magnesium, and zinc. It particularly supports bone health. It may be prescribed for conditions like:
- Osteoporosis: Reduces bone loss and fracture risk, especially in postmenopausal women.
- Osteomalacia: Treats softening of the bones due to vitamin D deficiency.
- Hypoparathyroidism: Addresses low parathyroid hormone levels leading to hypocalcemia.
- Renal Osteodystrophy: Manages bone disease associated with chronic kidney disease.
Pharmacological Classification: Nutritional Supplement, Vitamin & Mineral Supplement
Mechanism of Action: The components work synergistically to support bone health and mineral balance. Calcitriol, the active form of vitamin D3, enhances calcium and phosphorus absorption from the gut and regulates parathyroid hormone. Calcium is essential for bone mineralization. Magnesium oxide contributes to bone health and supports vitamin D activation. Zinc oxide is involved in bone formation and immune function.
Alternate Names
This combination doesn’t have a universally recognized international non-proprietary name (INN). It’s marketed under various brand names (e.g., CALCIVA, Acro D3 Strong, Bonbeat CT). It’s sometimes referred to as a Calcium-Magnesium-Zinc-Vitamin D combination.
How It Works
Pharmacodynamics: Calcitriol regulates calcium and phosphorus homeostasis. Calcium and magnesium are essential for bone mineralization, neuromuscular function, and enzymatic reactions. Zinc contributes to immune function and cell growth.
Pharmacokinetics:
- Absorption: Calcitriol is readily absorbed from the gut, and vitamin D enhances calcium absorption. Magnesium and zinc absorption are affected by various dietary factors.
- Metabolism: Calcitriol is metabolized in the liver and kidneys.
- Elimination: Calcitriol and magnesium are primarily excreted renally, while zinc is mainly excreted in feces.
Mode of Action: Calcitriol binds to vitamin D receptors, influencing gene transcription related to calcium and phosphorus transport. Calcium, magnesium, and zinc act as cofactors in various enzymatic processes.
Dosage
Dosage depends on individual patient needs and the specific product formulation. Consult product labeling and a healthcare professional.
Standard Dosage
Adults: Dosage varies widely; one or two capsules/tablets daily with meals is common.
Children: Dosage must be determined by a pediatrician based on age, weight, and condition.
Special Cases:
- Elderly Patients: Start with a lower dose due to potential age-related changes in organ function.
- Patients with Renal Impairment: Dosage adjustments are crucial, requiring careful monitoring of serum calcium, phosphorus, magnesium, and creatinine.
- Patients with Hepatic Dysfunction: Caution is advised.
- Patients with Comorbid Conditions: Consider interactions with other medications and existing conditions.
Clinical Use Cases
Dosages in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU use, and emergencies should be determined based on the patient’s specific needs and condition. The combination may not be specifically indicated in these acute scenarios. Individual components may be administered separately as needed.
Dosage Adjustments
Adjustments are necessary based on renal/hepatic function, other medical conditions, and drug interactions. Monitor serum calcium, phosphorus, and magnesium levels closely.
Side Effects
Common Side Effects:
- Gastrointestinal upset (constipation, diarrhea, nausea, vomiting)
- Headache
- Dizziness
Rare but Serious Side Effects:
- Hypercalcemia (high blood calcium)
- Hypermagnesemia (high blood magnesium)
Long-Term Effects: Chronic hypercalcemia can lead to nephrocalcinosis and other soft-tissue calcification.
Contraindications
- Hypercalcemia
- Hypermagnesemia
- Hypervitaminosis D
- Hypersensitivity to any component
- Kidney stones (in some cases)
Drug Interactions
- Thiazide diuretics
- Tetracycline and quinolone antibiotics
- Bisphosphonates
- Digoxin
- Phosphate binders
- Iron supplements
- Other vitamin D supplements
- Foods high in calcium, phosphate, or vitamin D
Pregnancy and Breastfeeding
Consult a healthcare provider before use during pregnancy and breastfeeding. While generally considered safe, potential effects on the fetus and transfer into breast milk warrant careful evaluation.
Drug Profile Summary (See respective sections for details)
Popular Combinations
This combination itself is a common formulation. Additional combinations with vitamin K2 are also available.
Precautions
- Monitor serum levels of calcium, phosphorus, and magnesium.
- Assess renal and hepatic function.
- Caution in patients with cardiovascular disease.
- Limit alcohol intake.
FAQs
Q1: What is the recommended dosage for Calcitriol + Calcium + Magnesium Oxide + Zinc Oxide?
A: There’s no single recommended dosage. It varies with the specific product, patient age, and underlying conditions. Always consult a healthcare provider or refer to product labeling.
Q2: Can this combination be used in children?
A: It can be used, but the dosage must be determined by a pediatrician.
Q3: What are the most common side effects?
A: Common side effects include gastrointestinal issues like constipation, diarrhea, nausea, and vomiting, as well as headache and dizziness.
Q4: Are there any serious side effects?
A: Yes, though rare, serious side effects can include hypercalcemia and hypermagnesemia. These require immediate medical attention.
Q5: Can pregnant or breastfeeding women take this medication?
A: Consult with a healthcare provider before use during pregnancy or breastfeeding.
Q6: What should I do if I miss a dose?
A: Take the missed dose as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose to catch up.
Q7: Does this medication interact with any foods?
A: Yes, this medication can interact with foods rich in calcium, phosphate, or vitamin D. Your doctor may recommend dietary adjustments. Avoid foods like spinach, rhubarb, bran, and whole grains, which can decrease calcium absorption.
Q8: What should I do in case of an overdose?
A: Seek immediate medical attention or contact a poison control center.
Q9: How should I store this medication?
A: Store in a cool, dry place away from direct sunlight and out of reach of children.
Q10: Does this combination have any other names?
A: It does not have an official INN and is marketed under various brand names. It is sometimes referred to as a “calcium-magnesium-zinc-vitamin D combination”.
