Usage
This combination medication is primarily prescribed as a nutritional supplement to address deficiencies in calcium, vitamin D, and other essential nutrients. It’s commonly used to support bone health, particularly in conditions like osteoporosis, osteomalacia, and rickets. Additionally, it may be used to promote overall health and well-being, particularly regarding nervous system function, red blood cell production, and immune system regulation. It is not typically used in acute clinical settings. This combination belongs to the pharmacological class of vitamin and mineral supplements.
The mechanism of action involves the synergistic effects of its individual components: Calcitriol enhances calcium absorption and bone mineralization; Calcium Carbonate provides a source of calcium; Magnesium supports calcium absorption and bone formation; Methylcobalamin supports nerve function; Vitamin K2-7 directs calcium to bones; and Zinc contributes to bone formation and overall health.
Alternate Names
There is no single official international nonproprietary name (INN) for this combination product as it comprises multiple ingredients. Variations may exist depending on the specific formulation. Several brand names are available, including (but not limited to): Betercal K2 7, Matical-K2 7 Plus, DCOL-K2, Calfirm K2-7, Casbon-K Plus, and Shinepath. Regional variations in names may also exist.
How It Works
Pharmacodynamics: The combination’s effect on the body is a result of each component’s individual action. Calcitriol acts on vitamin D receptors to regulate calcium and phosphate homeostasis. Calcium Carbonate provides a calcium source, vital for bone structure, muscle function, and nerve transmission. Magnesium acts as a cofactor in various enzymatic reactions involved in bone metabolism. Methylcobalamin is crucial for nerve function and red blood cell production. Vitamin K2-7 activates osteocalcin and matrix GLA protein, proteins involved in bone mineralization. Zinc contributes to bone formation and immune function.
Pharmacokinetics: Calcitriol is absorbed in the gut and hydroxylated in the liver and kidneys to its active form. Calcium Carbonate’s absorption is influenced by vitamin D and other dietary factors. Magnesium is absorbed in the small intestine. Methylcobalamin absorption involves binding to intrinsic factor. Vitamin K2-7 is absorbed with dietary fats. Zinc is absorbed in the small intestine. Elimination pathways vary; calcitriol and its metabolites are mainly excreted in bile, calcium primarily through feces, magnesium through urine, methylcobalamin through urine and bile, vitamin K2-7 via biliary excretion, and zinc mainly through feces.
Dosage
Dosage is individualized based on patient-specific needs and the specific formulation of the supplement. Consultation with a physician is crucial for precise dosing instructions.
Standard Dosage
Adults:
A common regimen is one capsule/tablet daily, taken orally with a meal. Formulations vary, so always check the specific product instructions.
Children:
Dosage should be determined by a pediatrician based on age, weight, and specific needs.
Special Cases:
- Elderly Patients: Dose adjustments may be necessary due to age-related changes in renal function and other health conditions.
- Patients with Renal Impairment: Calcitriol dosage requires careful adjustment based on the degree of impairment. Close monitoring of calcium and phosphate levels is essential.
- Patients with Hepatic Dysfunction: Monitoring is advisable, though significant adjustments may not be required.
- Patients with Comorbid Conditions: Individualized dosing is necessary, considering specific conditions such as hypercalcemia or hyperparathyroidism.
Clinical Use Cases
This combination is not typically used in acute clinical settings (intubation, surgical procedures, mechanical ventilation, ICU use, emergency situations). Individual components may be used separately in such settings.
Dosage Adjustments
Adjustments are based on patient-specific factors (renal/hepatic dysfunction, metabolic disorders). Close monitoring of calcium, phosphate, and vitamin D levels is essential, particularly in renal impairment.
Side Effects
Common Side Effects:
Gastrointestinal issues (constipation, diarrhea, gas, nausea, stomach upset) are possible. Hypercalcemia can occur if excessive doses are taken.
Rare but Serious Side Effects:
Allergic reactions, kidney stones (with prolonged high doses), cardiac arrhythmias (in cases of severe hypercalcemia) are potential concerns.
Long-Term Effects:
Chronic high doses could lead to kidney problems or soft tissue calcification.
Adverse Drug Reactions (ADR):
Severe hypercalcemia can cause significant ADRs like confusion, fatigue, nausea, vomiting, cardiac arrhythmias, and coma.
Contraindications
- Hypercalcemia, hypervitaminosis D, hypersensitivity to any component, severe renal impairment.
- Conditions like sarcoidosis, hyperparathyroidism.
Drug Interactions
- Thiazide diuretics, digoxin, bisphosphonates, some antibiotics (tetracyclines, quinolones), antacids containing aluminum or magnesium, corticosteroids.
- These interactions can affect the absorption or metabolism of the components.
Pregnancy and Breastfeeding
Consult a physician. While generally considered safe in recommended doses, excessive vitamin D or calcium can have adverse effects.
Drug Profile Summary
- Mechanism of Action: Synergistic action of components to supplement nutrients and support bone health.
- Side Effects: Gastrointestinal issues, hypercalcemia (with high doses).
- Contraindications: Hypercalcemia, hypervitaminosis D, severe renal impairment.
- Drug Interactions: Thiazide diuretics, digoxin, antacids, some antibiotics.
- Pregnancy & Breastfeeding: Consult a physician.
- Dosage: One capsule/tablet daily (adult standard), individualized based on patient needs.
- Monitoring Parameters: Calcium, phosphate, vitamin D levels (especially in renal impairment).
Popular Combinations
Often combined with other vitamins and minerals (e.g., vitamin B complex, other trace minerals) for comprehensive nutritional support.
Precautions
- Monitor calcium, phosphate, and vitamin D levels.
- Caution in patients with kidney stones, hyperparathyroidism, sarcoidosis.
- Adequate hydration is essential.
- Avoid excessive intake of calcium and vitamin D from other sources.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage?
A: Dosage should be individualized. A typical starting dose for adults might be one capsule/tablet daily with a meal. Pediatric and special population dosing needs specific guidance.
Q2: Can this be used in patients with a history of kidney stones?
A: Use cautiously with close monitoring of calcium levels and adequate hydration. Consult a nephrologist/urologist.
Q3: Are there any specific drug interactions?
A: Yes, potential interactions exist with thiazide diuretics, some antibiotics, antacids, corticosteroids.
Q4: Can pregnant or breastfeeding women take this combination?
A: Consult a physician. Avoid excessive vitamin D or calcium.
Q5: What are the signs of hypercalcemia?
A: Nausea, vomiting, constipation, increased thirst, increased urination, confusion, lethargy.
Q6: What is the role of each ingredient in this combination?
A: Calcitriol enhances calcium absorption, Calcium Carbonate provides calcium, Magnesium supports calcium and bone metabolism, Methylcobalamin supports nerve function, Vitamin K2-7 directs calcium to bones, and Zinc supports bone formation and overall health.
Q7: What should patients be advised regarding lifestyle?
A: Maintain adequate hydration, avoid excessive calcium intake from other sources unless advised by a physician, follow a balanced diet, and inform healthcare providers of all medications and supplements being taken.
Q8: What are the long-term effects of taking this combination?
A: Long-term use at appropriate doses is generally safe. However, chronic high doses could lead to hypercalcemia and related complications such as kidney stones or soft tissue calcification. Regular monitoring is important for long-term use.
Q9: What should I do if a patient misses a dose?
A: They should take the missed dose as soon as they remember, unless it’s close to the time for the next dose. In that case, skip the missed dose and continue with the regular schedule. Do not double the dose to catch up.
