Usage
This combination is prescribed for the management and prevention of deficiencies in vitamin D, calcium, and zinc. It is primarily used to treat conditions like:
- Osteoporosis: A condition characterized by weak and brittle bones.
- Osteomalacia/Rickets: Softening of the bones due to vitamin D deficiency.
- Hypoparathyroidism: A condition in which the parathyroid glands do not produce enough parathyroid hormone, leading to low calcium levels.
- Calcium and Vitamin D deficiency: Conditions resulting from inadequate intake or absorption of calcium and vitamin D.
- Postmenopausal osteoporosis: Bone loss occurring in women after menopause.
This combination falls under the pharmacological classification of nutritional supplements and vitamins.
The mechanism of action involves the synergistic effects of the three components: calcitriol increases calcium absorption in the gut, calcium citrate provides a readily absorbable source of calcium for bone mineralization, and zinc sulfate supports bone formation and mineralization.
Alternate Names
There are no officially recognized alternate names for this specific combination. However, the individual components have various names. Calcitriol is sometimes referred to as 1,25-dihydroxyvitamin D3. Calcium citrate is a form of calcium, and zinc sulfate monohydrate is a hydrated form of zinc sulfate. This combination often appears under various brand names depending on the manufacturer. Some example brand names (as per the sources) are Calciva, Gemcal, Vahgem-C, and Calcirix Softgel. More brand names likely exist.
How It Works
Pharmacodynamics: Calcitriol, the active form of vitamin D, binds to vitamin D receptors in the intestines, kidneys, and bones. This promotes calcium absorption from the gut, reduces calcium loss from the kidneys, and facilitates bone mineralization. Calcium is essential for nerve and muscle function, blood clotting, and intracellular signaling. Zinc is a cofactor for numerous enzymes involved in bone formation and immune function.
Pharmacokinetics:
- Calcitriol: Absorbed from the gut, metabolized in the liver and kidneys, and excreted in bile and feces.
- Calcium Citrate: Absorbed from the small intestine, its absorption is enhanced by calcitriol. Excreted primarily through the kidneys.
- Zinc Sulfate: Absorbed in the small intestine, transported in the blood bound to proteins, and excreted mainly in feces.
Mode of Action: Calcitriol’s primary mode of action is through genomic mechanisms, involving binding to vitamin D receptors and modulating gene transcription related to calcium and phosphate homeostasis. Calcium acts as a second messenger in various cellular processes. Zinc plays a crucial role in enzyme activity and protein synthesis.
Elimination: Calcitriol is eliminated via hepatic and renal pathways. Calcium is primarily excreted renally. Zinc is primarily excreted through the feces.
Dosage
Standard Dosage
Adults: A common dosage is one capsule/tablet containing the combination once or twice daily. However, dosages vary significantly between brands and manufacturers.
Children: Dosage in children should be determined by a pediatrician based on age, weight, and the specific deficiency being addressed.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary based on kidney function.
- Patients with Renal Impairment: Careful dose adjustment and monitoring are required due to impaired calcitriol elimination.
- Patients with Hepatic Dysfunction: Caution is advised, although specific dose adjustments for hepatic impairment are not typically provided for this combination.
- Patients with Comorbid Conditions: Consider underlying medical conditions like hypercalcemia, hypercalciuria, and kidney stones, which may necessitate dose modifications or contraindicate the use of this combination.
Clinical Use Cases
The provided sources do not describe dosages specific to the below clinical situations. If this combination were to be employed (and this should always be directed by clinical judgement), dosage adjustments based on renal/hepatic function and ongoing electrolyte monitoring would be crucial.
- Intubation
- Surgical Procedures
- Mechanical Ventilation
- Intensive Care Unit (ICU) Use
- Emergency Situations
Dosage Adjustments
Dose modifications should be based on serum calcium, phosphate, and vitamin D levels. Renal and hepatic dysfunction should be taken into account.
Side Effects
Common Side Effects
Constipation, stomach upset, nausea, vomiting, headache, loss of appetite.
Rare but Serious Side Effects
Hypercalcemia (high blood calcium), hypercalciuria (high urine calcium), kidney stones.
Long-Term Effects
Potential for soft tissue calcification with chronic hypercalcemia.
Adverse Drug Reactions (ADR)
Allergic reactions (rash, itching, swelling).
Contraindications
Hypercalcemia, hypervitaminosis D, vitamin D toxicity, known hypersensitivity to any components, severe renal impairment, hyperparathyroidism.
Drug Interactions
Thiazide diuretics, digoxin, cholestyramine, bisphosphonates, quinolone antibiotics, tetracycline antibiotics, antacids containing aluminum, phenytoin, phenobarbital, ketoconazole.
Pregnancy and Breastfeeding
Consult a doctor before use during pregnancy and breastfeeding. Calcitriol can cross the placenta and may be present in breast milk. Excessive doses should be avoided.
Drug Profile Summary
- Mechanism of Action: Calcitriol enhances calcium and phosphate absorption, calcium provides structural support to bones, zinc supports bone formation.
- Side Effects: Constipation, nausea, stomach upset, headache, hypercalcemia.
- Contraindications: Hypercalcemia, vitamin D toxicity, hypersensitivity.
- Drug Interactions: Thiazide diuretics, digoxin, antacids, several antibiotics.
- Pregnancy & Breastfeeding: Consult a physician before use.
- Dosage: Varies by brand; typically one capsule/tablet once or twice daily for adults.
- Monitoring Parameters: Serum calcium, phosphate, vitamin D, and PTH levels.
Popular Combinations
Often combined with vitamin K2 and/or magnesium to enhance bone health.
Precautions
Monitor serum calcium, phosphate, vitamin D levels. Renal or hepatic impairment may require dosage adjustments. Monitor patients with a history of kidney stones. Avoid excessive alcohol intake.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcitriol + Calcium citrate + Zinc Sulphate Monohydrate?
A: Dosage varies depending on the specific product and patient factors. Consult the product’s packaging insert or a healthcare professional for guidance. One capsule/tablet once or twice a day is a common regimen in adults, but this should be determined and adjusted based on individual patient requirements.
Q2: What are the common side effects?
A: Common side effects include constipation, stomach upset, nausea, and headache.
Q3: Can this combination be used during pregnancy?
A: Consult a physician before using this combination during pregnancy or breastfeeding.
Q4: What are the contraindications for this drug?
A: Contraindications include hypercalcemia, hypervitaminosis D, and known hypersensitivity to any of the ingredients.
Q5: How does this combination interact with other medications?
A: This combination may interact with various medications, including thiazide diuretics, digoxin, certain antibiotics, and antacids. Provide a complete medication list to your healthcare provider to check for potential interactions.
Q6: What should be monitored while taking this combination?
A: Serum calcium, phosphate, and vitamin D levels should be monitored regularly, especially during initial therapy.
Q7: Can this combination be used in patients with kidney disease?
A: Patients with kidney disease require careful monitoring and dose adjustments as they are at increased risk of hypercalcemia and other complications.
Q8: What is the role of zinc in this combination?
A: Zinc contributes to bone mineralization and overall bone health.
Q9: How should this medication be stored?
A: Store at room temperature, away from moisture, heat, and direct sunlight.
Q10: Are there any dietary restrictions while using this medication?
A: Maintaining adequate hydration is essential, and excessive alcohol intake should be avoided. Specific dietary recommendations should be provided by a physician or dietician based on the individual’s health status and needs.
