Calcitriol + Calcium Citrate Malate + Magnesium Oxide + Zinc Oxide

Usage

This combination medication is primarily prescribed for the management and prevention of deficiencies in vitamin D, calcium, magnesium, and zinc. It is classified as a dietary supplement and is particularly beneficial for supporting bone health, reducing the risk of fractures (especially in elderly individuals), preventing bone loss in postmenopausal women, and providing nutritional support for those with inadequate dietary intake of these essential nutrients. It may also be used to treat certain skin conditions such as acne and eczema, support immune function, and in cases of hypocalcemia.

Alternate Names

There are no officially recognized alternate names for this specific combination. However, different manufacturers market this combination under various brand names, some of which include: Calciva, Jocure C, Calfirm Plus, Bonprime-CT, Calcirich-CZ, and others. The individual components have their own respective chemical names and classifications.

How It Works

Pharmacodynamics:

• Calcitriol: The active form of vitamin D3, calcitriol, binds to vitamin D receptors in the intestines, increasing the absorption of calcium and phosphorus. It also regulates parathyroid hormone production, crucial for maintaining calcium and phosphorus balance and supporting bone mineralization.

• Calcium Citrate Malate: This form of calcium is readily absorbed and utilized by the body. Calcium is vital for maintaining bone mass, density, and strength, reducing the risk of osteoporosis and fractures.

• Magnesium Oxide: Magnesium is another essential mineral for bone health, involved in bone mineralization and crystal formation. It also helps activate vitamin D, promoting calcium absorption.

• Zinc Oxide: Zinc plays a crucial role in stimulating bone-building cells (osteoblasts) and collagen synthesis, further supporting bone and connective tissue health. Zinc also enhances immune system function.

Pharmacokinetics:

• Absorption: Calcitriol is absorbed in the small intestine. Calcium citrate malate is also absorbed in the small intestine, but absorption can be influenced by factors like the presence of food and other medications. Magnesium is absorbed primarily in the small intestine and the colon. Zinc is absorbed primarily in the small intestine.

• Metabolism: Calcitriol undergoes further metabolism in the liver and kidneys. The other components are not significantly metabolized in the same way as drugs.

• Elimination: Calcitriol metabolites are primarily excreted in bile and feces, with a small portion in urine. Excess calcium is excreted through the kidneys and intestines. Magnesium is primarily excreted in the urine. Zinc is primarily excreted in feces.

Dosage

Dosage can vary depending on individual patient needs and the specific product formulation. Always consult the product’s packaging and a healthcare professional for specific dosage instructions.

Standard Dosage

Adults:

The typical adult dosage is one capsule or tablet daily, usually taken with food to enhance absorption. Some formulations may recommend two capsules/tablets daily.

Children:

Dosage for children should be determined by a pediatrician, considering the child’s age, weight, and specific needs.

Special Cases:

• Elderly Patients: Dosages might be adjusted based on kidney function, considering the potential for decreased clearance in older adults.

• Patients with Renal Impairment: Careful dose adjustments and monitoring are crucial for patients with renal impairment due to the increased risk of hypercalcemia and other complications.

• Patients with Hepatic Dysfunction: Caution should be exercised in patients with liver conditions.

• Patients with Comorbid Conditions: If a patient has conditions like cardiovascular disease, diabetes, hypercalcemia, hypercalciuria, hypermagnesemia, malabsorption syndromes or kidney stones, the doctor should be informed for suitable dosage recommendations.

Clinical Use Cases

The use of this supplement in specific clinical scenarios like intubation, surgical procedures, mechanical ventilation, ICU use, and emergency situations is not routinely indicated. Its primary purpose is to supplement dietary intake of vitamins and minerals to support bone health and overall wellbeing, not for acute medical interventions.

Dosage Adjustments

Dosage should be adjusted based on factors like renal function, existing medical conditions, and concurrent medications. Regular monitoring of serum calcium, phosphorus, magnesium, and creatinine levels may be necessary, especially in patients with renal impairment.

Side Effects

Common Side Effects:

Gastrointestinal issues like stomach upset, nausea, vomiting, constipation, diarrhea, bloating, loss of appetite, metallic taste in mouth, headache, dizziness.

Rare but Serious Side Effects:

Hypercalcemia (high blood calcium levels), signs of kidney problems (changes in urine output), weakness, unusual weight loss, mental/mood changes, muscle pain, headache, bone/muscle pain. Seek immediate medical attention if such side effects occur.

Long-Term Effects:

Long-term effects are generally minimal when taken as directed. However, prolonged high doses could potentially lead to hypercalcemia and related complications.

Adverse Drug Reactions (ADR):

Serious ADRs include hypercalcemia and renal complications, which require immediate medical attention.

Contraindications

• Hypercalcemia
• Hypercalciuria
• Hypermagnesemia
• Hypervitaminosis D
• Known hypersensitivity to any of the ingredients
• Metastatic calcification
• Kidney stones
• Certain bowel diseases
• Sarcoidosis

Drug Interactions

This combination may interact with certain medications, including:

• Thiazide diuretics (e.g., hydrochlorothiazide)
• Antibiotics (e.g., tetracycline, quinolone antibiotics like doxycycline, ciprofloxacin, levofloxacin)
• Bisphosphonates (e.g., alendronate)
• Thyroid hormone (levothyroxine)
• Antifungals (ketoconazole)
• Cholesterol-lowering medications (cholestyramine)
• Iron supplements
• Antacids
• Digoxin
• Steroids
• Anticonvulsants

It’s essential to inform your doctor about all medications, supplements, and herbal products being taken.

Interactions with food can also occur. For instance, spinach, rhubarb, bran, and whole grains may reduce calcium absorption. Alcohol and caffeine can also inhibit calcium absorption.

Pregnancy and Breastfeeding

Pregnant and breastfeeding women should consult their doctor before taking this combination. While generally considered safe when taken in recommended doses, higher doses of vitamin D may pose risks to the fetus. Calcitriol can be excreted in breast milk, so caution is advised.

Drug Profile Summary

• Mechanism of Action: Enhances calcium and phosphorus absorption, supports bone mineralization, and provides essential nutrients for bone and overall health.
• Side Effects: Primarily gastrointestinal issues; rarely, hypercalcemia.
• Contraindications: Hypercalcemia, hypermagnesemia, hypersensitivity to ingredients.
• Drug Interactions: Several drug interactions; see detailed section above.
• Pregnancy & Breastfeeding: Consult a doctor before use.
• Dosage: Typically one capsule or tablet daily with food; varies based on individual needs and product.
• Monitoring Parameters: Serum calcium, phosphorus, magnesium, creatinine (as needed).

Popular Combinations

This combination itself is commonly formulated. Additional combinations with Vitamin K2 are also available.

Precautions

• Monitor serum calcium, phosphorus, and magnesium levels.
• Assess renal and hepatic function prior to and during treatment.
• Exercise caution in patients with cardiovascular disease.
• Limit alcohol and caffeine intake as they can affect calcium absorption.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Calcitriol + Calcium Citrate Malate + Magnesium Oxide + Zinc Oxide?

A: The usual adult dose is one capsule or tablet daily, often with food. However, it is crucial to check the specific product labeling and consult a physician for individualized dosage recommendations. Dosages may vary for children, elderly patients, and those with underlying health conditions.

Q2: Can this combination be taken during pregnancy or breastfeeding?

A: Pregnant or breastfeeding women should consult their doctor before use.

Q3: What are the common side effects?

A: The most common side effects involve the gastrointestinal system and include stomach upset, nausea, vomiting, constipation, or diarrhea.

Q4: Are there any serious side effects?

A: While rare, a potential serious side effect is hypercalcemia (high blood calcium levels). Symptoms of hypercalcemia can include excessive thirst, frequent urination, constipation, nausea, vomiting, muscle weakness, bone pain, and confusion. If any of these occur, consult a physician immediately.

Q5: What should I do if I miss a dose?

A: If you miss a dose, take it as soon as you remember. However, if it’s almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose to catch up.

Q6: Can I take this supplement with other medications?

A: It’s crucial to inform your doctor about all other medications you are taking, including prescription drugs, over-the-counter medications, and herbal supplements, as some may interact with this combination.

Q7: How should this supplement be stored?

A: Store it in a cool, dry place away from direct sunlight and moisture. Keep out of the reach of children.

Q8: Does this supplement interact with food?

A: Yes, some foods like spinach, rhubarb, bran, and whole grains can reduce calcium absorption. It is best to discuss dietary considerations with a physician or registered dietitian while taking this supplement. Alcohol and caffeine should also be limited.

Q9: Is this combination a steroid?

A: No, this combination is not a steroid. It is a combination of a vitamin (Vitamin D3 in its active form), minerals, and other nutrients essential for bone health and general wellbeing.

Q10: What conditions does this supplement treat other than deficiencies?

A: It can be used to support bone health, reduce the risk of fractures and osteoporosis, particularly in postmenopausal women. Some studies suggest it may also have benefits for skin health and immune function. However, it’s best to consult with a physician about specific conditions and whether this supplement is appropriate.