Usage
This combination medication is prescribed for the management and prevention of calcium and vitamin D deficiencies. It is also used in the treatment of conditions associated with low calcium levels, such as:
- Osteoporosis: A condition characterized by weakened and brittle bones.
- Osteomalacia/Rickets: Softening of the bones due to vitamin D deficiency.
- Hypoparathyroidism: A condition where the parathyroid glands do not produce enough parathyroid hormone, leading to low calcium levels.
- Latent Tetany: A muscle disease associated with low blood calcium.
- Secondary Hyperparathyroidism in Renal Dialysis Patients: High levels of parathyroid hormone due to impaired kidney function.
Pharmacological Classification: Vitamin and Mineral Supplement
Mechanism of Action: This combination works by supplementing the body with essential nutrients for bone health. Calcitriol (active form of vitamin D3) increases calcium absorption in the intestine and regulates calcium and phosphate levels in the blood. Calcium citrate malate provides a readily absorbable form of calcium for bone mineralization. Vitamin K2-7 (menaquinone-7) helps direct calcium towards the bones, improving bone density, and inhibits calcium deposition in blood vessels.
Alternate Names
There are no officially recognized alternate names. However, it may be referred to as Calcium + Calcitriol + Vitamin K2-7 or similar variations.
Brand Names: Several brand names exist for this combination, depending on the manufacturer and specific formulation (e.g., Avical, Calday-C, Bonetuf, Strongcal-CM, Vicavit K2-7, CELLOMAX K27, C-More K2, Glocal K2, ADITIS-K27, SHINEPATH, Calwart K2).
How It Works
Pharmacodynamics:
- Calcitriol: Binds to vitamin D receptors, increasing intestinal calcium absorption, regulating calcium and phosphate homeostasis, and promoting bone mineralization.
- Calcium Citrate Malate: Provides calcium ions for bone formation, nerve function, muscle contraction, and blood clotting.
- Vitamin K2-7: Activates osteocalcin (bone protein), promoting calcium binding in bone matrix, and inhibits matrix Gla protein, preventing vascular calcification.
Pharmacokinetics:
- Calcitriol: Absorbed from the intestine, metabolized in the liver and kidneys, and excreted in bile and urine.
- Calcium Citrate Malate: Absorbed from the intestine, influenced by vitamin D and dietary factors, and excreted in urine and feces.
- Vitamin K2-7: Absorbed from the intestine, metabolized in the liver, and excreted in bile and urine.
Receptor Binding: Calcitriol binds to vitamin D receptors.
Elimination Pathways: Primarily renal and hepatic excretion for all components.
Dosage
Dosage guidelines vary by product and patient condition. Consult a healthcare professional for personalized recommendations. The following is general information and should not be considered medical advice. This information is deemed accurate, but might change.
Standard Dosage
Children: Dosage should be determined by a pediatrician based on the child’s age, weight, and specific condition.
Special Cases: Dosage adjustments may be necessary based on individual patient factors, including:
- Elderly Patients: Monitor renal function and adjust dosage as needed.
- Patients with Renal Impairment: Lower doses may be required. Close monitoring of calcium and phosphate levels is essential.
- Patients with Hepatic Dysfunction: Careful monitoring is advised, and dosage adjustment may be necessary.
- Patients with Comorbid Conditions: Individualized dosage adjustments based on specific conditions like diabetes or cardiovascular disease.
Clinical Use Cases
Dosage in specific clinical settings should be determined by the attending physician based on the patient’s condition and response to therapy. There are no established standard dosages for this combination in these scenarios:
- Intubation
- Surgical Procedures
- Mechanical Ventilation
- Intensive Care Unit (ICU) Use
- Emergency Situations
Dosage Adjustments
Dose modifications are based on serum calcium, phosphate, creatinine, and PTH levels, as well as the patient’s clinical response.
Side Effects
Common Side Effects:
- Constipation
- Stomach upset
- Nausea
- Vomiting
- Loss of appetite
- Headache
- Weakness
- Fatigue
- Dry mouth
Rare but Serious Side Effects:
- Hypercalcemia (high calcium levels)
- Hypercalciuria (high calcium in urine)
- Kidney stones
- Cardiac arrhythmias
Long-Term Effects: Potential long-term effects include kidney stones and vascular calcification if not monitored closely.
Contraindications
- Hypercalcemia
- Hypervitaminosis D (high vitamin D levels)
- Hypercalciuria
- Metastatic calcification
- Severe renal impairment
- Hypersensitivity to any component of the formulation
Drug Interactions
- Thiazide diuretics (e.g., hydrochlorothiazide)
- Digoxin
- Corticosteroids (e.g., prednisone)
- Bile acid sequestrants (e.g., cholestyramine)
- Orlistat
- Anticonvulsants (e.g., phenytoin, phenobarbital)
- Anticoagulants (e.g., warfarin)
- Tetracycline antibiotics (e.g., doxycycline, minocycline)
- Bisphosphonates (e.g., alendronate)
- Estramustine
- Levothyroxine
- Quinolone antibiotics (e.g., ciprofloxacin, levofloxacin)
- Alcohol
- Caffeine
- Soft drinks
Pregnancy and Breastfeeding
Use with caution during pregnancy and breastfeeding only if clearly needed. Consult a physician before use.
Drug Profile Summary
- Mechanism of Action: See “How It Works” section.
- Side Effects: See “Side Effects” section.
- Contraindications: See “Contraindications” section.
- Drug Interactions: See “Drug Interactions” section.
- Pregnancy & Breastfeeding: Use with caution if clearly needed. Consult a physician.
- Dosage: See “Dosage” section.
- Monitoring Parameters: Serum calcium, phosphate, PTH, creatinine, BUN.
Popular Combinations
This combination itself is commonly used. Other combinations may include magnesium, methylcobalamin (vitamin B12), L-methylfolate, zinc, boron, and omega-3 fatty acids.
Precautions
- Monitor for hypercalcemia and adjust dosage accordingly.
- Assess renal function before and during treatment.
- Caution in patients with a history of kidney stones.
- Evaluate dietary calcium intake.
- Avoid excessive sunlight exposure.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcitriol + Calcium Citrate Malate + Vitamin K2-7?
A: The recommended dosage varies depending on the specific formulation and the patient’s condition. Typically, one or two capsules/tablets are taken daily after a meal, or as directed by a physician.
Q2: What are the common side effects?
A: Common side effects include constipation, stomach upset, nausea, vomiting, loss of appetite, headache, weakness, and fatigue.
Q3: Who should not take this medication?
A: Individuals with hypercalcemia, hypervitaminosis D, severe renal impairment, or hypersensitivity to any component should avoid this medication.
Q4: Can this medication be taken during pregnancy or breastfeeding?
A: Use cautiously and consult a physician before taking this medication during pregnancy or breastfeeding.
Q5: What are the signs of hypercalcemia?
A: Signs of hypercalcemia can include excessive thirst, frequent urination, constipation, nausea, vomiting, abdominal pain, muscle weakness, bone pain, confusion, and lethargy.
Q6: How should this medication be stored?
A: Store in a cool, dry place, protected from light and moisture.
Q7: What if I miss a dose?
A: If you miss a dose, take it as soon as you remember. However, if it is close to the time for your next dose, skip the missed dose and continue with your regular dosing schedule.
Q8: Can I take this medication with other supplements?
A: Consult a physician before taking this combination with other supplements, as interactions may occur.
Q9: How does alcohol affect this medication?
A: Alcohol can interfere with calcium absorption and should be limited while taking this medication.
Q10: What should I do if I experience any side effects?
A: Contact your physician if you experience any persistent or bothersome side effects.
