Calcium Carbonate + L-Methyl Folate Calcium + Methylcobalamin + Pyridoxal-5-phosphate + Vitamin D3

Usage

This combination medication is primarily prescribed for the prevention and treatment of nutritional deficiencies, particularly those involving calcium, vitamin D, vitamin B12, folate, and vitamin B6. It is commonly used to address conditions like osteoporosis, osteomalacia, rickets (in children), and megaloblastic anemia (specifically caused by B12 or folate deficiency), and during pregnancy and lactation for increased nutritional demands or deficiencies. It may also be used as an adjunctive therapy in patients with diabetic peripheral neuropathy.

• Pharmacological Classification: Multivitamin, mineral supplement.

• Mechanism of Action: This combination drug works by replenishing deficient nutrients essential for various physiological processes. Calcium is crucial for bone health, nerve function, and muscle contraction. Vitamin D aids calcium absorption and bone mineralization. Methylcobalamin (B12) and L-Methylfolate (B9) are vital for DNA synthesis, red blood cell formation, and nerve function. Pyridoxal-5-Phosphate (B6) is a coenzyme in various metabolic pathways, including amino acid metabolism.

Alternate Names

There are no officially recognized alternate names for this specific combination. However, it may be referred to by different names depending on the manufacturer or specific formulation.

How It Works

• Pharmacodynamics: Calcium carbonate neutralizes stomach acid. Vitamin D promotes calcium absorption from the gut and its deposition in bone. Methylcobalamin and L-Methylfolate are involved in DNA synthesis and red blood cell formation. Pyridoxal-5-Phosphate acts as a coenzyme in various metabolic reactions.

• Pharmacokinetics: Calcium carbonate is absorbed from the small intestine, influenced by factors like vitamin D levels and stomach acidity. Vitamin D undergoes hepatic and renal metabolism to its active form, calcitriol. Methylcobalamin, L-methylfolate, and Pyridoxal-5-Phosphate are absorbed from the gastrointestinal tract.

• Elimination Pathways: Calcium is primarily excreted renally, with some fecal elimination. Vitamin D metabolites are excreted in bile and urine. Methylcobalamin, L-methylfolate, and Pyridoxal-5-Phosphate excess is primarily eliminated renally.

Dosage

Dosage guidelines vary considerably based on individual patient factors, specific formulations, and the targeted deficiency. Always consult with a healthcare professional for individualized dosage recommendations.

Standard Dosage

Adults: Dosage varies depending on the specific product and indication. It is best to follow the manufacturer’s instructions or consult a healthcare professional.

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

Special Cases:

• Elderly Patients: Dose adjustments may be necessary due to age-related changes in renal function and calcium absorption.

• Patients with Renal Impairment: Dosage adjustment is crucial, as calcium and vitamin D metabolites can accumulate in patients with reduced kidney function.

• Patients with Hepatic Dysfunction: Caution is advised in patients with severe liver disease, as vitamin D metabolism might be impaired.

• Patients with Comorbid Conditions: Consider comorbidities like hypercalcemia, hyperparathyroidism, or kidney stones, and adjust the dose accordingly.

Clinical Use Cases

This combination is generally not specifically dosed for clinical settings like intubation, surgical procedures, mechanical ventilation, or ICU use. It might be included in overall nutritional support, with dosages adapted to the patient’s needs.

Dosage Adjustments

Dosage should be individualized based on patient-specific factors like age, renal function, comorbid conditions, and the severity of the deficiency. Monitoring calcium, vitamin D, and other relevant blood levels might be necessary for optimal dosage titration.

Side Effects

Common Side Effects

• Upset stomach
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Loss of appetite
• Headache

Rare but Serious Side Effects

• Hypercalcemia (high blood calcium)
• Kidney stones
• Allergic reactions

Long-Term Effects

Long-term excessive intake can potentially lead to hypercalcemia, kidney stones, and other complications.

Adverse Drug Reactions (ADR)

Clinically significant ADRs include hypercalcemia, requiring immediate medical attention.

Contraindications

• Hypersensitivity to any of the components
• Hypercalcemia
• Hypervitaminosis D
• Severe renal impairment
• Certain types of kidney stones (e.g., calcium oxalate stones)

Drug Interactions

• Antacids can reduce calcium absorption. Administer at least two hours apart.
• Certain antibiotics (e.g., tetracyclines, quinolones) may interact with calcium.
• Medications affecting bone metabolism (e.g., bisphosphonates) may require dosage adjustments.
• Consult a healthcare professional regarding potential interactions with other medications the patient is taking.
• Avoid dairy products close to administration time, as it can increase vitamin D intake.
• Alcohol can impair vitamin absorption and increase the risk of side effects.

Pregnancy and Breastfeeding

This combination is generally considered safe during pregnancy and breastfeeding when used at recommended dosages. However, always consult a healthcare professional before use, as individual needs and potential risks vary. Excessive vitamin D intake should be avoided during pregnancy.

Drug Profile Summary

• Mechanism of Action: Replenishes deficiencies of calcium, vitamin D, B vitamins (B6, B9, B12).
• Side Effects: Gastrointestinal upset, hypercalcemia (rare).
• Contraindications: Hypersensitivity, hypercalcemia, hypervitaminosis D.
• Drug Interactions: Antacids, some antibiotics, medications affecting bone metabolism.
• Pregnancy & Breastfeeding: Generally safe at recommended doses; consult a healthcare professional.
• Dosage: Varies based on individual needs; consult a healthcare professional or follow product instructions.
• Monitoring Parameters: Calcium, vitamin D, and other relevant blood levels may be monitored as needed.

Popular Combinations

This combination itself represents a common grouping of nutrients often prescribed together. Additional supplementation with other vitamins or minerals may be tailored to individual patient needs.

Precautions

• Assess for pre-existing conditions like renal impairment, hypercalcemia, or history of kidney stones.
• Monitor for signs and symptoms of hypercalcemia.
• Advise patients on proper administration with food (except calcium citrate formulations, if applicable).
• Caution patients about potential drug-food interactions (dairy, alcohol).

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Calcium Carbonate + L-Methyl Folate Calcium + Methylcobalamin + Pyridoxal-5-phosphate + Vitamin D3?

A: Dosage varies based on the specific product, patient age, and the targeted deficiency. Consult a healthcare professional for appropriate dosage recommendations.

Q2: Can this combination be used during pregnancy?

A: It’s generally considered safe when used at recommended dosages, but always consult a healthcare professional before use during pregnancy or while breastfeeding.

Q3: What are the common side effects?

A: Common side effects include upset stomach, nausea, constipation, and diarrhea.

Q4: Are there any drug interactions I should be aware of?

A: Yes, antacids can reduce calcium absorption. Certain antibiotics and other medications may interact. Provide a complete medication list to your healthcare provider for assessment of potential interactions.

Q5: Can this combination be used in patients with kidney disease?

A: Dosage adjustment is essential in patients with renal impairment. Consult a healthcare professional for guidance.

Q6: What are the signs of hypercalcemia?

A: Signs and symptoms include nausea, vomiting, constipation, increased thirst and urination, muscle weakness, confusion, and in severe cases, cardiac arrhythmias.

Q7: Should this combination be taken with food?

A: Yes, unless the calcium is formulated as calcium citrate, it should be taken with food for optimal absorption. Calcium citrate can be taken with or without food.

Q8: Can I crush or chew the tablets?

A: Unless the formulation is specifically chewable, swallow the tablets whole. Crushing or chewing can affect the release of some medications.

Q9: What if I miss a dose?

A: If a dose is missed, take it as soon as remembered. However, if it’s close to the time of the next dose, skip the missed dose and resume the regular dosing schedule. Do not double the dose.