Usage
This combination medication is primarily prescribed for the prevention and treatment of calcium deficiency and conditions associated with it, such as osteoporosis, osteomalacia, rickets, and hypoparathyroidism. It is also used as a dietary supplement when calcium intake from food is insufficient. It can be categorized as a mineral and vitamin supplement. This combination works by providing the body with essential nutrients required for bone health, nerve function, muscle contraction, and overall well-being.
Alternate Names
There isn’t one single international nonproprietary name (INN) for this specific combination. However, the individual components have their own INNs: calcium carbonate, magnesium hydroxide, colecalciferol (vitamin D3), and zinc sulfate monohydrate. The combination is marketed under various brand names, one example being Santocal-500.
How It Works
Pharmacodynamics:
- Calcium: Essential for bone mineralization, muscle contraction, nerve transmission, and blood clotting.
- Magnesium: Supports calcium absorption, nerve and muscle function, and enzyme activity.
- Vitamin D3: Promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations for bone mineralization.
- Zinc: Plays a role in bone formation, cell growth, and immune function.
Pharmacokinetics:
- Calcium Carbonate: Converted to calcium chloride in the stomach by hydrochloric acid and absorbed in the small intestine. Vitamin D enhances its absorption. Excreted primarily through the kidneys and feces.
- Magnesium Hydroxide: Poorly absorbed in the gut. Excreted through the kidneys.
- Vitamin D3: Absorbed in the small intestine, undergoes hepatic and renal metabolism to become its active form, calcitriol. Excreted in bile and feces.
- Zinc Sulphate Monohydrate: Absorbed in the small intestine. Primarily excreted in feces, with some renal excretion.
Dosage
Standard Dosage
Adults:
The general recommended dose for adults is one tablet or capsule daily. Depending on the specific product formulation and the severity of the deficiency, the dose can be increased gradually under medical supervision.
Children:
Dosage in children should be determined by a pediatrician based on the child’s age, weight, and the specific condition being treated.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary depending on renal function and other health conditions.
- Patients with Renal Impairment: Dosage reduction is usually required due to decreased calcium excretion. Close monitoring of calcium levels is essential.
- Patients with Hepatic Dysfunction: No specific dosage adjustment is typically required, though monitoring is recommended.
- Patients with Comorbid Conditions: Dose adjustments might be necessary for patients with certain conditions like hyperparathyroidism or sarcoidosis.
Clinical Use Cases
The provided sources do not specify dosage recommendations for clinical settings such as intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations. In these cases, calcium, magnesium, vitamin D, and zinc are usually administered separately as needed based on the patient’s specific requirements and clinical condition.
Dosage Adjustments
Dosage adjustments should be made based on serum calcium, magnesium, and vitamin D levels. Regular monitoring of these levels is necessary, especially in patients with renal impairment or other relevant conditions.
Side Effects
Common Side Effects
Constipation, nausea, abdominal pain, flatulence.
Rare but Serious Side Effects
Hypercalcemia (high blood calcium), hypercalciuria (high calcium in the urine), renal stones.
Long-Term Effects
Long-term excessive intake can potentially lead to kidney problems.
Adverse Drug Reactions (ADR)
Allergic reactions such as rash, itching, or swelling are possible. Severe allergic reactions are rare but require immediate medical attention.
Contraindications
Hypercalcemia, hypercalciuria, vitamin D toxicity, hypersensitivity to any of the ingredients.
Drug Interactions
Thiazide diuretics, digoxin, tetracyclines, bisphosphonates. Antacids can reduce the absorption of calcium and zinc.
Pregnancy and Breastfeeding
Generally considered safe to use during pregnancy and breastfeeding at recommended dosages. However, it is crucial to consult a doctor before taking any medication or supplement during these periods.
Drug Profile Summary
- Mechanism of Action: Provides essential nutrients for bone health and various physiological functions.
- Side Effects: Constipation, nausea, abdominal pain, flatulence, rare but serious: hypercalcemia, hypercalciuria.
- Contraindications: Hypercalcemia, vitamin D toxicity, hypersensitivity.
- Drug Interactions: Thiazide diuretics, digoxin, tetracyclines.
- Pregnancy & Breastfeeding: Generally safe at recommended doses.
- Dosage: Adults: Typically one tablet or capsule daily, adjustments may be necessary.
- Monitoring Parameters: Serum calcium, magnesium, and vitamin D levels.
Popular Combinations
This combination itself is a popular one. Other potential additions for specific patient populations could include other minerals or vitamins.
Precautions
- General Precautions: Assess baseline calcium, magnesium, and vitamin D levels. Monitor for signs and symptoms of hypercalcemia.
- Specific Populations: Consult a healthcare professional for appropriate dosing during pregnancy and breastfeeding. Dosage adjustments might be needed for children and elderly patients.
- Lifestyle Considerations: No specific lifestyle considerations mentioned in the provided sources besides taking the medication with food to minimize gastrointestinal upset.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcium Carbonate + Magnesium Hydroxide + Vitamin D3 + Zinc Sulphate Monohydrate?
A: The usual recommended adult dose is one tablet or capsule daily. However, the dosage might vary depending on the specific product and individual patient needs. Dosage adjustments may be necessary for children, the elderly, and patients with renal impairment.
Q2: What are the primary uses of this combination medication?
A: It is primarily used to prevent and treat calcium deficiency and associated conditions such as osteoporosis, osteomalacia, and rickets.
Q3: Can this combination be taken during pregnancy and breastfeeding?
A: Generally considered safe at recommended dosages, but consult a doctor before use.
Q4: What are the common side effects?
A: Constipation, nausea, abdominal pain, and flatulence are common side effects.
Q5: Are there any serious side effects?
A: While rare, serious side effects such as hypercalcemia and hypercalciuria can occur. Regular monitoring of calcium levels is crucial.
Q6: What are the contraindications to using this combination?
A: Hypercalcemia, vitamin D toxicity, and hypersensitivity to any of the ingredients are contraindications.
Q7: Does this combination interact with other medications?
A: Yes, it can interact with thiazide diuretics, digoxin, and tetracyclines, among others.
Q8: Are there any dietary restrictions while taking this medication?
A: The provided sources do not list any specific dietary restrictions, although taking the medication with food is recommended to enhance calcium absorption and minimize gastrointestinal upset.
Q9: What should I do if I miss a dose?
A: If you miss a dose, take it as soon as you remember. If it’s close to the time for your next dose, skip the missed dose and continue with your regular schedule. Do not double the dose.
Q10: Can I take this medication long-term?
A: Long-term use should be under medical supervision, with regular monitoring of calcium and vitamin D levels.
