Usage
This combination medication is primarily prescribed to address calcium deficiency, particularly in conditions like osteopenia, osteoporosis, hypoparathyroidism, latent tetany, pregnancy-induced hypertension, and pre-eclampsia. It is beneficial during pregnancy and lactation. It also helps in improving the length of gestation & birth weight of the baby. This combination may also be prescribed to ensure sufficient calcium intake in individuals at risk of deficiency, such as postmenopausal women and those taking certain medications (e.g., phenytoin, phenobarbital, or prednisone). It is used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), and decreased activity of the parathyroid gland (hypoparathyroidism). This combination falls under the pharmacological classification of mineral and vitamin supplements. It works by providing the essential nutrients needed for calcium absorption, bone health maintenance, and overall physiological function.
Alternate Names
While this specific combination may not have a distinct international non-proprietary name (INN), the individual components are recognized globally. Some regional variations may exist in nomenclature. Brand names for this combination include “OSTANU” and “CALCIQ.”
How It Works
Pharmacodynamics: Calcium is crucial for nerve and muscle function, bone formation, and various enzymatic processes. Magnesium contributes to bone structure and supports calcium absorption. Vitamin D3 facilitates calcium and phosphorus absorption in the gut. Zinc plays a role in bone metabolism and cell growth.
Pharmacokinetics: Calcium citrate is absorbed in the small intestine, aided by vitamin D3. Magnesium hydroxide is also absorbed in the gut, though its absorption is variable. Vitamin D3 is absorbed from the intestine and undergoes hepatic and renal metabolism. Zinc is absorbed in the small intestine, and its excretion is primarily through the feces.
Mode of Action: Vitamin D3 promotes calcium absorption by increasing the expression of calcium transport proteins in the intestinal epithelium. Calcium and magnesium are incorporated into the bone matrix, contributing to bone mineralization. Zinc influences bone formation and resorption through its role in enzyme activity and cellular processes.
Elimination Pathways: Calcium is primarily excreted renally, while magnesium and zinc are mainly excreted in the feces. Vitamin D3 metabolites are eliminated through both renal and biliary routes.
Dosage
Standard Dosage
Adults:
The typical adult dosage is one to two tablets daily, taken orally with or without food. Depending on individual requirements. Some sources suggest one tablet daily. If the total daily dose exceeds 600 mg of elemental calcium, divide the dose and administer it at intervals throughout the day.
Children:
Pediatric dosing should be determined by a pediatrician based on the child’s age, weight, and specific clinical needs.
Special Cases:
- Elderly Patients: Dosage adjustments may be necessary based on renal function and other comorbid conditions.
- Patients with Renal Impairment: Dose reduction is often required based on creatinine clearance or estimated glomerular filtration rate (eGFR).
- Patients with Hepatic Dysfunction: Caution is advised, and dosage adjustments may be needed.
- Patients with Comorbid Conditions: Individualized dosing should be considered for patients with conditions like diabetes or cardiovascular disease.
Clinical Use Cases
Specific dosage recommendations for clinical scenarios like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations should be guided by clinical guidelines and patient-specific factors. Generally, the standard dose is continued unless contraindicated.
Dosage Adjustments
Dose modifications are essential for patients with renal or hepatic impairment and metabolic disorders. Genetic polymorphisms affecting drug metabolism should also be considered.
Side Effects
Common Side Effects:
Constipation, nausea, bloating, flatulence.
Rare but Serious Side Effects:
Hypercalcemia, nephrolithiasis, allergic reactions.
Long-Term Effects:
Chronic high doses may increase the risk of kidney stones.
Adverse Drug Reactions (ADR):
Severe hypercalcemia, renal dysfunction.
Contraindications
Hypercalcemia, hypervitaminosis D, known hypersensitivity to any of the components, severe renal impairment.
Drug Interactions
Antacids, bisphosphonates, certain antibiotics (e.g., tetracyclines, quinolones), thiazide diuretics, thyroid hormones.
Pregnancy and Breastfeeding
This combination is generally considered safe during pregnancy and lactation when taken as directed. However, it’s crucial to consult a physician to ensure appropriate dosing and to monitor calcium levels.
Drug Profile Summary
- Mechanism of Action: Provides essential nutrients for bone health and physiological function.
- Side Effects: Constipation, nausea, bloating, hypercalcemia (rare).
- Contraindications: Hypercalcemia, hypervitaminosis D, severe renal impairment.
- Drug Interactions: Antacids, bisphosphonates, certain antibiotics, thiazide diuretics.
- Pregnancy & Breastfeeding: Generally safe when taken as directed, but consult a physician.
- Dosage: Typically, one to two tablets daily for adults; pediatric dosing varies.
- Monitoring Parameters: Serum calcium, magnesium, and phosphorus levels.
Popular Combinations
This combination itself represents a commonly used formulation. It may be co-administered with other medications based on specific patient needs, like other vitamins or minerals.
Precautions
Assess for pre-existing conditions, monitor calcium levels, avoid excessive doses. Advise on appropriate lifestyle modifications, including diet and sun exposure.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Calcium citrate + Magnesium Hydroxide + Vitamin D3 + Zinc Sulphate Monohydrate?
A: The standard adult dosage is typically one or two tablets daily, taken orally with food. Pediatric and special population dosing should be determined by a physician. Doses above 600mg elemental calcium should be split.
Q2: What are the primary uses of this combination medication?
A: It’s used to prevent or treat calcium deficiency, particularly in conditions like osteoporosis, osteopenia, and hypoparathyroidism. It’s also beneficial during pregnancy and lactation.
Q3: Are there any significant drug interactions I should be aware of?
A: Yes, it can interact with medications like antacids, bisphosphonates, certain antibiotics (tetracyclines, quinolones), thiazide diuretics, and thyroid hormones.
Q4: What are the common side effects patients might experience?
A: Common side effects include constipation, nausea, bloating, and flatulence.
Q5: Is this combination safe during pregnancy and breastfeeding?
A: It’s generally considered safe during pregnancy and lactation when taken as directed by a physician.
Q6: What precautions should I take when prescribing this medication?
A: Assess for pre-existing conditions like hypercalcemia or renal impairment. Monitor serum calcium, magnesium, and phosphorus levels. Advise patients to avoid excessive doses.
Q7: How does this combination work to improve bone health?
A: Calcium and magnesium are building blocks for bone tissue, vitamin D3 aids calcium absorption, and zinc contributes to bone metabolism and cell growth.
Q8: Are there any specific dietary recommendations for patients taking this medication?
A: Encourage a balanced diet rich in calcium-rich foods (dairy, leafy greens) and adequate sun exposure for vitamin D synthesis.
Q9: What should I do if a patient experiences hypercalcemia while taking this medication?
A: Discontinue the medication immediately and initiate appropriate management for hypercalcemia, which may include hydration and other medical interventions.
