Calcium citrate + Magnesium Sulphate + Vitamin D3 + Zinc Sulfate

Usage

This combination medication is primarily prescribed for the prevention and treatment of deficiencies in calcium, magnesium, vitamin D3, and zinc. It supports bone health, muscle function, nerve function, and immune system function. It may also be used in conditions like osteoporosis, osteomalacia, hypoparathyroidism, and during pregnancy and lactation when increased demand for these nutrients exists.

• Pharmacological Classification: This combination drug falls under several classifications, including:

  • Calcium Supplement
  • Magnesium Supplement
  • Vitamin Supplement
  • Mineral Supplement

• Mechanism of Action: This combination provides the body with essential nutrients that play vital roles in various physiological processes:

  • Calcium: Essential for bone formation, muscle contraction, nerve transmission, and blood clotting.
  • Magnesium: Involved in bone formation, enzyme function, muscle and nerve function, blood glucose control, and blood pressure regulation.
  • Vitamin D3: Regulates calcium and phosphorus absorption, crucial for bone health, immune function, and cell growth.
  • Zinc: Supports immune function, cell growth and division, wound healing, and the senses of taste and smell.

Alternate Names

There isn’t one single international non-proprietary name (INN) for this combination. The individual components have their established INNs (calcium citrate, magnesium sulfate, cholecalciferol/vitamin D3, zinc sulfate). This combination may be referred to generically as a calcium-magnesium-zinc-vitamin D supplement.

• Brand Names: Several brand names exist, including (but not limited to) Fractocal-D3 and Calvimac. Brand names vary by region and manufacturer.

How It Works

• Pharmacodynamics:

  • Calcium strengthens bones and teeth, enables muscle contraction, and supports nerve function.
  • Magnesium supports bone health, muscle and nerve function, energy production, and enzyme activity.
  • Vitamin D3 facilitates calcium and phosphorus absorption, optimizing bone mineralization.
  • Zinc promotes immune function, wound healing, and cell growth.

• Pharmacokinetics:

  • Calcium Citrate: Absorbed in the small intestine, facilitated by vitamin D. Excreted primarily through the kidneys.
  • Magnesium Sulfate: Absorbed in the small intestine. Excreted mainly by the kidneys.
  • Vitamin D3: Absorbed in the small intestine. Stored in the liver and fat tissues. Metabolized in the liver and kidneys.
  • Zinc Sulfate: Absorbed in the small intestine. Excreted primarily in the feces.

• Mode of Action (at cellular/molecular level):

  • Calcium influences cellular signaling pathways, muscle contraction through interaction with troponin-C, and neurotransmitter release.
  • Magnesium acts as a cofactor for numerous enzymes, influences ion channels, and modulates neuronal activity.
  • Vitamin D3 binds to vitamin D receptors (VDRs) in target cells, modulating gene expression related to calcium and phosphorus homeostasis.
  • Zinc acts as a structural component of many enzymes and proteins, influencing gene expression and various cellular processes.

• Elimination Pathways: Primarily renal excretion for calcium, magnesium, and vitamin D metabolites. Zinc is eliminated primarily through feces.

Dosage

Dosage recommendations can vary based on individual needs and the specific product formulation. Consulting a healthcare professional is crucial for determining the appropriate dosage.

Standard Dosage

Adults:

General recommendations suggest 1000 mg of calcium citrate, 400-500 mg of magnesium, 200-400 IU of Vitamin D3, and 15-50 mg of elemental zinc daily. The exact dosage will depend on the specific formulation of the combined supplement. Dosages may be divided throughout the day.

Children:

Dosage should be determined by a pediatrician or healthcare professional based on the child’s age, weight, and specific needs.

Special Cases:

• Elderly Patients: Dosage adjustments may be necessary based on kidney function and other health conditions.
• Patients with Renal Impairment: Dose reduction may be required based on the degree of impairment.
• Patients with Hepatic Dysfunction: Careful monitoring is advisable.
• Patients with Comorbid Conditions: Dosage adjustments may be needed depending on other medical conditions.

Clinical Use Cases

The combination is typically used for nutritional supplementation, not specific clinical interventions like intubation, surgery, mechanical ventilation, or emergency situations.

Dosage Adjustments

Dosage adjustments should be individualized based on renal function, hepatic function, other medical conditions, and response to therapy.

Side Effects

Common Side Effects:

• Constipation
• Nausea
• Upset stomach

Rare but Serious Side Effects:

• Allergic reactions (rash, itching, swelling)
• Hypercalcemia (high blood calcium levels)
• Hypermagnesemia (high blood magnesium levels)

Long-Term Effects:

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

Adverse Drug Reactions (ADR): Severe allergic reactions, marked gastrointestinal distress.

Contraindications

• Hypercalcemia
• Hypermagnesemia
• Hypervitaminosis D
• Renal failure
• Hypersensitivity to any of the components

Drug Interactions

• Antacids: May reduce the absorption of calcium and zinc.
• Tetracyclines, quinolones, and certain other antibiotics: May form complexes with calcium and reduce their absorption.
• Bisphosphonates: Should be taken at a different time of day than calcium supplements.
• Thiazide diuretics: Can increase calcium levels.
• Digoxin: Magnesium can potentiate the effects of digoxin.

Pregnancy and Breastfeeding

Generally considered safe during pregnancy and breastfeeding when taken at recommended dosages. Excessive intake should be avoided. Consult a physician for advice on appropriate dosage during these periods.

Drug Profile Summary

• Mechanism of Action: Provides essential nutrients for bone health, muscle and nerve function, and immune function.
• Side Effects: Constipation, nausea, upset stomach. Rarely: allergic reactions, hypercalcemia, hypermagnesemia.
• Contraindications: Hypercalcemia, hypermagnesemia, hypervitaminosis D, renal failure, hypersensitivity.
• Drug Interactions: Antacids, tetracyclines, quinolones, bisphosphonates, thiazide diuretics, digoxin.
• Pregnancy & Breastfeeding: Generally safe at recommended doses.
• Dosage: Varies based on age and individual needs. Typically 1000 mg calcium citrate, 400-500 mg magnesium, 200-400 IU Vitamin D3, and 15-50 mg zinc.
• Monitoring Parameters: Serum calcium, magnesium, phosphorus, and vitamin D levels may be monitored as needed.

Popular Combinations

Often combined as a single supplement containing all four ingredients.

Precautions

Standard precautions apply. Monitor for adverse effects. Adjust dosage in patients with renal or hepatic impairment.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Calcium citrate + Magnesium Sulphate + Vitamin D3 + Zinc Sulfate?

A: Dosage recommendations vary depending on the individual’s age, health status, and the specific product. Consult with a healthcare professional for personalized dosage advice. General guidelines suggest 1000 mg of calcium citrate, 400-500 mg of magnesium, 200-400 IU of vitamin D3, and 15-50 mg of elemental zinc daily for adults.

Q2: Can pregnant or breastfeeding women take this combination?

A: Generally considered safe at recommended dosages during pregnancy and breastfeeding. Consult a doctor for personalized advice.

Q3: What are the common side effects?

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

Q4: Are there any serious side effects?

A: While rare, serious side effects can include allergic reactions and electrolyte imbalances such as hypercalcemia and hypermagnesemia.

Q5: What are the contraindications to using this combination?

A: Contraindications include pre-existing hypercalcemia, hypermagnesemia, hypervitaminosis D, severe renal impairment, and hypersensitivity to any components.

Q6: Does this combination interact with other medications?

A: Yes, it can interact with medications like antacids, certain antibiotics (tetracyclines, quinolones), bisphosphonates, thiazide diuretics, and digoxin.

Q7: How should this combination be taken?

A: Typically taken orally with food. Follow the instructions provided with the specific product.

Q8: Can this combination be used in children?

A: Yes, but the dosage must be determined by a pediatrician based on the child’s individual needs.

Q9: What should I do if I miss a dose?

A: Take the missed dose as soon as you remember, unless it is close to the time for your next dose. Do not double the dose.

Q10: What should I monitor while taking this combination?

A: Be aware of any potential side effects. Periodic monitoring of serum calcium, magnesium, phosphorus, and vitamin D levels may be recommended by your doctor.