Calcium Citrate Malate + Vitamin D3 + Vitamin K2-7

Usage

• This combination medication is prescribed to prevent or treat low blood calcium levels (hypocalcemia) in individuals who don’t get enough calcium from their diet. It is also used for conditions caused by low calcium levels, such as:

  • Osteoporosis (bone loss)
  • Osteomalacia/rickets (weak bones)
  • Hypoparathyroidism (decreased activity of the parathyroid gland)
  • Latent tetany (a muscle disease)

• Pharmacological Classification: Vitamin and mineral supplement, bone health agent.

• Mechanism of Action: Calcium is essential for nerve, cell, muscle, and bone function. Vitamin D3 aids calcium and phosphorus absorption, crucial for strong bones. Vitamin K2-7 directs calcium to bones and teeth, enhancing bone mineralization and reducing arterial calcification.

Alternate Names

• No widely recognized alternate names exist for this specific combination. The individual components may be referred to as:
  • Calcium citrate malate (CCM)
  • Cholecalciferol (vitamin D3)
  • Menaquinone-7 (MK-7, vitamin K2-7)
• Brand names vary depending on the manufacturer. Some possible brand names could include “Supracal K2” or similar formulations. (Please note that brand names are subject to regional variations and availability.)

How It Works

• Pharmacodynamics: Calcium is a crucial structural component of bones and teeth, necessary for nerve impulse transmission, muscle contraction, and blood coagulation. Vitamin D3 facilitates calcium absorption from the intestines, regulates calcium and phosphorus homeostasis, and promotes bone mineralization. Vitamin K2-7 activates osteocalcin, a bone protein crucial for binding calcium to the bone matrix, leading to increased bone density. It also activates Matrix Gla-protein (MGP), which inhibits vascular calcification.

• Pharmacokinetics:

  • Absorption: Calcium citrate malate is absorbed well in the gastrointestinal tract, even without food. Vitamin D3 is absorbed in the small intestine. Vitamin K2-7 is absorbed in the presence of bile salts and fats.
  • Metabolism: Vitamin D3 is metabolized in the liver and kidneys to its active form, calcitriol. Vitamin K undergoes extensive hepatic metabolism.
  • Elimination: Calcium is primarily excreted in the urine and feces. Vitamin D metabolites are eliminated through bile and urine. Vitamin K is excreted in bile and urine.

• Mode of Action (Cellular/Molecular Level): Vitamin D3 binds to vitamin D receptors (VDRs) in the intestine, increasing the expression of calcium transport proteins. Vitamin K2-7 post-translationally modifies osteocalcin, enabling calcium binding in bones. It also carboxylates MGP, blocking calcium deposition in arteries.

Dosage

Dosage depends on the specific formulation and patient needs. Always follow medical advice and prescribed dosage. The following are general guidelines:

Standard Dosage

Adults: Typically, 1000-1500 mg of elemental calcium and 400-800 IU of Vitamin D3 are recommended daily. Vitamin K2-7 dosage recommendations vary, generally between 45-180 mcg daily.

Children: Dosage is dependent on age and specific needs. Consult a pediatrician for appropriate pediatric dosing.

Special Cases:

• Elderly Patients: May require adjusted dosages due to reduced absorption and potential renal impairment.
• Patients with Renal Impairment: Dosage should be adjusted based on creatinine clearance.
• Patients with Hepatic Dysfunction: Monitor liver function tests and adjust dosage if necessary.
• Patients with Comorbid Conditions: Adjustments may be necessary for conditions such as diabetes, cardiovascular disease, or malabsorption syndromes.

Clinical Use Cases

Dosage recommendations for specialized medical settings (e.g., intubation, surgical procedures, ICU use) should be determined based on individual patient needs and the overall treatment plan.

Dosage Adjustments

• Dose modifications are based on serum calcium levels, vitamin D levels, renal function, and other relevant factors.

Side Effects

Common Side Effects:

• Constipation
• Nausea
• Stomach upset
• Flatulence

Rare but Serious Side Effects:

• Hypercalcemia (high blood calcium)
• Hypercalciuria (high urine calcium)
• Kidney stones

Long-Term Effects:

• Potential for kidney stones with prolonged high-dose calcium supplementation.

Contraindications

• Hypercalcemia
• Hypervitaminosis D
• Hypersensitivity to any component
• Severe renal impairment
• Certain types of kidney stones

Drug Interactions

• Thiazide diuretics (increased calcium levels)
• Some antibiotics (reduced calcium absorption)
• Corticosteroids (reduced calcium absorption)
• Levothyroxine (altered calcium absorption)
• Antacids containing aluminum or magnesium (reduced calcium absorption)
• Bisphosphonates (may decrease absorption of bisphosphonates)

Pregnancy and Breastfeeding

Consult a physician for appropriate dosing during pregnancy and breastfeeding. High doses of vitamin D should be avoided during pregnancy.

Drug Profile Summary

• Mechanism of Action: Enhances calcium absorption, promotes bone mineralization, and inhibits vascular calcification.
• Side Effects: Constipation, nausea, stomach upset, rarely hypercalcemia.
• Contraindications: Hypercalcemia, hypervitaminosis D, severe renal impairment.
• Drug Interactions: Thiazide diuretics, some antibiotics, corticosteroids, levothyroxine, antacids.
• Pregnancy & Breastfeeding: Consult a physician for appropriate dosing.
• Dosage: Varies based on age, condition, and formulation.
• Monitoring Parameters: Serum calcium, phosphorus, vitamin D, and renal function.

Popular Combinations

This combination itself is a popular formulation for bone health. Occasionally, it might be combined with magnesium or other minerals/vitamins.

Precautions

• Monitor serum calcium levels, particularly with high doses or in patients with renal impairment.
• Adequate hydration is recommended to reduce the risk of kidney stones.

FAQs (Frequently Asked Questions)

Q1: What is the recommended dosage for Calcium Citrate Malate + Vitamin D3 + Vitamin K2-7?

A: Dosages vary based on individual needs and product formulation. Standard adult dosages are usually in the range of 1000-1500 mg of calcium citrate malate, 400-800 IU of Vitamin D3, and 45-180 mcg of vitamin K2-7 per day. A physician should determine the appropriate dosage.

Q2: Can this combination be taken with other medications?

A: It can interact with certain medications. It is important to inform your doctor about all other medications, supplements, and herbal products you are taking.

Q3: Are there any dietary restrictions while taking this combination?

A: A balanced diet is important. Limit intake of caffeine, alcohol, and carbonated beverages, as they may inhibit calcium absorption.

Q4: Can this combination be taken during pregnancy or breastfeeding?

A: Consult a physician for appropriate dosing during pregnancy and breastfeeding. Excessive vitamin D intake should be avoided during pregnancy.

Q5: What are the signs of hypercalcemia?

A: Symptoms may include nausea, vomiting, constipation, increased thirst, frequent urination, muscle weakness, bone pain, confusion, and lethargy.

Q6: Does calcium citrate malate cause constipation?

A: Constipation can be a side effect. Adequate fluid intake and a high-fiber diet can help prevent it.

Q7: Is this combination safe for long-term use?

A: Generally, it is safe for long-term use when taken as directed and monitored by a physician. Regularly monitor serum calcium levels.

Q8: Who should not take this combination?

A: Individuals with hypercalcemia, hypervitaminosis D, severe renal impairment, or specific types of kidney stones should avoid this combination. Those with allergies to any component should also not take it.

Q9: What are the benefits of taking calcium citrate malate instead of other calcium forms?

A: Calcium citrate malate is generally well-absorbed, even on an empty stomach, and is less likely to cause constipation compared to calcium carbonate.