(KAL see um FOS fate tri BAY sik)
Dietary supplement
Dietary Reference Intake for Calcium: Oral:
Adults, Females/Males: RDA:
19-50 years: 1000 mg/day
≥51 years, females: 1200 mg/day
51-70 years, males: 1000 mg/day
Females: Pregnancy/Lactating: RDA: Requirements are the same as in nonpregnant or nonlactating females
Dietary supplement: Oral: 2 tablets daily
Dietary Reference Intake for Calcium: RDA: Oral:
Females: Refer to adult dosing.
Males ≤70 years: Refer to adult dosing.
Males >70 years: 1200 mg/day
Dietary supplement: Refer to adult dosing.
Dietary Reference Intake for Calcium: Oral:
1-6 months: Adequate intake: 200 mg/day
7-12 months: Adequate intake: 260 mg/day
1-3 years: RDA: 700 mg/day
4-8 years: RDA: 1000 mg/day
9-18 years: RDA: 1300 mg/day
Female: Pregnancy/Lactating: RDA: Requirements are the same as in non-pregnant or non-lactating females
Store at room temperature.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Caplet:
Posture ‚ ®: Calcium 600 mg and phosphorus 280 mg [as tricalcium phosphate]
Alpha-Lipoic Acid: May decrease the absorption of Calcium Salts. Calcium Salts may decrease the absorption of Alpha-Lipoic Acid. Consider therapy modification
Antacids: May decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate administration. Administer oral phosphate supplements at least 1 hour before, or 2 hours after, antacid administration. Consider therapy modification
Bisphosphonate Derivatives: Calcium Salts may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral calcium supplements within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Consider therapy modification
Bisphosphonate Derivatives: May enhance the hypocalcemic effect of Phosphate Supplements. Monitor therapy
Calcium Acetate: Calcium Salts may enhance the adverse/toxic effect of Calcium Acetate. Avoid combination
Calcium Channel Blockers: Calcium Salts may diminish the therapeutic effect of Calcium Channel Blockers. Monitor therapy
Calcium Salts: May decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate and calcium administration. Administering oral phosphate supplements at least 1 hour before or 2 hours after administration of an oral calcium salt may minimize the significance of the interaction. Consider therapy modification
Cardiac Glycosides: Calcium Salts may enhance the arrhythmogenic effect of Cardiac Glycosides. Monitor therapy
Deferiprone: Calcium Salts may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Consider therapy modification
DOBUTamine: Calcium Salts may diminish the therapeutic effect of DOBUTamine. Monitor therapy
Dolutegravir: Calcium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral calcium. Alternatively, dolutegravir and oral calcium can be taken together with food. Consider therapy modification
Eltrombopag: Calcium Salts may decrease the serum concentration of Eltrombopag. Management: Separate administration of eltrombopag and any polyvalent cation (e.g., calcium-containing products) by at least 4 hours. Consider therapy modification
Estramustine: Calcium Salts may decrease the absorption of Estramustine. Consider therapy modification
Iron Salts: May decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate and iron administration. Administer oral phosphate supplements at least 1 hour before, or 2 hours after, oral iron salt administration. Exceptions: Ferric Carboxymaltose; Ferric Gluconate; Ferric Pyrophosphate Citrate; Ferumoxytol; Iron Dextran Complex; Iron Sucrose. Consider therapy modification
Magnesium Salts: May decrease the serum concentration of Phosphate Supplements. Management: This applies only to oral phosphate and magnesium administration. Administer oral phosphate supplements at least 1 hour before, or 2 hours after, oral magnesium salt administration. Consider therapy modification
Multivitamins/Fluoride (with ADE): May increase the serum concentration of Calcium Salts. Calcium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). More specifically, calcium salts may impair the absorption of fluoride. Management: Avoid eating or drinking dairy products or consuming vitamins or supplements with calcium salts one hour before or after of the administration of fluoride. Consider therapy modification
Multivitamins/Minerals (with ADEK, Folate, Iron): May decrease the serum concentration of Phosphate Supplements. Management: This applies only to oral phosphate and multivitamin administration. Administer oral phosphate supplements at least 1 hour before, or 2 hours after, administration of an iron-containing multivitamin. Consider therapy modification
Phosphate Supplements: Calcium Salts may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate and calcium administration. Administering oral phosphate supplements at least 1 hour before or 2 hours after administration of an oral calcium salt may minimize the significance of the interaction. Exceptions: Sodium Glycerophosphate Pentahydrate. Consider therapy modification
Quinolone Antibiotics: Calcium Salts may decrease the absorption of Quinolone Antibiotics. Of concern only with oral administration of both agents. Exceptions: Moxifloxacin (Systemic). Consider therapy modification
Strontium Ranelate: Calcium Salts may decrease the serum concentration of Strontium Ranelate. Management: Separate administration of strontium ranelate and oral calcium salts by at least 2 hours in order to minimize this interaction. Consider therapy modification
Sucralfate: May decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate administration. Administering oral phosphate supplements at least 1 hour before or 2 hours after administration of sucralfate may reduce the significance of the interaction. Consider therapy modification
Tetracycline Derivatives: Calcium Salts may decrease the serum concentration of Tetracycline Derivatives. Management: If coadministration of oral calcium with oral tetracyclines can not be avoided, consider separating administration of each agent by several hours. Consider therapy modification
Thiazide Diuretics: May decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. Monitor therapy
Thyroid Products: Calcium Salts may diminish the therapeutic effect of Thyroid Products. Management: Separate the doses of the thyroid product and the oral calcium supplement by at least 4 hours. Consider therapy modification
Trientine: May decrease the serum concentration of Calcium Salts. Calcium Salts may decrease the serum concentration of Trientine. Consider therapy modification
Vitamin D Analogs: Calcium Salts may enhance the adverse/toxic effect of Vitamin D Analogs. Monitor therapy
<1% (Limited to important or life-threatening): Constipation, dry mouth, hypercalcemia, hypophosphatemia, milk-alkali syndrome, nausea
Concerns related to adverse effects:
- Gastrointestinal effects: Constipation, bloating, and gas are common with calcium supplements (especially carbonate salt).
Disease-related concerns:
- Achlorhydria: Calcium absorption is impaired in achlorhydria; common in elderly, use an alternate salt (eg, citrate) and administer with food.
- Hypoparathyroid disease: Hypercalcemia and hypercalciuria are most likely to occur in hypoparathyroid patients receiving high doses of vitamin D.
- Kidney stones (calcium-containing): Use caution when administering calcium supplements to patients with a history of kidney stones.
- Renal impairment: Use with caution in patients with renal failure to avoid hypercalcemia; frequent monitoring of serum calcium and phosphorus is necessary.
Concurrent drug therapy issues:
- Minerals/other oral drugs: Calcium administration interferes with absorption of some minerals and drugs; use with caution.
- Vitamin D: It is recommended to concomitantly administer vitamin D for optimal calcium absorption.
Other warnings/precautions:
- Absorption: Taking calcium ( ≤500 mg) with food improves absorption.
- Appropriate product selection: Multiple salt forms of calcium exist; close attention must be paid to the salt form when ordering and administering calcium; incorrect selection or substitution of one salt for another without proper dosage adjustment may result in serious over or under dosing.
Calcium crosses the placenta. Intestinal absorption of calcium increases during pregnancy. The amount of calcium reaching the fetus is determined by maternal physiological changes. Calcium requirements are the same in pregnant and nonpregnant females (IOM, 2011).
As dietary supplement, used to prevent or treat negative calcium balance; in osteoporosis, it helps to prevent or decrease the rate of bone loss. The calcium in calcium salts moderates nerve and muscle performance and allows normal cardiac function.
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience constipation. Have patient report immediately to prescriber severe nausea (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients.