Names and pronunciation
C Calcarb, Calci-Chew, Calci-Mix, Maalox Antacid, Mylanta, Oysterase, Os-Cal, Rolaids, Tums
PDF page 217
Loading InternPractice…
Drug reference
C Calcarb, Calci-Chew, Calci-Mix, Maalox Antacid, Mylanta, Oysterase, Os-Cal, Rolaids, Tums
PDF page 217
Func. class.: Antacid, calcium supplement
PDF page 217
Chem. class.: Calcium product
PDF page 217
Do not confuse: calcium/calcitriol/calcitonin
PDF page 217
ACTION: Neutralizes gastric acidity
PDF page 217
USES: Antacid, calcium supplement
PDF page 217
CONTRAINDICATIONS: Hyper- sensitivity, hypercalcemia Precautions: Pregnancy, breastfeed- ing, geriatric patients, fluid restric- tion, decreased GI motility, GI obstruction, dehydration, renal dis- ease, hyperparathyroidism, bone tumors
PDF page 217
SIDE EFFECTS GI: Constipation, anorexia, nausea, vomiting, diarrhea GU: Calculi, hypercalciuria
PDF page 218
INTERACTIONS Increase: digoxin toxicity—hypercalcemia Increase: plasma levels of quiNIDine, amphetamines Increase: hypercalcemia—thiazide diuret- ics, calcium supplements Decrease: levels of salicylates, calcium channel blockers, ketoconazole, iron salts, tetracyclines, fluoroquinolones, phenytoin, etidronate, risedronate, atenolol PO, thy- roid hormones Drug/Food Decrease: calcium supplement effect— cereal, spinach Drug/Lab Test Decrease: phosphates False increase: chloride False positive: benzodiazepines False decrease: magnesium, oxalate, lipase
PDF page 218
DOSAGE AND ROUTES Hypocalcemia prevention, osteoporosis • Adult: PO 1-2 g • Adult 19-50 yr: PO 1000 mg/day ele- mental calcium (2500 mg/day calcium carbonate) Chronic hypocalcemia • Adult: PO 2-4 g/day elemental cal- cium (5-10 g/day calcium carbonate) in 3-4 divided doses • Child: PO 45-65 mg/kg/day elemental calcium (112.5-162.5 mg/kg/day cal- cium carbonate) in 4 divided doses • Neonate: PO 50-150 mg/kg/day ele- mental calcium (125-375 mg/kg/day in 4-6 divided doses, max 1 g/day) Supplementation • Child: PO 45-65 mg/kg/day Hyperphosphatemia (Acetate) • Adult: PO 1334 mg with meals Heartburn, dyspepsia, hyperacidity (OTC) • Adult: PO 1-2 tablets q2hr, max 9 tablets/24 hr (Alka-Mints); chew 2-4 tablets q1hr prn, max 16 tablets (Tums regular strength); chew 2-4 tablets q1hr prn, max 10 tablets (Tums E-X)
PDF pages 217, 218
Available forms: Calcium carbonate: chewable tablets 350, 420, 450, 500, 750, 1000, 1250 mg; tablets 500, 600, 650, 667, 1000, 1250, 1500 mg; gum 300, 450, 500 mg; suspension 1250 mg/5 mL; capsules 1250 mg; powder 6.5 g/packet
PDF page 218
Administer: PO route • 1 g calcium carbonate = 400 mg ele- mental calcium = 10 mmol calcium = 20 mEq calcium • Do not give enteric-coated within 1 hr of calcium carbonate • For ulcer treatment (adjunct): give 1 and 3 hr after meals and at bedtime • For a phosphate binder: give 1 hr after each meal or snack and at bedtime • For supplement: give 1-1½ hr after meals; avoid oxalic acid foods (spinach, rhubarb), phytic acid (brans, cereals), or phosphorus (milk, dairy), may decrease calcium absorption • Suspension: shake well; use cali- brated measuring device • Laxatives or stool softeners if consti- pation occurs
PDF page 218
Assess: • Calcium (serum, urine), serum cal- cium should be 8.5-10.5 mg/dL, correct or use ionized calcium in low albumin or acid/base disorders, monitor weekly if used to treat electrolyte imbalances or use a daily supplement; urine calcium should be 150 mg/day, monitor weekly; serum phosphate • Milk-alkali syndrome: nausea, vomit- ing, disorientation, headache • Constipation; increase bulk in the diet if needed • Hypercalcemia: headache, nausea, vomiting, confusion • Hypocalcemia: paresthesia, twitching, colic, dysrhythmias, Chvostek’s sign, Trous- seau’s sign • Those taking digoxin for toxicity; moni- tor frequently • Antacid—for abdominal pain, heartburn, indigestion before, after administration
PDF page 218
Evaluate: • Therapeutic response: absence of pain, decreased acidity; decreased hyperphos- phatemia with renal failure
PDF page 218
CLINICAL CONSIDERATIONS
PDF page 218
Patient and caregiver information: • To increase fluids to 2 L unless contraindicated; to add bulk, liquids to diet for constipation; to notify prescriber of constipation • Not to switch antacids unless directed by prescriber; not to use as antacid for >2 wk without approval by prescriber • That therapeutic dose recommenda- tions are figured as elemental calcium • To avoid excessive use of alcohol, caf- feine, tobacco • To avoid spinach, cereals, dairy prod- ucts in large amounts, other foods high in oxalates before taking the product; may interfere with absorption of calcium • To take enteric product within 1 hr of calcium carbonate • To take on regular schedule • Pregnancy/breastfeeding: Notify pre- criber if planned or suspected, hypocalce- mia/hypercalcemia causes severe reactions • To maintain vitamin D levels CALCIUM SALTS
PDF pages 218, 219
PHARMACOKINETICS 1 3 of dose absorbed by small intestine, excreted in feces and urine, crosses pla- centa, must have adequate vitamin D for absorption
PDF page 218
• Child: PO 45-65 mg/kg/day elemental calcium (112.5-162.5 mg/kg/day cal- cium carbonate) in 4 divided doses
PDF pages 217, 218
• Child: PO 45-65 mg/kg/day Hyperphosphatemia (Acetate)
PDF pages 217, 218