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Calcium carbonate: Drug information

Calcium carbonate: Drug information
2024© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Calcium carbonate: Patient drug information" and "Calcium carbonate: Pediatric drug information"

For abbreviations, symbols, and age group definitions show table
Brand Names: US
  • Alcalak [OTC] [DSC];
  • Antacid Calcium Rich [OTC];
  • Antacid Calcium [OTC];
  • Antacid Extra Strength [OTC];
  • Antacid [OTC];
  • Cal-Gest Antacid [OTC];
  • Cal-Mint [OTC];
  • Calcium 600 [OTC];
  • Calcium Antacid Extra Strength [OTC];
  • Calcium Antacid [OTC];
  • Calcium High Potency [OTC];
  • Caltrate 600 [OTC] [DSC];
  • Florical [OTC];
  • FT Antacid Extra Strength [OTC];
  • FT Antacid Regular Strength [OTC];
  • GoodSense Antacid Extra Str [OTC];
  • GoodSense Antacid [OTC];
  • Maalox Childrens [OTC];
  • Maalox [OTC];
  • Medi-First Antacid [OTC];
  • TC Max [OTC];
  • Titralac [OTC];
  • Tums Chewy Bites [OTC];
  • Tums Chewy Delights [OTC];
  • Tums E-X 750 [OTC];
  • Tums Extra Strength 750 [OTC];
  • Tums Lasting Effects [OTC];
  • Tums Smoothies [OTC];
  • Tums Ultra 1000 [OTC];
  • Tums [OTC]
Pharmacologic Category
  • Antacid;
  • Antidote;
  • Calcium Salt;
  • Electrolyte Supplement, Oral;
  • Phosphate Binder
Dosing: Adult

Note: One gram of calcium carbonate is equal to 400 mg of elemental calcium.

Antacid, various GI symptoms, including gastroesophageal reflux disease, intermittent symptom relief

Antacid, various GI symptoms (eg, acid indigestion), including gastroesophageal reflux disease, intermittent symptom relief: Oral: 1 to 4 tablets (~500 to 1,250 mg calcium carbonate per tablet) or 5 to 10 mL (1,250 mg per 5 mL) as needed for periodic episodes (≤1 episode per week) (Ref); maximum dose: 8 g calcium carbonate/day; if needed for >1 episode/week or symptoms persist beyond 2 weeks, evaluate need for alternative treatment (Ref).

Note: OTC dosing recommendations vary by product and/or manufacturer; consult specific product labeling.

Calcium supplementation

Calcium supplementation (OTC labeling): Oral: 500 mg to 4 g/day as calcium carbonate (equivalent to 200 mg to 1.6 g of elemental calcium) in 1 to 3 divided doses.

Note: The recommended daily intake of elemental calcium (from dietary sources and supplemental sources if needed) for optimal bone health is 1.2 g/day (postmenopausal women) or 1 to 1.2 g/day in other adults. It is preferred to obtain these daily amounts primarily through dietary sources. There is no evidence that intakes higher than these improve bone strength (Ref).

Hyperphosphatemia in chronic kidney disease, treatment

Hyperphosphatemia in chronic kidney disease, treatment (off-label use):

Note: Use in combination with dietary phosphate restriction (Ref).

Oral: Initial: Start with low initial doses (eg, 500 mg calcium carbonate 3 times per day with meals) (Ref).

Dosage adjustment: Increase or decrease dose every 2 to 3 weeks as needed to obtain targeted serum phosphorus concentrations. Usual dosage range: 1,250 to 3,750 mg calcium carbonate per day in divided doses with meals (Ref).

Note: Do not exceed 3,750 mg/day calcium carbonate (1,500 mg/day elemental calcium) and limit total elemental calcium intake from all sources (ie, dietary and phosphate binders) to ≤2,000 mg/day (Ref). Monitor serum calcium concentrations and consider non-calcium-containing phosphate binders if hypercalcemia develops; do not administer additional calcium supplements.

Hypocalcemia, chronic

Hypocalcemia, chronic (off-label use):

Note: Use of IV calcium may be required in patients who become unable to take or absorb oral calcium. Vitamin D replacement may also be required depending on the cause of hypocalcemia (eg, hypoparathyroidism, vitamin D deficiency). Correct concurrent hypomagnesemia if present (Ref). These recommendations do not apply to patients with chronic kidney disease; refer to specific dosing recommendations in this population (eg, for hyperphosphatemia).

Oral: Initial: 1 to 2 g/day of elemental calcium administered in 2 to 3 divided doses; adjust dose as needed to control symptoms and maintain albumin-corrected calcium levels in the low-normal range (Ref).

Hypoparathyroidism, acute postsurgical, mild

Hypoparathyroidism, acute postsurgical, mild (off-label use):

Note: For use in patients with mild symptoms (eg, oral paresthesias) and/or an albumin-corrected serum calcium level below normal but ≥7.5 mg/dL (≥1.87 mmol/L); use of IV calcium is required in patients with more severe symptoms of hypocalcemia, patients unable to take or absorb oral calcium, or patients whose symptoms do not improve with oral therapy. Correct concurrent hypomagnesemia if present and initiate vitamin D replacement as soon as feasible (Ref).

Oral: Initial: 1 to 4 g/day of elemental calcium administered in 2 to 3 divided doses; adjust dose as needed to control symptoms and maintain albumin-corrected calcium levels in the low-normal range (Ref). Note: Postsurgical hypoparathyroidism may be transient; attempt a slow taper of calcium and vitamin D supplements starting 3 to 6 weeks after surgery (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function:

eGFR ≥60 mL/minute/1.73 m2: No dosage adjustment necessary (Ref).

eGFR <60 mL/minute/1.73 m2: There are no specific dosage adjustments recommended; however, a positive calcium balance (calculated by subtracting total body calcium losses from total calcium inputs) has been associated with increased mortality in patients with chronic kidney disease (CKD) (Ref). Daily elemental calcium intake (including dietary sources and calcium-based phosphate binders) recommendations in patients with CKD G3A through G5D (patients on hemodialysis, peritoneal dialysis) vary; one guideline recommends not exceeding 2,000 mg/day (Ref), but more recent short-term studies in nondialysis patients suggest limiting intake to 800 to 1,000 mg/day (Ref). Decisions regarding calcium carbonate use and dose must be individualized to the patient, and hypercalcemia should be avoided (Ref).

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Older Adult

Refer to adult dosing.

Dosing: Pediatric

(For additional information see "Calcium carbonate: Pediatric drug information")

Antacid

Antacid: Note: Chronic antacid therapy not recommended for management of gastroesophageal reflux disease in pediatric patients (Ref). OTC products may vary in approved ages and uses; consult product-specific labeling for details.

Children 2 to 5 years, weighing >10.9 kg: Dose expressed as calcium carbonate: Oral: 400 mg as symptoms occur for up to 2 weeks; maximum daily dose: 1,200 mg/day.

Children 6 to 11 years: Dose expressed as calcium carbonate: Oral: 800 mg as symptoms occur for up to 2 weeks; maximum daily dose: 2,400 mg/day.

Children ≥12 years and Adolescents: Dose expressed as calcium carbonate: Oral: 1,000 to 3,000 mg as symptoms occur for up to 2 weeks; maximum daily dose: 7,500 mg/day.

Hyperphosphatemia in chronic kidney disease

Hyperphosphatemia in chronic kidney disease: Limited data available: Infants, Children, and Adolescents: Oral: Calcium provided from phosphate binders should be limited to 1,500 mg/day of elemental calcium and total calcium intake (including dietary sources and calcium-based phosphate binders) should not exceed 2,000 mg/day of elemental calcium (Ref).

Hypocalcemia, asymptomatic

Hypocalcemia, asymptomatic: Limited data available: Infants, Children, and Adolescents: Dose expressed as elemental calcium: Oral: 30 to 75 mg/kg/day in 4 to 5 divided doses (Ref).

Rickets, treatment

Rickets, treatment: Limited data available: Infants, Children, and Adolescents: Dose expressed as elemental calcium: Oral: 30 to 75 mg/kg/day in 3 divided doses; begin at higher end of range and titrate downward over 2 to 4 weeks (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Infants, Children, and Adolescents: Initiate at the lowest dose of the recommended dosage range; monitor serum calcium concentrations closely. Accumulation may occur with renal impairment and subsequent doses may require adjustment based on serum calcium concentrations.

Dosing: Hepatic Impairment: Pediatric

Infants, Children, and Adolescents: There are no dosage adjustments provided in the manufacturer's labeling. No initial dosage adjustment necessary; subsequent doses should be guided by serum calcium concentrations.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Well tolerated

1% to 10%:

Central nervous system: Headache, laxative effect

Endocrine & metabolic: Hypercalcemia, hypophosphatemia, milk-alkali syndrome (with very high, chronic dosing and/or renal failure [headache, nausea, irritability, and weakness or alkalosis, hypercalcemia, renal impairment])

Gastrointestinal: Abdominal pain, anorexia, constipation, flatulence, hyperacidity (acid rebound), nausea, vomiting, xerostomia

Contraindications

Hypersensitivity to any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Gastrointestinal effects: Constipation, bloating, and gas are common with calcium supplements (especially carbonate salt) (IOM 2011).

• Hypercalcemia: Chronic hypercalcemia may result in generalized vascular and soft tissue calcification, exacerbate nephrolithiasis, and has been associated with increased mortality in adults with chronic kidney disease (CKD) (KDIGO 2017).

Disease-related concerns:

• Achlorhydria: Calcium absorption is impaired in achlorhydria; administration is followed by increased gastric acid secretion within 2 hours of administration especially with high doses. Common in older adults, use an alternate salt (eg, citrate) and administer with food (IOM 2011; Recker 1985).

• Chronic kidney disease: In CKD patients receiving phosphate-lowering treatment, consider using non-calcium-based phosphate-lowering agents (eg, sevelamer, lanthanum) as an alternative to calcium-based phosphate-lowering agents (eg, calcium acetate, calcium carbonate) or restricting the dose of the calcium-based phosphate-lowering agents (Allison 2013; KDIGO 2017). A meta-analysis observed a trend towards a decrease in all-cause mortality in CKD patients receiving non-calcium-based phosphate-lowering agents compared with those receiving calcium-based phosphate-lowering agents (Jamal 2013); however, further research is needed to identify causes of mortality and fully assess safety of long-term use based on phosphate-lowering agent type.

• Hypoparathyroid disease: Hypercalcemia and hypercalciuria are most likely to occur in patients with hypoparathyroidism who are receiving high doses of vitamin D.

• Kidney stones (calcium-containing): Use caution when administering calcium supplements to patients with a history of kidney stones (IOM 2011).

Other warnings/precautions:

• 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.

Dosage Forms Considerations

1 g calcium carbonate = elemental calcium 400 mg = calcium 20 mEq = calcium 10 mmol

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Florical: 364 mg (elemental calcium 145 mg) and fluoride 3.75 mg

Powder, Oral:

TC Max: 588 mg/10 g (500 g) [corn free, dairy free, protein free, soy free]

Generic: Elemental calcium 800 mg/2 g (480 g)

Suspension, Oral:

Generic: 1250 mg (elemental calcium 500 mg) per 5 mL (5 mL, 473 mL, 500 mL)

Tablet, Oral:

Calcium 600: 1500 mg (elemental calcium 600 mg) [DSC]

Calcium 600: 1500 mg (elemental calcium 600 mg) [DSC] [scored]

Calcium 600: 1500 mg (elemental calcium 600 mg) [contains soy polysaccarides]

Calcium High Potency: 1500 mg (elemental calcium 600 mg) [contains fd&c yellow #6 (sunset yellow)]

Caltrate 600: 1500 mg (elemental calcium 600 mg) [DSC]

Florical: 364 mg (elemental calcium 145 mg) and fluoride 3.75 mg

Generic: 648 mg, 1250 mg (elemental calcium 500 mg), 1500 mg (elemental calcium 600 mg)

Tablet, Oral [preservative free]:

Calcium 600: 1500 mg (elemental calcium 600 mg) [DSC] [lactose free, salt free, sugar free]

Generic: 1250 mg (elemental calcium 500 mg), 1500 mg (elemental calcium 600 mg) [DSC]

Tablet Chewable, Oral:

Alcalak: 420 mg [DSC] [contains aspartame; mint flavor]

Antacid: 500 mg

Antacid: 500 mg [peppermint flavor]

Antacid: 500 mg [contains fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine)aluminum lake, fd&c yellow #6(sunset yellow)alumin lake]

Antacid: 500 mg [contains fd&c blue #1 (brilliant blue), fd&c yellow #6 (sunset yellow), quinoline yellow (d&c yellow #10)]

Antacid Calcium: 500 mg [peppermint flavor]

Antacid Calcium: 500 mg [gluten free; peppermint flavor]

Antacid Calcium Rich: 500 mg [sodium free; contains fd&c blue #1 (brill blue) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake]

Antacid Extra Strength: 750 mg [contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake; assorted flavor]

Cal-Gest Antacid: 500 mg [contains fd&c blue #1 (brill blue) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake; assorted fruit flavor]

Cal-Mint: Elemental calcium 260 mg [animal products free, gelatin free, gluten free, lactose free, no artificial color(s), no artificial flavor(s), starch free, sugar free, yeast free]

Calcium Antacid: 500 mg [DSC] [contains fd&c blue #1 (brill blue) aluminum lake]

Calcium Antacid: 500 mg [contains fd&c blue #1 (brill blue) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake; assorted fruit flavor]

Calcium Antacid: 500 mg [contains fd&c blue #1 (brilliant blue), fd&c red #40 (allura red ac dye), fd&c yellow #6 (sunset yellow), quinoline yellow (d&c yellow #10)]

Calcium Antacid Extra Strength: 750 mg [contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake; assorted flavor]

Calcium Antacid Extra Strength: 750 mg [DSC] [contains fd&c blue #1 (brilliant blue), fd&c red #40 (allura red ac dye)]

FT Antacid Extra Strength: 750 mg [contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake]

FT Antacid Extra Strength: 750 mg [sugar free; contains aspartame, fd&c yellow #6(sunset yellow)alumin lake]

FT Antacid Regular Strength: 500 mg [contains corn starch]

FT Antacid Regular Strength: 500 mg [contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake]

GoodSense Antacid: 500 mg [contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake]

GoodSense Antacid: 500 mg [gluten free; contains corn starch; peppermint flavor]

GoodSense Antacid: 750 mg [gluten free; contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake; assorted flavor]

GoodSense Antacid: 750 mg [gluten free; contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake; assorted flavor]

GoodSense Antacid: 1000 mg [gluten free; contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake; assorted flavor]

GoodSense Antacid: 1000 mg [gluten free; contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake; assorted flavor]

GoodSense Antacid Extra Str: 750 mg [contains corn starch, fd&c yellow #6(sunset yellow)alumin lake, quinoline (d&c yellow #10) aluminum lake]

GoodSense Antacid Extra Str: 750 mg [gluten free; contains coconut oil (copra/cocos nucifera oil), corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine)aluminum lake, fd&c yellow #6 (sunset yellow), fd&c yellow #6(sunset yellow)alumin lake, methylparaben, propylparaben, sodium benzoate, soybean lecithin, soybean oil]

Maalox: 600 mg [contains aspartame; wild berry flavor]

Maalox Childrens: 400 mg [contains aspartame; wild berry flavor]

Medi-First Antacid: 420 mg [contains aspartame; mint flavor]

Titralac: 420 mg [low sodium, sugar free; contains saccharin]

Tums: 500 mg [peppermint flavor]

Tums: 500 mg [gluten free]

Tums: 500 mg [gluten free; contains fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine), fd&c yellow #6(sunset yellow)alumin lake]

Tums Chewy Bites: 750 mg [contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c blue #2 (indigo carm) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine)aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, methylparaben, propylparaben, sodium benzoate, soybean lecithin, soybean oil]

Tums Chewy Delights: 1177 mg [contains coconut oil (copra/cocos nucifera oil), corn starch, fd&c yellow #6 (sunset yellow), soybean lecithin]

Tums Chewy Delights: 1177 mg [contains fd&c red #40(allura red ac)aluminum lake, soybean lecithin; cherry flavor]

Tums E-X 750: 750 mg

Tums E-X 750: 750 mg [assorted flavor]

Tums E-X 750: 750 mg [gluten free; contains fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake; assorted berries flavor]

Tums E-X 750: 750 mg [sugar free]

Tums Extra Strength 750: 750 mg [gluten free; contains fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine)aluminum lake, fd&c yellow #6(sunset yellow)alumin lake; assorted fruit flavor]

Tums Extra Strength 750: 750 mg [sugar free; contains fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine)aluminum lake]

Tums Lasting Effects: 500 mg [contains fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine), fd&c yellow #6(sunset yellow)alumin lake]

Tums Smoothies: 750 mg [peppermint flavor]

Tums Smoothies: 750 mg [contains fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, soybeans (glycine soja); assorted tropical fruit flavor]

Tums Smoothies: 750 mg [contains fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, soybeans (glycine soja); berry flavor]

Tums Smoothies: 750 mg [gluten free; contains corn starch, fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine)aluminum lake, fd&c yellow #6(sunset yellow)alumin lake, soybeans (glycine soja)]

Tums Ultra 1000: 1000 mg [DSC]

Tums Ultra 1000: 1000 mg [peppermint flavor]

Tums Ultra 1000: 1000 mg [contains fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine)aluminum lake, fd&c yellow #6(sunset yellow)alumin lake; assorted berries flavor]

Tums Ultra 1000: 1000 mg [contains fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine), fd&c yellow #6(sunset yellow)alumin lake; assorted tropical fruit flavor]

Tums Ultra 1000: 1000 mg [gluten free; contains fd&c blue #1 (brill blue) aluminum lake, fd&c red #40(allura red ac)aluminum lake, fd&c yellow #5 (tartrazine), fd&c yellow #6(sunset yellow)alumin lake]

Generic: 500 mg, 750 mg [DSC], 1250 mg (elemental calcium 500 mg), Elemental calcium 260 mg

Generic Equivalent Available: US

May be product dependent

Pricing: US

Capsules (Florical Oral)

8.3-364 mg (per each): $0.12

Chewable (Cal-Gest Antacid Oral)

500 mg (per each): $0.02

Chewable (Calcium Carbonate Antacid Oral)

500 mg (per each): $0.02 - $0.03

Chewable (Calcium Carbonate Oral)

1250 (500 Ca) mg (per each): $0.08

Chewable (Maalox Childrens Oral)

400 mg (per each): $0.13

Chewable (Maalox Oral)

600 mg (per each): $0.03

Chewable (Titralac Oral)

420 mg (per each): $0.05

Chewable (Tums Chewy Bites Oral)

750 mg (per each): $0.21

Chewable (Tums Chewy Delights Oral)

1177 mg (per each): $0.15

Chewable (Tums E-X 750 Oral)

750 mg (per each): $0.04

Chewable (Tums Extra Strength 750 Oral)

750 mg (per each): $0.07

Chewable (Tums Lasting Effects Oral)

500 mg (per each): $0.09

Chewable (Tums Oral)

500 mg (per each): $0.05

Chewable (Tums Smoothies Oral)

750 mg (per each): $0.08

Chewable (Tums Ultra 1000 Oral)

1000 mg (per each): $0.07

Suspension (Calcium Carbonate Antacid Oral)

1250 mg/5 mL (per mL): $0.03

Tablets (Calcium Carbonate Antacid Oral)

648 mg (per each): $0.01

Tablets (Calcium Carbonate Oral)

1500 (600 Ca) mg (per each): $0.04

Tablets (Florical Oral)

8.3-364 mg (per each): $0.11

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

Oral: Administer with food. Doses >600 mg (elemental calcium) per day should be divided for optimal absorption (Ref).

Capsules may be swallowed whole or opened and the contents mixed with food or drink. Shake suspension well before use.

Administration: Pediatric

Oral: Administer with plenty of fluids with or immediately following meals; if using for phosphate-binding, administer with meals.

Suspension: Shake well before administration.

Chewable tablets: Thoroughly chew tablets before swallowing.

Use: Labeled Indications

Antacid, various GI symptoms (eg, acid indigestion), including gastroesophageal reflux disease, intermittent symptom relief: For the relief of acid indigestion, heartburn, sour stomach, and GI upset associated with these symptoms (ACG [Katz 2022]).

Calcium supplementation: For use as a dietary supplement when calcium intake may be inadequate (eg, osteoporosis, osteomalacia, hypocalcemic rickets) (IOM 2011)

Use: Off-Label: Adult

Hyperphosphatemia in chronic kidney disease, treatment; Hypocalcemia, chronic; Hypoparathyroidism, acute postsurgical, mild

Medication Safety Issues
Sound-alike/look-alike issues:

Calcium carbonate may be confused with calcitriol

Children’s Pepto may be confused with Pepto-Bismol products

Maalox and Children’s Maalox may be confused with other Maalox products

Mylanta may be confused with Mynatal

Os-Cal [DSC] may be confused with Asacol

International issues:

Remegel [Hungary, Great Britain, and Ireland] may be confused with Renagel brand name for sevelamer [US, Canada, and multiple international markets]

Remegel: Brand name for calcium carbonate [Hungary, Great Britain, and Ireland], but also the brand name for aluminum hydroxide and magnesium carbonate [Netherlands]

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Acalabrutinib: Antacids may decrease the serum concentration of Acalabrutinib. Management: Separate administration of acalabrutinib capsules from the administration of any antacid by at least 2 hours in order to minimize the potential for a significant interaction. Acalabrutinib tablets are not expected to interact with antacids. Risk D: Consider therapy modification

Alpha-Lipoic Acid: Calcium Salts may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Calcium Salts. Management: Separate administration of alpha-lipoic acid from that of any calcium-containing compounds by several hours. If alpha-lipoic acid is given 30 minutes before breakfast, then administer oral calcium-containing products at lunch or dinner. Risk D: Consider therapy modification

Antipsychotic Agents (Phenothiazines): Antacids may decrease the absorption of Antipsychotic Agents (Phenothiazines). Risk C: Monitor therapy

Atazanavir: Antacids may decrease the absorption of Atazanavir. Management: Administer antacids 1 to 2 hours before or 2 hours after atazanavir to minimize the risk of a clinically significant interaction. Risk D: Consider therapy modification

Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Risk X: Avoid combination

Belumosudil: Antacids may decrease the serum concentration of Belumosudil. Management: Consider separating administration of belumosudil and antacids by 2 hours and monitor for reduced belumosudil efficacy. Risk D: Consider therapy modification

Bictegravir: Calcium Salts may decrease the serum concentration of Bictegravir. Management: Bictegravir can be given with calcium under fed conditions. When fasting, coadministration with, or 2 hours after, calcium is not recommended. In pregnancy, bictegravir can be given 2 hours before or 6 hours after calcium under fasting conditions. Risk D: Consider therapy modification

Bisacodyl: Antacids may diminish the therapeutic effect of Bisacodyl. Antacids may cause the delayed-release bisacodyl tablets to release drug prior to reaching the large intestine. Gastric irritation and/or cramps may occur. Management: Antacids should not be used within 1 hour before bisacodyl administration. Risk D: Consider therapy modification

Bismuth Subcitrate: Antacids may diminish the therapeutic effect of Bismuth Subcitrate. Management: Avoid administration of antacids within 30 minutes of bismuth subcitrate (tripotassium bismuth dicitrate) administration. Risk D: Consider therapy modification

Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider therapy modification

Bosutinib: Antacids may decrease the serum concentration of Bosutinib. Management: Administer antacids more than 2 hours before or after bosutinib. Risk D: Consider therapy modification

Bromperidol: Antacids may decrease the absorption of Bromperidol. Risk C: Monitor therapy

Cabotegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider therapy modification

Calcium Acetate: Calcium Salts may enhance the adverse/toxic effect of Calcium Acetate. Risk X: Avoid combination

Calcium Channel Blockers: Calcium Salts may diminish the therapeutic effect of Calcium Channel Blockers. Risk C: Monitor therapy

Calcium Polystyrene Sulfonate: Antacids may enhance the adverse/toxic effect of Calcium Polystyrene Sulfonate. The combined use of these two agents may result in metabolic alkalosis. Risk C: Monitor therapy

Captopril: Antacids may decrease the serum concentration of Captopril. Risk C: Monitor therapy

Cardiac Glycosides: Calcium Salts may enhance the arrhythmogenic effect of Cardiac Glycosides. Risk C: Monitor therapy

Cefditoren: Antacids may decrease the serum concentration of Cefditoren. Risk X: Avoid combination

Cefpodoxime: Antacids may decrease the serum concentration of Cefpodoxime. Risk C: Monitor therapy

Cefuroxime: Antacids may decrease the serum concentration of Cefuroxime. Management: Administer cefuroxime axetil at least 1 hour before or 2 hours after the administration of short-acting antacids. Taking cefuroxime with food may lessen the magnitude of this interaction. Risk D: Consider therapy modification

Chloroquine: Antacids may decrease the serum concentration of Chloroquine. Management: Separate the administration of antacids and chloroquine by at least 4 hours to minimize any potential negative impact of antacids on chloroquine bioavailability. Risk D: Consider therapy modification

Corticosteroids (Oral): Antacids may decrease the bioavailability of Corticosteroids (Oral). Management: Consider separating doses by 2 or more hours. Budesonide enteric coated tablets could dissolve prematurely if given with drugs that lower gastric acid, with unknown impact on budesonide therapeutic effects. Risk D: Consider therapy modification

Cysteamine (Systemic): Antacids may diminish the therapeutic effect of Cysteamine (Systemic). Risk C: Monitor therapy

Dabigatran Etexilate: Antacids may decrease the serum concentration of Dabigatran Etexilate. Management: Dabigatran etexilate Canadian product labeling recommends avoiding concomitant use with antacids for 24 hours after surgery. In other situations, administer dabigatran etexilate 2 hours prior to antacids. Monitor clinical response to dabigatran therapy. Risk D: Consider therapy modification

Dasatinib: Antacids may decrease the serum concentration of Dasatinib. Management: Simultaneous administration of dasatinib and antacids should be avoided. Administer antacids 2 hours before or 2 hours after dasatinib. Risk D: Consider therapy modification

Deferiprone: Polyvalent Cation Containing Products 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. Risk D: Consider therapy modification

Delavirdine: Antacids may decrease the serum concentration of Delavirdine. Management: Separate doses of delavirdine and antacids by at least 1 hour. Monitor for decreased delavirdine therapeutic effects with this combination. Risk D: Consider therapy modification

Diacerein: Antacids may decrease the absorption of Diacerein. Risk C: Monitor therapy

DOBUTamine: Calcium Salts may diminish the therapeutic effect of DOBUTamine. Risk C: 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. Administer dolutegravir/rilpivirine at least 4 hours before or 6 hours after oral calcium salts. Alternatively, dolutegravir and oral calcium can be taken together with food. Risk D: Consider therapy modification

Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider therapy modification

Elvitegravir: Antacids may decrease the serum concentration of Elvitegravir. Management: Separate administration of aluminum and magnesium containing antacids and elvitegravir-containing products by at least 2 hours in order to minimize the risk for an interaction. Risk D: Consider therapy modification

Erdafitinib: Serum Phosphate Level-Altering Agents may diminish the therapeutic effect of Erdafitinib. Management: Avoid coadministration of serum phosphate level-altering agents with erdafitinib before initial dose increase period based on serum phosphate levels (Days 14 to 21). Risk D: Consider therapy modification

Erlotinib: Antacids may decrease the serum concentration of Erlotinib. Management: Separate the administration of erlotinib and any antacid by several hours in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification

Estramustine: Calcium Salts may decrease the absorption of Estramustine. Management: Administer estramustine on an empty stomach, at least 1 hour before or 2 hours after the dose of an oral calcium supplement. If coadministered with calcium salts, monitor for decreased estramustine therapeutic effects. Risk D: Consider therapy modification

Fosinopril: Antacids may decrease the serum concentration of Fosinopril. Management: The US and Canadian fosinopril manufacturer labels recommend separating the doses of antacids and fosinopril by 2 hours. Risk D: Consider therapy modification

Gefitinib: Antacids may decrease the serum concentration of Gefitinib. Management: Administer gefitinib at least 6 hours before or 6 hours after administration of an antacid, and closely monitor clinical response to gefitinib. Risk D: Consider therapy modification

Hyoscyamine: Antacids may decrease the serum concentration of Hyoscyamine. Management: Administer immediate release and sublingual oral hyoscyamine before meals, and antacids after meals, when these agents are given in combination. Risk D: Consider therapy modification

Infigratinib: Antacids may decrease serum concentrations of the active metabolite(s) of Infigratinib. Antacids may decrease the serum concentration of Infigratinib. Management: Avoid coadministration of infigratinib with antacids or other gastric acid-lowering agents. If antacids cannot be avoided, administer infigratinib 2 hours before or after administration of antacids. Risk D: Consider therapy modification

Iron Preparations: Antacids may decrease the absorption of Iron Preparations. Management: No action is likely necessary for the majority of patients who only use antacids intermittently or occasionally. Consider separating doses of oral iron and antacids in patients who require chronic use of both agents and monitor for reduced iron efficacy. Risk D: Consider therapy modification

Isoniazid: Antacids may decrease the absorption of Isoniazid. Risk C: Monitor therapy

Itraconazole: Antacids may decrease the serum concentration of Itraconazole. Antacids may increase the serum concentration of Itraconazole. Management: Administer Sporanox brand itraconazole at least 2 hours before or 2 hours after administration of any antacids. Exposure to Tolsura brand itraconazole may be increased by antacids; consider itraconazole dose reduction. Risk D: Consider therapy modification

Ketoconazole (Systemic): Antacids may decrease the serum concentration of Ketoconazole (Systemic). Management: Administer antacids at least 1 hour prior to, or 2 hours after, ketoconazole. Additionally, administer ketoconazole with an acidic beverage (eg, non-diet cola) and monitor patients closely for signs of inadequate clinical response to ketoconazole. Risk D: Consider therapy modification

Lanthanum: Antacids may diminish the therapeutic effect of Lanthanum. Management: Administer antacid products at least 2 hours before or after lanthanum. Risk D: Consider therapy modification

Ledipasvir: Antacids may decrease the serum concentration of Ledipasvir. Management: Separate the administration of ledipasvir and antacids by 4 hours. Risk D: Consider therapy modification

Levoketoconazole: Antacids may decrease the absorption of Levoketoconazole. Management: Advise patients to take antacids at least 2 hours after taking levoketoconazole. Risk D: Consider therapy modification

Levonadifloxacin: Calcium Salts may decrease the serum concentration of Levonadifloxacin. Risk X: Avoid combination

Levonadifloxacin: Antacids may decrease the serum concentration of Levonadifloxacin. Risk X: Avoid combination

Mesalamine: Antacids may diminish the therapeutic effect of Mesalamine. Antacid-mediated increases in gastrointestinal pH may cause the premature release of mesalamine from specific sustained-release mesalamine products. Management: Avoid concurrent administration of antacids with the Apriso brand of mesalamine extended-release capsules. The optimal duration of dose separation is unknown. Other mesalamine products do not contain this interaction warning. Risk D: Consider therapy modification

Methenamine: Antacids may diminish the therapeutic effect of Methenamine. Management: Consider avoiding the concomitant use of medications that alkalinize the urine, such as antacids, and methenamine. Monitor for decreased therapeutic effects of methenamine if used concomitant with antacids. Risk D: 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. Risk D: Consider therapy modification

Multivitamins/Minerals (with ADEK, Folate, Iron): Antacids may decrease the serum concentration of Multivitamins/Minerals (with ADEK, Folate, Iron). Specifically, antacids may decrease the absorption of orally administered iron. Management: Separate dosing of oral iron-containing multivitamins and antacids by as much time as possible to minimize impact of this interaction. Monitor for decreased therapeutic efficacy of oral iron preparations during coadministration. Risk D: Consider therapy modification

Neratinib: Antacids may decrease the serum concentration of Neratinib. Specifically, antacids may reduce neratinib absorption. Management: Separate the administration of neratinib and antacids by giving neratinib at least 3 hours after the antacid. Risk D: Consider therapy modification

Nilotinib: Antacids may decrease the serum concentration of Nilotinib. Management: Separate the administration of nilotinib and any antacid by at least 2 hours whenever possible in order to minimize the risk of a significant interaction. Risk D: Consider therapy modification

Nirogacestat: Antacids may decrease the serum concentration of Nirogacestat. Management: If acid-reducing therapy is required, separate nirogacestat administration from antacids by 2 hours. Risk D: Consider therapy modification

Octreotide: Antacids may decrease the serum concentration of Octreotide. Risk C: Monitor therapy

PAZOPanib: Antacids may decrease the serum concentration of PAZOPanib. Management: Avoid the use of antacids in combination with pazopanib whenever possible. Separate doses by several hours if antacid treatment is considered necessary. The impact of dose separation has not been investigated. Risk D: Consider therapy modification

PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider therapy modification

Pexidartinib: Antacids may decrease the serum concentration of Pexidartinib. Management: Administer pexidartinib at least 2 hours before or 2 hours after antacids. Risk D: Consider therapy modification

Phosphate Supplements: Antacids may decrease the absorption of Phosphate Supplements. Management: This applies only to oral phosphate administration. Separating administration of oral phosphate supplements from antacid administration by as long as possible may minimize the interaction. Risk D: 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 as far apart from the administration of an oral calcium salt as possible may be able to minimize the significance of the interaction. Risk D: Consider therapy modification

Potassium Phosphate: Antacids may decrease the serum concentration of Potassium Phosphate. Management: Consider separating administration of antacids and oral potassium phosphate by at least 2 hours to decrease risk of a significant interaction. Risk D: Consider therapy modification

Quinolones: Antacids may decrease the absorption of Quinolones. Of concern only with oral administration of quinolones. Management: Avoid concurrent administration of quinolones and antacids to minimize the impact of this interaction. Recommendations for optimal dose separation vary by specific quinolone; see full monograph for details. Risk D: Consider therapy modification

Quinolones: Calcium Salts may decrease the absorption of Quinolones. Of concern only with oral administration of both agents. Management: Consider administering an oral quinolone at least 2 hours before or 6 hours after the dose of oral calcium to minimize this interaction. Monitor for decreased therapeutic effects of quinolones during coadministration. Risk D: Consider therapy modification

Raltegravir: Calcium Carbonate may decrease the serum concentration of Raltegravir. Management: Use of once-daily raltegravir with calcium carbonate is not recommended; dose separation does not appear to be adequate to minimize the significance of this interaction. Use of other raltegravir products do not require any dose change. Risk D: Consider therapy modification

Rilpivirine: Antacids may decrease the serum concentration of Rilpivirine. Management: Administer antacids at least 2 hours before or 4 hours after oral rilpivirine when used with most rilpivirine products. However, administer antacids at least 6 hours before or 4 hours after the rilpivirine/dolutegravir combination product. Risk D: Consider therapy modification

Riociguat: Antacids may decrease the serum concentration of Riociguat. Management: Separate the administration of antacids and riociguat by at least 1 hour in order to minimize any potential interaction. Monitor clinical response to riociguat more closely in patients using this combination. Risk D: Consider therapy modification

Rosuvastatin: Antacids may decrease the serum concentration of Rosuvastatin. Risk C: Monitor therapy

Roxadustat: Polyvalent Cation Containing Products may decrease the serum concentration of Roxadustat. Management: Administer roxadustat at least 1 hour after the administration of oral polyvalent cation containing products. Risk D: Consider therapy modification

Selpercatinib: Antacids may decrease the serum concentration of Selpercatinib. Management: Coadministration of selpercatinib and antacids should be avoided. If coadministration cannot be avoided, selpercatinib should be administered 2 hours before or 2 hours after antacids. Risk D: Consider therapy modification

Sodium Polystyrene Sulfonate: Antacids may enhance the adverse/toxic effect of Sodium Polystyrene Sulfonate. Specifically, the risk of metabolic alkalosis may be increased. Antacids may diminish the therapeutic effect of Sodium Polystyrene Sulfonate. Risk C: Monitor therapy

Sotalol: Antacids may decrease the serum concentration of Sotalol. Management: Avoid simultaneous administration of sotalol and antacids. Administer antacids 2 hours after sotalol. Risk D: Consider therapy modification

Sotorasib: Antacids may decrease the serum concentration of Sotorasib. Management: Avoid coadministration of sotorasib and antacids. If use of a gastric acid suppressing medication cannot be avoided, administer sotorasib 4 hours before or 10 hours after oral antacid administration. Risk D: Consider therapy modification

Sparsentan: Antacids may decrease the serum concentration of Sparsentan. Management: Administer sparsentan 2 hours before or 2 hours after antacids. Risk D: 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. Risk D: Consider therapy modification

Sucralfate: Antacids may diminish the therapeutic effect of Sucralfate. Management: Consider separating the administration of antacids and sucralfate by at least 30 minutes. Risk D: Consider therapy modification

Sulpiride: Antacids may decrease the serum concentration of Sulpiride. Management: Separate administration of antacids and sulpiride by at least 2 hours in order to minimize the impact of antacids on sulpiride absorption. Risk D: Consider therapy modification

Tetracyclines: Antacids may decrease the absorption of Tetracyclines. Management: Separate administration of antacids and oral tetracycline derivatives by several hours when possible to minimize the extent of this potential interaction. Monitor for decreased therapeutic effects of tetracyclines. Risk D: Consider therapy modification

Tetracyclines: Calcium Salts may decrease the serum concentration of Tetracyclines. Management: If coadministration of oral calcium with oral tetracyclines cannot be avoided, consider separating administration of each agent by several hours. Risk D: Consider therapy modification

Thiazide and Thiazide-Like Diuretics: May increase the serum concentration of Calcium Salts. Risk C: 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. Monitor for decreased therapeutic effects of thyroid products if an oral calcium supplement is initiated/dose increased. Risk D: Consider therapy modification

Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant use of trientine and polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. For other oral polyvalent cations, give trientine 1 hour before, or 1 to 2 hours after the polyvalent cation. Risk D: Consider therapy modification

Unithiol: May diminish the therapeutic effect of Polyvalent Cation Containing Products. Risk X: Avoid combination

Vadadustat: Phosphate Binders may decrease the serum concentration of Vadadustat. Management: Administer vadadustat at least 1 hour before or 2 hours after phosphate binders. Risk D: Consider therapy modification

Velpatasvir: Antacids may decrease the serum concentration of Velpatasvir. Management: Separate administration of velpatasvir and antacids by at least 4 hours. Risk D: Consider therapy modification

Vitamin D Analogs: Calcium Salts may enhance the adverse/toxic effect of Vitamin D Analogs. Risk C: Monitor therapy

Food Interactions

Food may increase calcium absorption. Calcium may decrease iron absorption. Bran, foods high in oxalates, or whole grain cereals may decrease calcium absorption. Management: Administer with food.

Pregnancy Considerations

Calcium crosses the placenta (IOM 2011).

Calcium is required for fetal growth. Intestinal absorption and urinary excretion of calcium increase during pregnancy. The amount of calcium reaching the fetus is determined by maternal physiological changes which are generally not influenced by maternal diet or supplementation (IOM 2011; Prentice 2000).

Calcium requirements are the same in pregnant and nonpregnant females; the recommended dietary allowance (RDA) is not increased in pregnancy (IOM 2011).

When dietary changes and lifestyle modifications are insufficient, calcium carbonate may be used for the treatment of heartburn or gastroesophageal reflux in pregnant women when used in usual recommended doses (Body 2016; Dağlı 2017; Gomes 2018; Thélin 2020). High doses of calcium carbonate should be avoided (Thélin 2020). Chronic use of high doses of calcium carbonate as an antacid throughout pregnancy may lead to hypocalcemia and seizures in the neonate (Borkenhagen 2013; Robertson 2002) or severe hypercalcemia presenting as milk-alkali syndrome in the mother (D’Souza 2013; Gordon 2005; Kolnick 2011; Picolos 2004; Trezevant 2017).

Breastfeeding Considerations

Calcium is present in breast milk (IOM 2011).

Calcium is required for milk production. The amount of calcium in breast milk is homeostatically regulated and not altered by maternal calcium intake. Actual milk concentrations of calcium are variable between women and within the same female at various times during the lactation period (IOM 2011; Prentice 2000).

Calcium requirements are the same in lactating and nonlactating females; the recommended dietary allowance (RDA) is not increased in breastfeeding women (IOM 2011). Antacids are considered acceptable for use in breastfeeding females when used in recommended doses (Thélin 2020). Chronic use of high doses of calcium carbonate as an antacid may cause severe hypercalcemia presenting as milk-alkali syndrome in the mother (Caplan 2004; Murphy 2016).

Dietary Considerations

Take with food. Limit intake of bran, foods high in oxalates, or whole grain cereals which may decrease calcium absorption.

Some products may contain phenylalanine and/or sodium.

Dietary reference intake for calcium (IOM 2011):

0 to <6 months: Adequate intake: 200 mg elemental calcium/day.

6 to 12 months: Adequate intake: 260 mg elemental calcium/day.

1 to 3 years: Recommended dietary allowance (RDA): 700 mg elemental calcium/day.

4 to 8 years: RDA: 1,000 mg elemental calcium/day.

9 to 18 years: RDA: 1,300 mg elemental calcium/day.

19 to 50 years: RDA: 1,000 mg elemental calcium/day.

51 to 70 years: RDA:

Females: 1,200 mg elemental calcium/day.

Males: 1,000 mg elemental calcium/day.

>70 years: RDA: 1,200 mg elemental calcium/day.

Pregnancy/Lactating: RDA: Requirements are the same as in nonpregnant or nonlactating females.

Monitoring Parameters

Monitor plasma calcium levels if using calcium salts as electrolyte supplements for deficiency.

Calcium supplementation in hypoparathyroidism (ES [Brandi 2016]): Note: Frequency of measurement is dependent upon on how stable a patient is to a given dosage regimen with more frequent measurements (eg, weekly) required initially during dosage titration. Once patient is well controlled, monitoring may be required on a yearly or twice-yearly basis.

Serum calcium, phosphate, and magnesium; renal function (ie, 24-hour urinary calcium and creatinine, blood urea nitrogen [BUN]), measured CrCl or estimated glomerular filtration rate (eGFR); renal imaging (every 5 years in asymptomatic patients with a history of renal lithiasis or calcinosis or more frequently as indicated); CNS imaging (basal ganglia and other sites of calcification), ophthalmologic exam, and/or BMD as clinically indicated

Hyperphosphatemia in Chronic Kidney Disease:

CKD stage G3a to G3b: Serum calcium and phosphate: Every 6 to 12 months; PTH: Frequency based on baseline level and progression of CKD

CKD stage G4: Serum calcium and phosphate: Every 3 to 6 months; PTH: Every 6 to 12 months

CKD stage G5 and G5D: Serum calcium and phosphate: Every 1 to 3 months; PTH: Every 3 to 6 months

Reference Range

Calcium supplementation:

Serum calcium: 8.6 to 10.2 mg/dL (SI: 2.2 to 2.6 mmol/L).

Due to a poor correlation between the serum ionized calcium (free) and total serum calcium, particularly in states of low albumin or acid/base imbalances, direct measurement of ionized calcium is recommended.

In low albumin states, the corrected total serum calcium may be estimated by:

Corrected total calcium (mg/dL) = measured serum calcium (mg/mL) + 0.8 (4 - measured serum albumin [g/dL])

or

Corrected total calcium (mmol/L) = measured serum calcium (mmol/L) + 0.02 (40 - measured serum albumin [g/L])

Calcium supplementation in hypoparathyroidism (ES [Brandi 2016]):

Correct serum calcium to low-normal range or no more than 0.5 mg/dL below normal; calcium-phosphate product <55 mg2/dL2

Hyperphosphatemia in Chronic Kidney Disease (KDIGO 2017):

Note: Due to the complexity and interdependency of the laboratory parameters used for therapeutic decisions in chronic kidney disease-mineral and bone disorder (CKD-MBD) patients, serial assessments of phosphate, calcium, and parathyroid hormone (PTH) levels should be considered together.

Calcium (total): Normal range: 8.6 to 10.2 mg/dL (SI: 2.2 to 2.6 mmol/L). Avoid hypercalcemia for chronic kidney disease (CKD) stages G3a to G5D.

Phosphorus: 3 to 4.5 mg/dL (SI: 1 to 1.5 mmol/L). Lower elevated phosphorus levels toward the normal range for CKD stages G3a to G5D.

PTH:

CKD stage G3a to G5: Optimal PTH level is unknown; evaluate patients with progressively elevated intact PTH levels or if levels are consistently above the normal range (assay-dependent) (KDIGO 2017).

Dialysis patients: Maintain intact parathyroid hormone (iPTH) within 2 to 9 times the upper limit of normal for the assay used (KDIGO 2017).

Mechanism of Action

As dietary supplement, used to prevent or treat negative calcium balance; in osteoporosis, it helps to prevent or decrease the rate of bone loss. Calcium is an integral component of the skeleton and also moderates nerve and muscle performance and allows normal cardiac function. Also used to treat hyperphosphatemia in patients with chronic kidney disease by combining with dietary phosphate to form insoluble calcium phosphate, which is excreted in feces. Calcium salts as antacids neutralize gastric acidity resulting in increased gastric and duodenal bulb pH; they additionally inhibit proteolytic activity of pepsin if the pH is increased >4 and increase lower esophageal sphincter tone (IOM 2011).

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Minimal unless chronic, high doses; absorption predominantly in the duodenum and dependent on calcitriol and vitamin D; mean absorption of calcium intake varies with age (infants 60%, prepubertal children 28%, pubertal children 34%, adults 25%); during pregnancy, calcium absorption doubles; calcium is absorbed in soluble, ionized form; solubility of calcium is increased in an acid environment (IOM 2011); decreased absorption occurs in patients with achlorhydria, renal osteodystrophy, steatorrhea, or uremia

Distribution: Primarily in bones, teeth (IOM 2011)

Protein binding: ~40%, primarily to albumin (Wills 1971)

Excretion: Primarily feces (75%; as unabsorbed calcium); urine (22%) (IOM 2011)

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Calcium | Caltrate | Chooz | Oscaseef | Oyster shell calcium | Oystercal | Tums extra strength;
  • (AR) Argentina: Acomplex p | Calcio | Calcio base | Calcio Base Vannier | Calcio de ostras | Calcio pharma | Cavirox junior | Mylanta fresh | Pluscal | Tums | Ultracalcium | Uvasal tums;
  • (AT) Austria: Dreisacarb;
  • (AU) Australia: Amcal calcium | Andrews tums | Cal 600 | Cal care | Cal sup | Cal-500 | Calci Tab | Calcia | Calcium | Calregain | Living healthy calcium | Natural antacid | Natures way digestade | No gas | Pharmacy care calcium | Quickeze | Smiles kids calc | Vitelle antacid;
  • (BD) Bangladesh: A-cal | Acical | Adhydrox | Apocal | Bonacal | Bonec | Bpcal | Cabonat | Cal | Cal D | Cal Plus | Calbon | Calcar | Calcarb | Calci | Calcicar | Calcid | Calcifil | Calcitab | Calcium | Calcium sandoz | Calcium-j | Calcizen DS | Caldical | Caldil | Caldil ot | Caletal | Calfeed | Calfor | Calium | Caljuven | Calpo | Calsan | Calsil | Carb | Carbocal | Casalt | Costin | Dolocid | Edical | Eurocal | Forbon | Ipical | Isocal | Jasocal | Magal n | Miracal | Monocal | Mycal | Mylen | Myocal | Mystocal | Naafcal | Nedcal | Neocal | Oracal | Orthocal | Oscal | Ossi | Ostacid | Ostim | Ostocal | Ostocurb | Ostogen | Ostoplus | Procala | Rocal | Sandocal | Seemacid | Silcal | Suplecal | Sycal | Tycal;
  • (BE) Belgium: Calcichew | Steocar;
  • (BF) Burkina Faso: Cc-nefro;
  • (BG) Bulgaria: Vitacalcin;
  • (BR) Brazil: Alkasid | Calcio ca | Calcio de ostra | Calcio de ostras | Calcio zurita | Calciolite | Calcitheo | Calcium | Calcium oyster shell | Calsan | Carbonato calcio | Carbonato de calcio | Efical | Eno tabs | Fontical | Gastroplan | Imecalcio | Maxicalc | Mobility os cal | Natecal | Nesh calcio | Neutracido | Os Cal | Osporin | Osseopor | Osteofix S | Rhamical | Tums;
  • (CH) Switzerland: Calcium carbonat salmon pharma | Calcium-phosphatbinder | Calsan | Rennie Fruits cassis | Rennie Fruits framboise;
  • (CL) Chile: Calcefor | Calcium factor | Calcivorin | Caprimida | Elcal | Extracal | Levucal;
  • (CN) China: Calcichew | Gai shu tai | Gai tian li | Jian gu gai | Lan da | Mu li tan suan gai | Mylanta | Na nuo ka | Oyster shell calcium | Xie da li;
  • (CO) Colombia: Acidfrut | Calciforte | Calcio | Caldoral | Carbonato calcio | Carbonato de calcio | Megacal | Orocal | Osteocal | Tums | Zivical;
  • (CZ) Czech Republic: Calcii carbon prae | Calcii carbonici | Vitacalcin;
  • (DE) Germany: Alka tabs kalzium | Calci GRY | Calcilac mono | Calcimagon | Calciprotect | Calcium | Calcium CT | Calcium Dago | Calcium dura | Calciumcarbonat | Calciumcarbonat Abanta | Cc-nefro | Dreisacarb | Korallenkalzium | Magen | Original Rugener Heilkreide | Renacal;
  • (DK) Denmark: Oestersskal | Unikalk basic;
  • (DO) Dominican Republic: Antacid | Calcio | Calciolac | Calcium | Caltrate | Carbo C | Carbogen | Tums;
  • (EC) Ecuador: Alkacid | Calcefor | Calsan | Caprimida | Carbonato de calci | Carbonato de calcio | Tums;
  • (EE) Estonia: Calci max | Calcigran sine | Calcistrong | Maj calcium | Renichew | Samarin | Swisscal chewable calcium | Tums | Unikalk basic | Vapnik;
  • (EG) Egypt: Bone Cal | Calcichew | Calcimat | Calcimate | Calcimate fort | Calcium | Chooz | Os Cal | Oscal | Uskade;
  • (ES) Spain: Carbocal | Cimascal | Densical | Mastical | Natecal;
  • (FI) Finland: Calcichew | Calcichew spearmint | Calsorin | Kalcidon | Kalcipos | Puru Calsorin Neutral | Tums;
  • (FR) France: Calcidose | Calcium merck | Calnova | Calprimum | Caltrate | Fixical;
  • (GB) United Kingdom: Adcal | Antacid peppermint flavour | Bisodol | Calcette | Calcichew | Calcium | Calcium Carbonate Teva | Calcium sandoz | Chewical | Meggeson | Rap eze | Remegel | Remegel wl. | Rennie gold | Setlers antacid | Tums;
  • (GR) Greece: Alcamex | Body calcin | Calcioral | Tums;
  • (HK) Hong Kong: Apo cal | Caltrate | Os Cal | Scott's hi calcium;
  • (HR) Croatia: Kalcijev Karbonat Krka;
  • (HU) Hungary: Beres calcium | Calcicarb | Calcichew | Phosphodep | Tums;
  • (ID) Indonesia: Calcium sandoz jr | Calnat | Calos | Calsan | Licokalk | Osteocal;
  • (IE) Ireland: Calcichew | Rap eze | Rennie Fruit Flavoured;
  • (IL) Israel: Calcimore | Calcium | Caltrate | Density | Tums | Tums EX | Tums Ultra Spearmint;
  • (IN) India: Acidinol | Calcicip | Calcistrong-3a | Calcium sandoz | Califul | Calzac | Coecoral | Eno | Factocal | Karecal | Kidcal | Lanum C | Lodocid | M cal | Ostigen | Oxycal | Realcal | Sandocal | Unical | Zycalci;
  • (IQ) Iraq: Calcium | Calcium kindi;
  • (IT) Italy: Calcio carbonato | Metocal;
  • (JO) Jordan: Adcal | Boncal | Calcicar | Caltrate | Jovital Jocal | Oscal | Tums extra strength;
  • (JP) Japan: Calc.l kunihiro | Caltan | Tankaru | Tankaru kn;
  • (KE) Kenya: Eno | Sonacid;
  • (KR) Korea, Republic of: Almabol | Calcid | Caned | Canit | Cantacid | Catase | Cc-bone | Cicibon | Dagrin | Edee | Edi | Js calcium carbonate | Nexpharm calcium carbonate | Oscal | Pharma calcium carbonate | Pritan | Taiguk calcium carbonate;
  • (KW) Kuwait: Calcium | Chooz | Chooz antacid | Os Cal | Oystercal;
  • (LB) Lebanon: Antacid | Calcarb | Calcium | Calcium antacid | Calperos | Caltrate | Chooz | Fortical | Orocal | Oscalvit | Pharmacal | Tums extra strength;
  • (LT) Lithuania: Calcigran sine | Calcikids | Calcimax | Calcistrong | Mysigelum | Now foods coral calcium | Oyster Shell Calci;
  • (LU) Luxembourg: Calcichew | Steocar;
  • (LV) Latvia: Calci max | Calcicip | Calcigran sine | Calcistrong | Mysigelum | Vitacalcin | Yl coral calcium;
  • (MX) Mexico: Calcio | Calciplus | Calsan | Calsan-dos | Caltron | Ciocar | Flaten | Grisical | Osteomin | Tums;
  • (MY) Malaysia: Apo cal | Calcarb | Calcinate | Calsonate | Caltrate | Dyna calcium carbonate;
  • (NL) Netherlands: Calci chew;
  • (NO) Norway: Calcium carbonicum nmd grossist | Nycoplus calcium | Titralac | Unikalk basic | Weifa-kalsium;
  • (NZ) New Zealand: Arrow Calcium | Cal sup | Calcium sandoz | Caltrate | Hardys | Oscal | Osteo | Osteo hi potency | Tums antacid;
  • (PE) Peru: Calbon | Calcefor | Calcio carbonato | Calcioplex | Calsan | Caltrate | Caprimida | Carbonato calcio | Carbonato de calcio | Elcal | Tums;
  • (PH) Philippines: Calbone | Calci-aid | Calcisaph | Calcium sandoz | Calmate | Calsan | Gastrocid | Osteofree | Tums;
  • (PK) Pakistan: Calcidin | Calcium factor | Caltab | Caltrate | Qalsan;
  • (PL) Poland: Calcineff | Calcium | Calperos | Caltrate | Frutical | Tums | Weglan wapnia | Zuber;
  • (PR) Puerto Rico: Antacid | Ban acid | Cal gest | Cal Mint | Calc Carb Arom | Calcium | Calcium oyster shell | Calsure | Caltrate | Gaviscon ES | Maalox | Maalox Childrens | Nephro calci | Oscal | Oyster shell calcium | Quick dissolve maalox | Tums | Tums freshers | Tums Kids;
  • (PT) Portugal: Calcior | Calcioral | Calcitab | Carbonato de calcio | Carbonato de Calcio Salusif | Natecal;
  • (PY) Paraguay: Brocalcio | Calcimax | Calcimeg | Calcio dallas | Calcio genfar | Calcio millet | Cam | Caprimida | Carbonato de calcio indufar | Phasacal | Tricalsil;
  • (QA) Qatar: Calci-life | Calcichew | Calcium Antacid Extra Strength | Caltrate | Tums Chewy Bites;
  • (RO) Romania: Antacid;
  • (RU) Russian Federation: Calcid | Calcimax | Namagel cherry | Vitacalcin;
  • (SA) Saudi Arabia: Adcal | Calcinate | Calcy | Caltrate | Carboset | Kalcipos | Oscal | Oystercal | Tums extra strength;
  • (SE) Sweden: Calcitugg | Kalcidon | Kalcipos | Kalcitena;
  • (SG) Singapore: Apo cal | Bonacal | Caltrate | Os Cal;
  • (SI) Slovenia: Calcii carbonas | Calcii carbonitas | Kalcijev karbonat | Rupugum;
  • (SK) Slovakia: Maxi-kalz | Tums | Vitacalcin;
  • (TH) Thailand: Amogin | Antacia | Baycal | Bo-ne-ca | Bonacal | Cal | Cal os | Calbone | Calcanate | Calcar | Calcicap | Calcicar | Calcida | Calcium | Calcium jonior | Calcium Sandoz Bonacal | Calcium Sandoz Junior | Calcium Weifa | Calhof | Calmate | Calnate | Calstar | Calsum | Calsum forte | Caltab | Caltrate | Caltrex | Calvin | Carbocalc | Chalk | Chalkcap | Duracal | Fissie-cal | Kabonyst | Kal kids | Manocal | Oracalc | Pharcal | Prima-cal | Procal | T-bon | V-calcium;
  • (TN) Tunisia: Calcifast | Calcitop | Densical;
  • (TR) Turkey: Anti fosfat cc | Sovital calcium carbonate;
  • (TW) Taiwan: A-cal | Alunigel | Basic | Calcium | Canat | Chiasucon | Dacon | Gaining | Hoshizo Calcium L | Nigel | Os Cal | Top-Cal | Tums | U-Cal | Xpar Cal | Zocan;
  • (UY) Uruguay: Brocalcio | Calcical | Calcical forte | Calcio | Calcio Gador | Calcio Phs | Calciofar | Nacidex | Noacid | Ostrical | Renacalcio Plus | Tums;
  • (VE) Venezuela, Bolivarian Republic of: Aplacal | Calcio carbonato | Caltrate | Frutacid | Longevity health calcio | Maxical | Osteocal | Polvo de ostras | Sandocal | Tums;
  • (ZA) South Africa: Afgel | Calcichew | Eno tablet extra strength assorted flavour | Eno tums
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