ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد ایتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Calcium carbonate: Drug information

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

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Antacid Calcium Extra Strength [OTC] [DSC];
  • Antacid Calcium Rich [OTC];
  • Antacid Calcium [OTC];
  • Antacid Extra Strength [OTC];
  • Antacid [OTC];
  • Cal-Carb Forte [OTC] [DSC];
  • Cal-Gest Antacid [OTC];
  • Cal-Mint [OTC];
  • Calci-Chew [OTC] [DSC];
  • Calcium 600 [OTC];
  • Calcium Antacid Extra Strength [OTC];
  • Calcium Antacid [OTC];
  • Calcium High Potency [OTC];
  • Caltrate 600 [OTC] [DSC];
  • Florical [OTC];
  • GoodSense Antacid [OTC];
  • Maalox Childrens [OTC];
  • Maalox [OTC];
  • Oysco 500 [OTC] [DSC];
  • TC Max [OTC];
  • Titralac [OTC];
  • Tums Chewy Bites [OTC];
  • Tums Chewy Delights [OTC];
  • Tums E-X 750 [OTC];
  • Tums Extra Strength 750 [OTC];
  • Tums Kids [OTC] [DSC];
  • 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

Antacid: Oral: Generally, 1 to 4 tablets or 5 to 10 mL as symptoms occur; maximum: 8 g/day as calcium carbonate for up to 2 weeks; OTC dosing recommendations may vary by product and/or manufacturer; specific product labeling should be consulted.

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 (AACE [Camacho 2020]; ES [Watts 2012]; IOM 2011; NOF [Cosman 2014]).

Hyperphosphatemia in chronic kidney disease

Hyperphosphatemia in chronic kidney disease (off-label use): Oral: Total dose of elemental calcium (including dietary sources and calcium-based phosphate binders) should not exceed 2 g/day (Eknoyan 2003).

Hypoparathyroidism

Hypoparathyroidism (management of chronic hypocalcemia) (off-label use): Oral: 500 mg to 1 g of elemental calcium administered 2 to 3 times daily; required dose can vary greatly and more frequent dosing may be necessary. Note: Use of IV calcium may be required in acute hypocalcemia with corrected calcium <7 mg/dL [≤1.75 mmol/L] or in severely symptomatic patients (eg, arrhythmias, broncho- or laryngospasm, tetany, seizures) (Bilezikian 2016)

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

CrCl <25 mL/minute: Dosage adjustments may be necessary depending on the serum calcium levels.

Dosing: Hepatic Impairment: Adult

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

Dosing: Pediatric

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

Antacid: Note: Chronic antacid therapy not recommended for management of gastroesophageal reflux disease in pediatric patients (AAP [Lightdale 2013]; NASPGHAN/ESPGHAN [Rosen 2018]). 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: 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 (KDOQI [Uhlig 2010]).

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 (Lynch 2017; Root 2020).

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 (Misra 2008; Root 2020).

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.

Dosing: Older Adult

Refer to adult dosing.

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:

Cal-Carb Forte: 1250 mg (elemental calcium 500 mg) [DSC]

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

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

Oysco 500: 1250 mg (elemental calcium 500 mg) [DSC] [contains brilliant blue fcf (fd&c blue #1), tartrazine (fd&c yellow #5)]

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:

Antacid: 500 mg

Antacid: 500 mg [peppermint flavor]

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

Antacid: 500 mg [contains fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #5 aluminum lake, fd&c yellow #6 aluminum lake]

Antacid Calcium: 500 mg [peppermint flavor]

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

Antacid Calcium Extra Strength: 750 mg [DSC] [gluten free; contains fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake; assorted fruit flavor]

Antacid Calcium Rich: 500 mg [sodium free; contains fd&c blue #1 aluminum lake, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake]

Antacid Extra Strength: 750 mg [contains corn starch, fd&c blue #1 aluminum lake, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake; assorted flavor]

Cal-Gest Antacid: 500 mg [contains fd&c blue #1 aluminum lake, fd&c yellow #10 aluminum lake, fd&c yellow #6 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]

Calci-Chew: 1250 mg (elemental calcium 500 mg) [DSC] [cherry flavor]

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

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

Calcium Antacid: 500 mg [contains fd&c blue #1 aluminum lake, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake; assorted fruit flavor]

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

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

Calcium Antacid Extra Strength: 750 mg [DSC] [gluten free; contains brilliant blue fcf (fd&c blue #1), fd&c yellow #10 (quinoline yellow), fd&c yellow #6 (sunset yellow)]

GoodSense Antacid: 500 mg [contains corn starch, fd&c blue #1 aluminum lake, fd&c yellow #10 aluminum lake, fd&c yellow #6 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 aluminum lake, fd&c red #40 aluminum lake; assorted flavor]

GoodSense Antacid: 750 mg [gluten free; contains corn starch, fd&c blue #1 aluminum lake, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake; assorted flavor]

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

GoodSense Antacid: 1000 mg [gluten free; contains corn starch, fd&c blue #1 aluminum lake, fd&c yellow #10 aluminum lake, fd&c yellow #6 aluminum lake; assorted flavor]

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

Maalox Childrens: 400 mg [contains aspartame; wild berry 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 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #6 aluminum lake, tartrazine (fd&c yellow #5)]

Tums Chewy Bites: 750 mg [contains corn starch, fd&c blue #1 aluminum lake, fd&c blue #2 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #5 aluminum lake, fd&c yellow #6 aluminum 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 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 aluminum lake, fd&c red #40 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 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #5 aluminum lake, fd&c yellow #6 aluminum lake; assorted fruit flavor]

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

Tums Kids: 750 mg [DSC] [scored; contains fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake; cherry flavor]

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

Tums Smoothies: 750 mg [peppermint flavor]

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

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

Tums Smoothies: 750 mg [gluten free; contains corn starch, fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #5 aluminum lake, fd&c yellow #6 aluminum lake, soybeans (glycine max)]

Tums Ultra 1000: 1000 mg

Tums Ultra 1000: 1000 mg [peppermint flavor]

Tums Ultra 1000: 1000 mg [contains fd&c blue #1 aluminum lake, fd&c red #40 aluminum lake, fd&c yellow #5 aluminum lake, fd&c yellow #6 aluminum lake; assorted berries flavor]

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

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

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

Generic Equivalent Available: US

May be product dependent

Dosage Forms Considerations

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

Administration: Adult

Oral: Administer with food. Doses >600 mg (elemental calcium) per day should be divided for optimal absorption (AACE [Camacho 2020]).

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: For the relief of acid indigestion, heartburn, sour stomach, and GI upset associated with these symptoms

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; Hypoparathyroidism (management of chronic hypocalcemia)

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]

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 the elderly, 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 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 (IOM 2011).

• Renal insufficiency: Use with caution as these patients are more sensitive or susceptible to the effects of excess calcium (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.

Metabolism/Transport Effects

None known.

Drug Interactions

Acalabrutinib: Antacids may decrease the serum concentration of Acalabrutinib. Management: Separate administration of acalabrutinib from the administration of any antacids by at least 2 hours in order to minimize the potential for a significant interaction. 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

Amphetamines: Antacids may decrease the excretion of Amphetamines. Risk C: Monitor therapy

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, emtricitabine, and tenofovir alafenamide can be administered with calcium salts under fed conditions, but coadministration with or 2 hours after a calcium salt is not recommended 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 and/or loss of efficacy of the cation exchange resin. Management: To minimize this interaction, consider: a)separating doses by 2 or more hours; b)rectal administration of the exchange resin; or c)alternatives to antacids. Monitor for metabolic alkalosis and attenuation of CPS effects. Avoid magnesium hydroxide. Risk D: Consider therapy modification

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. Management: Coadministration of cefditoren and antacids is not recommended. Consider administering cefditoren 2 hours before or 2 hours after the antacid in order to minimize this potential interaction. Risk D: Consider therapy modification

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. 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 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 oral ketoconazole at least 2 hours prior to use of any antacid product. 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

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

Naproxen: Antacids may decrease the absorption of Naproxen. Risk X: Avoid combination

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

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 2 hours before or 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

QuiNIDine: Antacids may decrease the excretion of QuiNIDine. Risk C: Monitor therapy

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. 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 an oral calcium supplement to minimize this interaction. Monitor for decrease 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

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

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

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 decrease the excretion of Calcium Salts. Continued concomitant use can also result in metabolic alkalosis. 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

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: 8.5 to 10.5 mg/dL (2.12 to 2.62 mmol/L) (IOM 2011).

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): Adults: 9 to 11 mg/dL (2.05 to 2.54 mmol/L), may slightly decrease with aging. Avoid hypercalcemia for chronic kidney disease (CKD) stages G3a to G5D

Phosphorus: 2.5 to 4.5 mg/dL (0.81 to 1.45 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

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)

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

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): $0.15

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): $0.53 - $0.61

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.

Brand Names: International
  • Acical (BD);
  • Additiva Calcium (PL);
  • Andrews TUMS Antacid (AU);
  • Apo-Cal (HK, MY);
  • Bica (AR);
  • Biolectra (AT);
  • Bo-Ne-Ca (TH);
  • Bonacal (SG);
  • Boncal (BD);
  • Bonfit (LK);
  • Cal-Sup (AU);
  • Calbo (LK);
  • Calbone (PH);
  • Calcanate (TH);
  • Calcefor (CL, PE);
  • Calci Aid (PH);
  • Calcichew (FI, GB, IE, LU, MT);
  • Calcifar (PL);
  • Calcigamma (DE);
  • Calcigran Sine (EE);
  • Calcilos (DE);
  • Calcimate (PH);
  • Calcimate Forte (EG);
  • Calcioral (PT);
  • Calcit (BE, FR, IT, NL);
  • Calcium (BG, PL);
  • Calcium Carbonate (FR);
  • Calcium Dago (DE);
  • Calcium effervescens (PL);
  • Calcium Genericon (AT);
  • Calcium Klopfer (AT);
  • Calcium-Carbonat Salmon Pharma (CH);
  • Calcium-Phosphatbinder Bichsel (CH);
  • Calcium-Sandoz Forte (BG);
  • Calciumcarbonat Fresenius (CH);
  • Calciumcarbonat-Dial (AT);
  • Calcuren (FI);
  • Calnat (ID);
  • Calos (ID);
  • Calperos (CH, PL);
  • Calsan (CH, MX, PH);
  • Calsuba (ZA, ZW);
  • Calsum (TH);
  • Calsum Forte (TH);
  • Caltab (TH);
  • Caltess (PL);
  • Caltrate (AE, AU, BB, BM, BS, BZ, CO, CY, GY, IL, IQ, IR, JM, JO, LB, LY, MX, MY, OM, PL, PR, QA, SA, SR, SY, TT, VN, YE);
  • Caltrate 600 (CO, PE, VE);
  • Caltrón (MX);
  • Cantacid (KR);
  • Caosina (ES);
  • CC-Nefro 500 (DE);
  • Chooz Antacid Gum 500 (AE, CY, IQ, IR, JO, LB, LY, OM, QA, SA, SY, YE);
  • Cimascal (ES);
  • Cipcal (IN);
  • Dreisacarb (AT);
  • Edee (KR);
  • Fixateur phospho-calcique Bichsel (CH);
  • Fixical (FR);
  • FructiCal (PL);
  • Gastrocid (PH);
  • Iroviton Calcium (AT);
  • Isofem (EC);
  • Jasocal (LK);
  • Kalcidon (SE);
  • Kalcij-karbonat (HR);
  • Kalcijev karbonat (HR);
  • Kalcitena (SE);
  • Kalzonorm (AT);
  • Mastical (ES);
  • Maxi-calc (CH);
  • Maxi-Kalz (CZ);
  • Mubonet (MX);
  • N-Zarevet (IL);
  • Natecal (ES);
  • Noacid (UY);
  • Orocal (FR);
  • Oscal (NZ);
  • Osteocal 500 (FR, ID);
  • Osteomin (MX);
  • Pharcal (TH);
  • Pluscal (AR);
  • Plusssz balance calcium (PL);
  • Rowarolan (IE);
  • Rowarolan Powder (BH);
  • Seacal (BH);
  • Tetesept Calcium (AT);
  • Titralac (NO);
  • Tums (IL);
  • Tums EX Sugar Free (IL);
  • Tums Smoothies EX Peppermint (IL);
  • Tums Ultra Assorted Berries (IL);
  • Tums Ultra Spearmint (IL);
  • Vicalvit (PL);
  • Vitacalcin (PL);
  • Weifa-Kalsium (NO)


For country abbreviations used in Lexicomp (show table)
  1. Abrams SA, Committee on Nutrition. Calcium and vitamin D requirements of enterally fed preterm infants. Pediatrics. 2013;131(5):e1676-1683. [PubMed 23629620]
  2. Allison SJ. Chronic kidney disease: calcium-based versus non-calcium-based phosphate binders: effect on mortality in patients with CKD. Nat Rev Nephrol. 2013;9(9):491. doi: 10.1038/nrneph.2013.132. [PubMed 23917795]
  3. Balasubramanian S, Dhanalakshmi K, Amperayani S. Vitamin D deficiency in childhood-a review of current guidelines on diagnosis and management. Indian Pediatr. 2013;50(7):669-675. doi:10.1007/s13312-013-0200-3 [PubMed 23942432]
  4. Bauwens SF, Drinka PJ, Boh LE. Pathogenesis and management of primary osteoporosis. Clin Pharm. 1986;5(8):639-659. [PubMed 3527528]
  5. Bilezikian JP, Brandi ML, Cusano NE, et al. Management of hypoparathyroidism: present and future. J Clin Endocrinol Metab. 2016;101(6):2313-2324. doi:10.1210/jc.2015-3910 [PubMed 26938200]
  6. Body C, Christie JA. Gastrointestinal diseases in pregnancy: nausea, vomiting, hyperemesis gravidarum, gastroesophageal reflux disease, constipation, and diarrhea. Gastroenterol Clin North Am. 2016;45(2):267‐283. doi:10.1016/j.gtc.2016.02.005 [PubMed 27261898]
  7. Bollerslev J, Rejnmark L, Marcocci C, et al; European Society of Endocrinology. European Society of Endocrinology clinical guideline: treatment of chronic hypoparathyroidism in adults. Eur J Endocrinol. 2015;173(2):G1-G20. doi:10.1530/EJE-15-0628 [PubMed 26160136]
  8. Borkenhagen JF, Connor EL, Stafstrom CE. Neonatal hypocalcemic seizures due to excessive maternal calcium ingestion. Pediatr Neurol. 2013;48(6):469-471. doi:10.1016/j.pediatrneurol.2013.02.010 [PubMed 23668874]
  9. Brandi ML, Bilezikian JP, Shoback D, et al. Management of hypoparathyroidism: summary statement and guidelines. J Clin Endocrinol Metab. 2016;101(6):2273-2283. doi:10.1210/jc.2015-3907 [PubMed 26943719]
  10. Calci-Chew (calcium carbonate) [prescribing information]. Livonia, MN: Rugby Laboratories; June 2013.
  11. Calcium 600 (calcium carbonate) [prescribing information]. Livonia, MN: Rugby Laboratories; April 2013.
  12. Calcium carbonate [prescribing information]. Livonia, MI: Major Pharmaceuticals; September 2020.
  13. Calcium carbonate oral suspension [prescribing information]. Greenville, SC: pai Pharmaceutical Associates Inc; September 2006.
  14. Cal-Gest (calcium carbonate) [prescribing information]. Livonia, MN: Rugby Laboratories; May 2013.
  15. Cal-Gest (calcium carbonate) [prescribing information]. Livonia, MN: Rugby Laboratories; May 2017.
  16. Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract. 2020;26(suppl 1):s1-s46. doi:10.4158/GL-2020-0524SUPPL [PubMed 32427503]
  17. Caplan RH, Miller CD, Silva PD. Severe hypercalcemia in a lactating woman in association with moderate calcium carbonate supplementation: a case report. J Reprod Med. 2004;49(3):214-217. [PubMed 15098893]
  18. Children's Soothe (calcium carbonate) [prescribing information]. Miami Lakes, FL: Walgreens; no date.
  19. Cosman F, de Beur SJ, LeBoff MS, et al; National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis [published correction appears in: Osteoporos Int. 2015;26(7):2045-7]. Osteoporos Int. 2014;25(10):2359-2381. doi:10.1007/s00198-014-2794-2 [PubMed 25182228]
  20. Dağlı Ü, Kalkan İH. Treatment of reflux disease during pregnancy and lactation. Turk J Gastroenterol. 2017;28(Suppl 1):S53‐S56. doi:10.5152/tjg.2017.14 [PubMed 29199169]
  21. D'Souza R, Gandhi S, Fortinsky KJ, et al. Calcium carbonate intoxication in pregnancy: the return of the milk-alkali syndrome. J Obstet Gynaecol Can. 2013;35(11):976-977. [PubMed 24246395]
  22. Eastell R, Rosen CJ, Black DM, Cheung AM, Murad MH, Shoback D. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2019;104(5):1595-1622. doi:10.1210/jc.2019-00221 [PubMed 30907953]
  23. Eknoyan G, Levin A, Levin NW; National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J of Kidney Dis. 2003:42(4)(suppl 3):S1-S201. [PubMed 14520607]
  24. Golden NH, Abrams SA; Committee on Nutrition. Optimizing bone health in children and adolescents. Pediatrics. 2014;134(4):e1229-e1243. doi:10.1542/peds.2014-2173 [PubMed 25266429]
  25. Gomes CF, Sousa M, Lourenço I, Martins D, Torres J. Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know? Ann Gastroenterol. 2018;31(4):385‐394. doi:10.20524/aog.2018.0264 [PubMed 29991883]
  26. Gordon MV, McMahon LP, Hamblin PS. Life-threatening milk-alkali syndrome resulting from antacid ingestion during pregnancy. Med J Aust. 2005;182(7):350-351. [PubMed 15804228]
  27. Heaney RP, Recker RR, Saville PD. Menopausal changes in calcium balance performance. J Lab Clin Med, 1978;92(6):953-63. [PubMed 739173]
  28. IOM (Institute of Medicine). Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press; 2011.
  29. Jamal SA, Vandermeer B, Raggi P, et al. Effect of calcium-based versus non-calcium-based phosphate binders on mortality in patients with chronic kidney disease: an updated systematic review and meta-analysis. Lancet. 2013;382(9900):1268-1277. [PubMed 23870817]
  30. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease—mineral and bone disorder (CKD-MBD). Kidney Int. 2017;7(suppl 1):1-59. doi:10.1016/j.kisu.2017.04.001
  31. Kolnick L, Harris BD, Choma DP, Choma NN. Hypercalcemia in pregnancy: a case of milk-alkali syndrome. J Gen Intern Med. 2011;26(8):939-942. [PubMed 21347876]
  32. Koo WWK, Tsang RC. Calcium and magnesium homestasis. In: MacDonald MG, Seshia MMK, eds. Avery's Neonatology - Pathophysiology and Management of the Newborn. 7th ed. LWW; 2015:646-669.
  33. Lightdale JR, Gremse DA; Section on Gastroenterology, Hepatology, and Nutrition. Gastroesophageal reflux: management guidance for the pediatrician. Pediatrics. 2013;131(5):e1684-e1695. doi:10.1542/peds.2013-0421 [PubMed 23629618]
  34. Lo SF. Reference intervals for laboratory tests and procedures. In: Kliegman RM, St. Geme J, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Saunders Elsevier; 2020:chap. 748.
  35. Lynch R, Wood EG, Neumayr TM. Fluid and electrolyte issues in pediatric critical illness. In: Fuhrman B, Zimmerman J, eds. Pediatric Critical Care. 5th ed. Elsevier Health; 2017:1007-1025.
  36. Maalox Children's Relief (calcium carbonate) [prescribing information]. Novartis Consumer Health Inc; 2014.
  37. Mason Natural (calcium carbonate) [prescribing information]. Miami Lakes, FL: Mason Vitamins Inc; received September 2019.
  38. Martin TJ, Kang Y, Robertson KM, et al. Ionization and Hemodynamic Effects of Calcium Chloride and Calcium Gluconate in the Absence of Hepatic Function. Anesthesiology. 1990;73(1):62-65. [PubMed 2360741]
  39. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M; Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society. Vitamin D deficiency in children and its management: review of current knowledge and recommendations. Pediatrics. 2008;122(2):398-417. doi:10.1542/peds.2007-1894 [PubMed 18676559]
  40. Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. Horm Res Paediatr. 2016;85(2):83-106. doi:10.1159/000443136 [PubMed 26741135]
  41. Murphy ML, Mattingly MJ, Meisner CT. Severe hypercalcemia in a postpartum patient. J Emerg Med. 2016;51(4):e93-e95. [PubMed 27460661]
  42. Navaneethan SD, Palmer SC, Craig JC, Elder GJ, Strippoli GF. Benefits and harm of phosphate binders in CKD: a systematic review of randomized controlled trials. Am J Kidney Dis. 2009:54(4):619-637. [PubMed 19692157]
  43. NIH Consensus Conference. Optimal calcium intake. JAMA. 1994;272(24):1942-1948. [PubMed 7990248]
  44. Pepto Bismol Kids Chewable Tablets Bubblegum (calcium carbonate) [prescribing information]. Cincinnati, OH: Procter & Gamble; received February 18, 2022.
  45. Picolos MK, Sims CR, Mastrobattista JM, Carroll MA, Lavis VR. Milk-alkali syndrome in pregnancy. Obstet Gynecol. 2004;104(5, pt 2):1201-1204. [PubMed 15516453]
  46. Prentice A. Calcium in pregnancy and lactation. Annu Rev Nutr. 2000;20:249-272. doi:10.1146/annurev.nutr.20.1.249 [PubMed 10940334]
  47. Recker RR. Calcium absorption and achlorhydria. N Engl J Med. 1985;313(2):70-73. doi:10.1056/NEJM198507113130202 [PubMed 4000241]
  48. Robertson WC Jr. Calcium carbonate consumption during pregnancy: an unusual cause of neonatal hypocalcemia. J Child Neurol. 2002;17(11):853-855. doi:10.1177/08830738020170111704 [PubMed 12585729]
  49. Root AW. Disorders of minderal metabolism II. Abnormalities of mineral homeostasis in the newborn, infant, child, and adolescent. In: Sperling MA, ed. Pediatric Endocrinology. 5th ed. Elsevier; 2020:chap. 20.
  50. Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2018;66(3):516-554. [PubMed 29470322]
  51. Thélin CS, Richter JE. Review article: the management of heartburn during pregnancy and lactation. Aliment Pharmacol Ther. 2020;51(4):421‐434. doi:10.1111/apt.15611 [PubMed 31950535]
  52. Trezevant MS, Winton JC, Holmes AK. Hypercalcemia-induced pancreatitis in pregnancy following calcium carbonate ingestion. J Pharm Pract. 2017;897190017745410. doi:10.1177/0897190017745410 [PubMed 29241388]
  53. Tums Chewy Bites (calcium carbonate) [prescribing information]. Philadelphia, PA: GlaxoSmithKline; received June 2020.
  54. Tums Chewy Delights (calcium carbonate) [prescribing information]. Philadelphia, PA: GlaxoSmithKline; date unknown.
  55. Tums Extra (calcium carbonate) [prescribing information]. Philadelphia, PA: GlaxoSmithKline; date unknown.
  56. Tums Freshers (calcium carbonate) [prescribing information]. Philadelphia, PA: GlaxoSmithKline; date unknown.
  57. Tums Kids (calcium carbonate) [prescribing information]. Philadelphia, PA: GlaxoSmithKline; date unknown.
  58. Tums Regular (calcium carbonate) [prescribing information]. Philadelphia, PA: GlaxoSmithKline; date unknown.
  59. Tums Smoothies (calcium carbonate) [prescribing information]. Philadelphia, PA: GlaxoSmithKline; date unknown.
  60. Tums Ultra (calcium carbonate) [prescribing information]. Philadelphia, PA: GlaxoSmithKline; date unknown.
  61. Uhlig K, Berns JS, Kestenbaum B, et al. KDOQI US commentary on the 2009 KDIGO clinical practice guideline for the diagnosis, evaluation, and treatment of CKD-mineral and bone disorder (CKD-MBD). Am J Kidney Dis. 2010;55(5):773-799. [PubMed 20363541]
  62. Watts NB, Adler RA, Bilezikian JP, et al; Endocrine Society. Osteoporosis in men: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(6):1802-22. doi:10.1210/jc.2011-3045 [PubMed 22675062]
  63. Wills MR, Lewin MR. Plasma calcium fractions and the protein-binding of calcium in normal subjects and in patients with hypercalcaemia and hypocalcaemia. J Clin Pathol. 1971;24(9):856-866. [PubMed 5139991]
Topic 9185 Version 496.0