Calcium

What is it?
Calcium is a mineral used to treat osteoporosis (bone loss), kidney stones, and menstrual cramps. It is also used as a vitamin supplement to increase bone mass and is used as an antacid (to treat stomach acid upset).

Other names for Calcium include: Calcium Carbonate, Calcium Citrate, Calcium Malate, Calcium Gluconate, Calcium Salt, Calcium Chloride, Oyster Shell Calcium, and Calcium Oxide.

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using:
Tell your doctor if you

• are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement)
• are pregnant or plan to become pregnant while using this medicine
• are breastfeeding
• have any other health problems, such as high blood pressure or heart or blood vessel disease

Dosage:
Talk with your caregiver about how much Calcium you should take. The amount depends on the strength of the medicine and the reason you are taking Calcium. If you are using this medicine without instructions from your caregiver, follow the directions on the medicine bottle. Do not take more medicine or take it more often than the directions tell you to.

To store this medicine:
Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Drug and Food Interactions:
Do not take Calcium without talking to your doctor first if you are taking:

• Medicines used for osteoporosis (Alendronate (Fosamax(R)); Etidronate (Didronel(R)) (2)
• Thyroid medicine (examples: Armor Thyroid(R), Synthroid(R) levothyroxine) (5)
• Verapamil (Calan(R), Isoptin(R)) (8)
• Heart medications (cardiac glycosides, example: digoxin (Lanoxin(R)) (8)
• Water pills (thiazide or thiazide-like diuretics, examples: bendroflumethiazide, benzthiazide, hydrochlorothiazide) (3,4)
• Medicines used to treat infection (examples: cefpodoxime, ciprofloxacin, levofloxacin, doxycycline, tetracycline) (12-14)
• Iron
• Guar gum
• Take your calcium with a light meal, but try to avoid taking it with dairy foods, bran, whole cereals, spinach, or rhubarb (4, 24)

Warnings:

• Before taking Calcium, tell your doctor if you are pregnant or breastfeeding
• Too much Calcium may cause kidney stones (7)

Side Effects:
Stop taking your medicine right away and talk to your doctor if you have any of the following side effects. Your medicine may be causing these symptoms which may mean you are allergic to it.

• Breathing problems or tightness in your throat or chest
• Chest pain
• Skin hives, rash, or itchy or swollen skin

Other Side Effects:
You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

• May cause constipation (not able to have a bowel movement) (4)
• Too much Calcium may cause you to have stomach pain or may cause you to throw up (7)
• Calcium chloride and Calcium gluconate are more likely to cause stomach upset. If this occurs, try Calcium lactate as it may cause less stomach upset (4)

References:
1. Anon: Optimal calcium intake. JAMA 1994; 272:1942-1948.
2. Fleisch H: Bisphosphonates: Pharmacology. Sem Arthritis Rheum 1994; 23:261-262.
3. Gora ML, Seth SK, Bay WK et al: Milk-alkali syndrome associated with use of chlorothiazide and calcium carbonate. Clin Pharm 1989; 8:227-229.
4. Gilman AF, Rall TW, Nies AS et al (eds): Goodman and Gilman's The Pharmacological Basis of Therapeutics, 8th ed. Pergamon Press, New York, NY; 1990.
5. Schneyer CR: Calcium carbonate and reduction of levothyroxine efficacy (letter). JAMA 1998; 33:408-413.
6. Wood RJ & Zheng JJ: High dietary calcium intakes reduce zinc absorption and balance in humans. Am J Clin Nutr 1997; 65:1803-1809.
7. Ivanovitch P, Fellows H & Rich C: The absorption of calcium carbonate. Ann Intern Med 1967; 66:917-923.
8. Dukes MNG: Meyler's side effects of drugs, vol.9. Excerpta Medica, New York, NY; 1980.
9. Shastri RA: Effect of antacids on salicylate kinetics. Int J Clin Pharmacol Ther Toxicol 1985; 23:480-484.
10. Kirch W, Schafer-Korting M, Axthelm T et al: Interaction of atenolol with furosemide and calcium and aluminum salts. Clin Pharmacol Ther 1981; 30:429-435.
11. Wagstaff AJ, Benfield P & Monk JP: Colloidal bismuth subcitrate: a review of its pharmacodynamic and pharmacokinetic properties, and its therapeutic use in peptic ulcer disease. Drugs 1988; 36:132-157.
12. Product Information: Vantin(R), cefpodoxime. Pharmacia & Upjohn Company, Kalamazoo, MI, (PI revised 11/2000) reviewed 3/2002.
13. Shiba K, Sakai O, Shimada J et al: Effects of antacids, ferrous sulfate, and ranitidine on absorption of DR-3355 in humans. Antimicrob Agents Chemother 1992; 36:2270-2274.
14. D'Arcy PF & McElnay JC: Drug-antacid interactions: assessment of clinical importance. Drug Intell Clin Pharm 1987; 21:607-617.
15. Carlson JA, Mann HJ & Canafax DM: Effect of pH on disintegration and dissolution of ketoconazole tablets. Am J Hosp Pharm 1983; 40:1334-1336.
16. Product Information: Sporanox(R), itraconazole. Janssen Pharmaceutica Products, L.P., Titusville, New Jersey, (PI revised 2/2002) reviewed 5/2002.
17. Product Information: Levsin(R), hyoscyamine sulfate. Schwarz Pharma, Inc., Milwaukee, WI, 1996.
18. Product Information: Pamine(R), methscopolamine. Upjohn Company, Kalamazoo, MI, 1991.
19. Baluarte HJ, Prebis J, Goldberg M et al: Metabolic alkalosis in an anephric child caused by the combined use of Kayexalate(R) and Basaljel(R). J Pediatr 1978; 92:237.
20. Product Information: Tritec(R), ranitidine bismuth citrate. Glaxo Wellcome Inc., Research Triangle Park, NC, 1999.
21. Product Information: Carafate(R), sucralfate. Hoechst Marion Roussel, Inc., Kansas City, MO, 1996.
22. Shah J, Fratis A, Ellis D et al: Effect of food and antacid on absorption of orally administered ticlopidine hydrochloride. J Clin Pharmacol 1990; 30:733-736.
23. O'Neil-Cutting MA & Crosby WH: The effect of antacids on the absorption of simultaneously ingested iron. JAMA 1986; 255:1468-1470.
24. Heaney RP, Smith KT, Recker RR et al: Meal effects on calcium absorption. Am J Clin Nutr 1989; 49(2):372-376.