Calcium carbonate


Concise Prescribing Info
Indications/Uses
Listed in Dosage.
Dosage/Direction for Use
Adult : PO Hypocalcaemia and calcium deficiency states 0.5-4 g/day in 1-3 divided doses. Hyperacidity 0.5-3 g as symptoms occur. Max: 7.5 g/day for up to 2 weeks. Hyperphosphataemia in patients with chronic renal failure 3-7 g/day in divided doses; adjust according to patient’s serum phosphate level.
Dosage Details
Oral
Hyperphosphataemia in patients with chronic renal failure
Adult: 3-7 g daily in divided doses. Adjust according to patient’s serum phosphate level.

Oral
Hyperacidity
Adult: 0.5-3 g as symptoms occur. Max: 7.5 g daily for up to 2 weeks. Dosage may vary according to product being used.
Child: 2-5 years 0.375-0.4 g as symptoms occur. Max: 1.5 g daily for up to 2 weeks; 6-11 years 0.75-0.8 g as symptoms occur. Max: 3 g daily for up to 2 weeks; ≥12 years Same as adult dose. Dosage may vary according to product being used.

Oral
Hypocalcaemia and calcium deficiency states
Adult: 0.5-4 g daily in 1-3 divided doses. Dosage may vary according to product being used.
Child: 6-10 years 500 mg daily; >10 years 1 g daily. Dosage may vary according to product being used.
Renal Impairment
CrCl (mL/min) Dosage
<25/min Dosage adjustment may be needed based on serum Ca levels.  
Administration
May be taken with or without food. Take w/ meals for better absorption. Avoid taking w/ large amount of fibre-rich food.
Contraindications
Patients with hypercalcaemia resulting from myeloma, bone metastases, or other malignant bone disease, sarcoidosis, primary hyperparathyroidism, vitamin D overdosage, long term immobilisation accompanied by hypercalcaemia and/or hypercalciuria; severe hypercalciuria, calci-lithiasis, and renal calculi. Severe renal failure untreated by renal dialysis.
Special Precautions
Patients with achlorhydria, hypoparathyroid disease, history of nephrolithiasis, mild hypercalciuria. Mild to moderate renal impairment. Pregnancy and lactation.
Adverse Reactions
Significant: Constipation, flatulence.
Endocrine disorders: Hypercalcaemia, hypophosphataemia, milk-alkali syndrome.
Gastrointestinal disorders: Abdominal pain, diarrhoea, hyperacidity (acid rebound), nausea, vomiting, xerostomia.
Metabolism and nutrition disorders: Anorexia.
Nervous system disorders: Headache.
MonitoringParameters
Monitor serum and urinary Ca levels, kidney function, and Ca excretion.
Overdosage
Symptoms: Gastrointestinal disturbance. Treatment: Ca levels should be lowered through a high fluid intake and low Ca diet. For severe cases, treatments with corticosteroids may be necessary.
Drug Interactions
Increased risk of hypercalcaemia and metabolic alkalosis in patients taking thiazide diuretics. Enhanced arrythmogenic effect for patients taking cardiac glycosides (e.g. digoxin). Reduces absorption of thyroxine, bisphosphonates, Na fluoride, antibiotics (quinolone and tetracycline), and Fe. Systemic corticosteroids may reduce Ca absorption.
Food Interaction
Bran, foods high in oxalates, or whole grain cereals may decrease Ca absorption.
Action
Description: Calcium carbonate acts as an antacid by neutralising gastric acidity resulting in increased gastric and duodenal pH. It inhibits proteolytic activity of pepsin if the pH is increased >4 and increase lower esophageal sphincter tone. Additionally, it forms insoluble complex with dietary phosphate, thereby reducing phosphate absorption in patients with chronic kidney disease.
Pharmacokinetics:
Absorption: Absorbed from the gastrointestinal tract, primarily in the duodenum.
Distribution: Primarily in bones and teeth. Crosses placenta and enters breast milk. Plasma protein binding: Approx 40%, to albumin.
Metabolism: Converted to Ca chloride by gastric acid.
Excretion: Mainly via faeces (75% as unabsorbed Ca); via urine (22%).
Chemical Structure

Chemical Structure Image
Calcium carbonate

Source: National Center for Biotechnology Information. PubChem Database. Calcium carbonate, CID=10112, https://pubchem.ncbi.nlm.nih.gov/compound/Calcium-carbonate (accessed on Jan. 21, 2020)

Storage
Store between 15-30°C.
ATC Classification
A12AA04 - calcium carbonate ; Belongs to the class of calcium-containing preparations. Used as dietary supplements.
A02AC01 - calcium carbonate ; Belongs to the class of calcium-containing antacids.
References
Anon. Calcium Carbonate. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 28/01/2019.

Buckingham R (ed). Calcium Carbonate. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 28/01/2019.

Calcium Carbonate (Antacid) Tablet (Pharbest Pharmaceuticals Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 28/01/2019.

Calcium Carbonate Extra Strength Antacid Tablet, Chewable (Geri-Care Pharmaceutical Corp). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 30/01/2019.

Calcium Carbonate Suspension (Pharmaceutical Associates, Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 30/01/2019.

Calcium Carbonate Tablet (West-Ward Pharmaceuticals Corp.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/. Accessed 30/01/2019.

Joint Formulary Committee. Calcium Carbonate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 28/01/2019.

Disclaimer: This information is independently developed by MIMS based on Calcium carbonate from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to MIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, MIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2020 MIMS. All rights reserved. Powered by MIMS.com
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