calcium carbonate + calcium lactate gluconate: clinical use

Prescribing considerations

• Assess dietary calcium and concurrent supplements to avoid unnecessary excess.
• Use under medical supervision in renal impairment.
• Consider sodium content where dietary sodium restriction is important.
• Check suitability in phenylketonuria, glucose-galactose malabsorption and sensitivity to sulphites or other excipients.
• Encourage adequate fluid intake in patients prone to urinary calculi.

Contraindications and cautions

• Hypersensitivity to either calcium salt or an excipient
• Conditions causing hypercalcaemia or hypercalciuria
• Nephrocalcinosis or nephrolithiasis
• Rare glucose-galactose malabsorption because the formulation contains glucose

Monitoring

• Urinary calcium with mild hypercalciuria or a history of urinary calculi
• Serum calcium and phosphate in renal impairment
• Serum calcium and renal function when hypercalcaemia risk is increased, including concurrent vitamin D use
• Serum calcium and ECG with cardiac glycosides
• Serum calcium during concurrent thiazide treatment

Clinical pharmacology

Calcium carbonate and calcium lactate gluconate dissolve in water to provide ionised calcium. Absorption occurs mainly in the proximal small intestine; calcium is distributed predominantly to bones and teeth and eliminated in urine, faeces and sweat.

Formulation and product differences

• The selected product is an oral effervescent preparation containing calcium carbonate and calcium lactate gluconate.
• It contains sodium, aspartame, sorbitol, glucose, benzyl alcohol and sulphur dioxide, which may affect suitability.
• It must be dissolved in water rather than swallowed or chewed whole.