calcium carbonate + colecalciferol; cholecalciferol: clinical use

Prescribing considerations

• Confirm the selected product's licensed indication and reconcile all calcium, vitamin D and alkali sources.
• Consider renal function, previous calculi, sarcoidosis, immobilisation and medicines affecting serum calcium.
• Select by swallowing ability, administration requirements, dietary restrictions and excipients.
• Document the full product and formulation because products are not interchangeable.

Contraindications and cautions

• Hypercalcaemia, hypercalciuria or a condition causing either.
• Nephrolithiasis or nephrocalcinosis, where listed for the selected product.
• Hypervitaminosis D.
• Severe renal impairment or renal failure.
• Hypersensitivity to an active ingredient or excipient. Some formulations contain soya and are unsuitable with soya or peanut allergy.
• Product-specific carbohydrate excipients may preclude use in certain hereditary intolerance or malabsorption disorders.

Monitoring

• Monitor serum calcium and renal function during prolonged treatment, especially in higher-risk people.
• Consider urinary calcium measurement with hypercalciuria, recurrent calculi or stone history.
• Monitor calcium and, where appropriate, ECG with cardiac glycosides.
• In renal impairment, assess calcium and phosphate balance and colecalciferol suitability.
• Higher maternal vitamin D exposure during breastfeeding may require infant clinical and biochemical monitoring.

Clinical pharmacology

Calcium carbonate supplies elemental calcium. Colecalciferol undergoes hepatic and renal hydroxylation to active metabolites that increase intestinal calcium absorption; severe renal impairment can alter activation.

Formulation and product differences

• Calceos is chewable and contains sorbitol, sucrose and hydrogenated soya-bean oil.
• Adcal-D3 Caplets are film-coated tablets intended to be swallowed and contain sucrose.
• Adcal-D3 Dissolve is a lemon-flavoured effervescent tablet dissolved in water and contains sodium, sorbitol and sucrose.
• Cacit D3 is supplied as effervescent granules for oral solution and contains potassium, sorbitol and sucrose.
• Accrete D3 is film-coated and may be broken to ease swallowing, not to provide equal portions; it contains sucrose and hydrogenated soya-bean oil.