CALCINEPH

Ferrous Ascorbate eq. to Elemntal Iron – 1oo mg

Calcium carbonate with vitamin d USES:

Calcium carbonate is used for: Treating or preventing calcium deficiency. It may also be used for other conditions as determined by your doctor. Calcium carbonate is a dietary supplement. It works. Calcium carbonate with vitamin d is a dietary supplement. It works by providing extra calcium to the body.

DOSES

Dose expressed in mg of elemental calcium: Children: 45 to 65 mg / kg / day in 4 divided doses Treatment of hyperphosphatemia in end-stage renal failure: Children and Adults: Dose expressed in mg of calcium carbonate: 1 g with each meal; increase as needed; range: 4 to 7 g / day Hydrofluoric acid (HF)...

Usual Adult Dose for Osteoporosis

2500 to 7500 mg/day orally in 2 to 4 divided doses.

Usual Adult Dose for Hypocalcemia

900 to 2500 mg/day orally in 2 to 4 divided doses. This dose may be adjusted as needed to achieve a normal serum calcium level.

Usual Adult Dose for Dyspepsia

300 to 8000 mg/day orally in 2 to 4 divided doses. This dose may be increased as needed and tolerated to decrease symptoms of stomach upset. Maximum Dose: 5,500 to 7980 mg (depending on product used). Not to exceed maximum daily dosage for a period of greater than 2 weeks unless directed by a physician.

Usual Adult Dose for Duodenal Ulcer

1250 to 3750 mg/day in 2 to 4 divided doses. This dose may be increased as needed and tolerated to decrease the abdominal discomfort. The major limiting factor to the chronic use of calcium carbonate is gastric hypersecretion and acid rebound.

Usual Adult Dose for Gastric Ulcer

1250 to 3750 mg/day in 2 to 4 divided doses. This dose may be increased as needed and tolerated to decrease the abdominal discomfort. The major limiting factor to the chronic use of calcium carbonate is gastric hypersecretion and acid rebound.

Usual Adult Dose for Erosive Esophagitis

1250 to 3750 mg/day orally in 2 to 4 divided doses. The potential for acid rebound could be detrimental. However, antacids have been frequently used in the management of erosive esophagitis and may be beneficial in decreasing the acidity of gastric contents. Maximum Dose: 5,500 to 7980 mg (depending on product used). Not to exceed maximum daily dosage for a period of greater than 2 weeks unless directed by a physician.

Usual Adult Dose for Gastroesophageal Reflux Disease

1250 to 3750 mg/day orally in 2 to 4 divided doses. The potential for acid rebound could be detrimental. However, antacids have been frequently used in the management of erosive esophagitis and may be beneficial in decreasing the acidity of gastric contents. Maximum Dose: 5,500 to 7980 mg (depending on product used). Not to exceed maximum daily dosage for a period of greater than 2 weeks unless directed by a physician.

Usual Pediatric Dose for Hypocalcemia

Neonatal: Hypocalcemia (dose depends on clinical condition and serum calcium level): Dose expressed in mg of elemental calcium: 50 to 150 mg/kg/day in 4 to 6 divided doses; not to exceed 1 g/day

Usual Dosage:

Antacid: Children 2 to 5 years: Childrens Pepto, Mylanta (R) Childrens: 1 tablet (400 mg calcium carbonate) as symptoms occur; not to exceed 3 tablets/day Children 6 to 11 years: Childrens Pepto, Mylanta (R) Childrens: 2 tablets (800 mg calcium carbonate) as symptoms occur; not to exceed 6 tablets/day Children 11 years and older:
Tums (R), Tums (R) E-X: 2 to 4 tablets chewed as symptoms occur; not to exceed 15 tablets [Tums (R)] or 10 tablets [Tums (R) E-X] per day Tums (R) Ultra: 2 to 3 tablets chewed as symptoms occur; not to exceed 7 tablets per day Hypocalcemia (dose depends on clinical condition and serum calcium level): Dose expressed in mg of elemental calcium: Children: 45 to 65 mg/kg/day in 4 divided doses Treatment of hyperphosphatemia in end-stage renal failure: Children and Adults: Dose expressed in mg of calcium carbonate: 1 g with each meal; increase as needed; range: 4 to 7 g/day Hydrofluoric acid (HF) burns (HF concentration less than 20%): Topical: Various topical calcium preparations have been used anecdotally for treatment of dermal exposure to HF solutions; calcium carbonate at concentrations ranging from 2.5% to 33% has been used; a topical calcium carbonate preparation must be compounded.

Renal Dose Adjustments

Patients with renal dysfunction have an increased risk of hypercalcemia. Periodically checking the serum calcium level, especially if signs or symptoms of hypercalcemia are detected, is recommended. The use of calcium carbonate is not indicated for the treatment of hyperphosphatemia in patients with calculated or estimated creatinine clearance equal to or greater than 25 mL/min.

Dialysis

Calcium is removed by hemodialysis. To ensure a positive net calcium flux into the patient during dialysis, a dialysate calcium concentration of 3 to 3.5 mEq/L is usually required. Mid-dialysis modest hypercalcemia is not uncommon when this concentration is used. Calcium is removed by peritoneal dialysis. The standard peritoneal dialysate contains 3.5 mEq/L of calcium (in 1.5% dextrose) to maintain a positive calcium balance and to prevent calcium losses. When higher concentrations of dextrose are used, the net calcium balance may be negative because of a greater convective removal of calcium during ultrafiltration. This counterbalances the diffusion of calcium from the dialysate to the patient

Other Comments

Dietary reference intake: Dosage is in terms of elemental calcium:
0 to 6 months: Adequate intake: 200 mg/day
7 to 12 months: Adequate intake: 260 mg/day
1 to 3 years: RDA: 700 mg/day
4 to 8 years: RDA: 1000 mg/day
9 to 18 years: RDA: 1300 mg/day
Adults, Female/Male: RDA:
19 to 50 years: 1000 mg/day
51 years and older, females: 1200 mg/day
51 to 70 years, males: 1000 mg/day
Female: Pregnancy/Lactating: RDA: Same as for Adults, Female/Male
Calcium carbonate:
Elemental calcium: 400 mg/1 g (20 mEq calcium/gram)
Approximate equivalent dose: 225 mg of calcium salt
Osteoporosis may be associated with increased serum parathyroid hormone, excessive alcohol intake, tobacco use, inactivity, and certain drugs. Additional factors to consider in males with osteoporosis include hypogonadism and/or age related decreases in serum testosterone. Adequate vitamin D intake and weight bearing exercise (if possible) are recommended.

BEFORE use calcium carbonate with vitamin d Kindly check:

Each 1 g of calcium carbonate contains 400 mg elemental calcium, or You Should contact your doctor or health care provider right away if any of these apply to you. Some medical conditions may interact with calcium carbonate with vitamin d. Tell your doctor o if you have any medical conditions, especially if any of the following apply to you:

• if you are pregnant, planning to become pregnant, or are breast-feeding
• if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement or food supplement .
• if you have allergies to medicines, foods, or other substances .
• if you have high blood phosphate levels or high levels of calcium in the urine
• if you have dehydration, heart problems, sarcoidosis , kidney problems, kidney stones, sarcoidosis or hardening of the arteries
• FOR KIDNEY PATIENTS : IF You are using Mycophenolate because its effectiveness may be decreased by calcium carbonate with vitamin d

This may not be a complete list of all interactions that may occur. Ask your health care provider if calcium carbonate with vitamin d may interact with other medicines that you take.

USER GUIDE:

Use calcium carbonate with vitamin d as directed by your doctor. Check the label on the medicine for exact dosing instructions.

• Take calcium carbonate with vitamin d by mouth with or without food.
• Take calcium carbonate with vitamin d with a full glass of water (8 oz/240 mL).
• If you also take azole antifungals (eg, ketoconazole), bisphosphonates (eg, etidronate), cation exchange resins (eg, sodium polystyrene
• sulfonate),cephalosporins (eg, cefdinir), doxycycline, iron, quinolones (eg, ciprofloxacin, levofloxacin), tetracyclines (eg, doxycycline), or thyroid hormones (eg, levothyroxine), ask your doctor how to take them with calcium carbonate with vitamin d.
• If you miss a dose of calcium carbonate with vitamin d, take it as soon as you remember. Continue to take it as directed by your doctor .

Safety information:

• Do not take large doses of vitamins while you use calcium carbonate with vitamin d unless your doctor tells you to.
• Tell your doctor or dentist that you take calcium carbonate with vitamin d before you receive any medical or dental care, emergency care, or surgery. This product may contain tartrazine dye therefore If you have ever had an allergic reaction to tartrazine, ask your Doctor . Lab tests, including serum calcium levels, may be performed while you use calcium carbonate with vitamin d.. Calcium carbonate with vitamin d should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using calcium carbonate with vitamin d while you are pregnant.

Side effects of calcium carbonate with vitamin d:

All medicines may cause side effects, but many people have no, or minor, side effects. No COMMON side effects have been reported with calcium carbonate with vitamin d. Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); loss of appetite; nausea; severe or persistent constipation; vomiting. This is not a complete list of all side effects that may occur. Contact Your Doctor

Storage of calcium carbonate with vitamin d:

Store calcium carbonate with vitamin d at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Keep calcium carbonate with vitamin d out of the reach of children and away from pets.

General information:

• If you have any questions about calcium carbonate with vitamin d, please talk with your doctor, pharmacist, or other health care provider.
• Calcium carbonate with vitamin d is to be used only by the patient for whom it is prescribed. Do not share it with other people.
• If your symptoms do not improve or if they become worse, check with your doctor

This information should not be used to decide whether or not to take calcium carbonate with vitamin d or any other medicine. Only your Doctor has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about calcium carbonate with vitamin d. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to calcium carbonate with vitamin d. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your Doctor for complete information about the risks and benefits of using calcium carbonate with vitamin d.

Dosage And Administration

The optimal daily dose of calcitriol capsules must be carefully determined for each patient. Calcitriol can be administered orally as a capsule (0.25 mcg or 0.50 mcg). Calcitriol therapy should always be started at the lowest possible dose and should not be increased without careful monitoring of serum calcium. The effectiveness of calcitriol capsule therapy is predicated on the assumption that each patient is receiving an adequate but not excessive daily intake of calcium. Patients are advised to have a dietary intake of calcium at a minimum of 600 mg daily. The U.S. RDA for calcium in adults is 800 mg to 1200 mg. To ensure that each patient receives an adequate daily intake of calcium, the physician should either prescribe a calcium supplement or instruct the patient in proper dietary measures. Because of improved calcium absorption from the gastrointestinal tract, some patients on calcitriol may be maintained on a lower calcium intake. Patients who tend to develop hypercalcemia may require only low doses of calcium or no supplementation at all. During the titration period of treatment with calcitriol, serum calcium levels should be checked at least twice weekly. When the optimal dosage of calcitriol has been determined, serum calcium levels should be checked every month (or as given below for individual indications). Samples for serum calcium estimation should be taken without a tourniquet.

Dialysis Patients

The recommended initial dose of calcitriol capsules is 0.25 mcg/day. If a satisfactory response in the biochemical parameters and clinical manifestations of the disease state is not observed, dosage may be increased by 0.25 mcg/day at 4 to 8 week intervals. During this titration period, serum calcium levels should be obtained at least twice weekly, and if hypercalcemia is noted, the drug should be immediately discontinued until normocalcemia ensues (see PRECAUTIONS, General). Phosphorus, magnesium, and alkaline phosphatase should be determined periodically. Patients with normal or only slightly reduced serum calcium levels may respond to calcitriol capsule doses of 0.25 mcg every other day. Most patients undergoing hemodialysis respond to doses between 0.5 and 1 mcg/day. Oral calcitriol capsules may normalize plasma ionized calcium in some uremic patients, yet fail to suppress parathyroid hyperfunction. In these individuals with autonomous parathyroid hyperfunction, oral calcitriol capsules may be useful to maintain normocalcemia, but have not been shown to be adequate treatment for hyperparathyroidism.

Hypoparathyroidism

The recommended initial dosage of calcitriol capsules is 0.25 mcg/day given in the morning. If a satisfactory response in the biochemical parameters and clinical manifestations of the disease is not observed, the dose may be increased at 2 to 4 week intervals. During the dosage titration period, serum calcium levels should be obtained at least twice weekly and, if hypercalcemia is noted, calcitriol capsules should be immediately discontinued until normocalcemia ensues (see PRECAUTIONS, General). Careful consideration should also be given to lowering the dietary calcium intake. Serum calcium, phosphorus, and 24 hour urinary calcium should be determined periodically. Most adult patients and pediatric patients age 6 years and older have responded to dosages in the range of 0.5 mcg to 2 mcg daily. Pediatric patients in the 1 to 5 year age group with hypoparathyroidism have usually been given 0.25 mcg to 0.75 mcg daily. The number of treated patients with pseudohypoparathyroidism less than 6 years of age is too small to make dosage recommendations. Malabsorption is occasionally noted in patients with hypoparathyroidism; hence, larger doses of calcitriol may be needed.

Predialysis Patients

The recommended initial dosage of calcitriol is 0.25 mcg/day in adults and pediatric patients 3 years of age and older. This dosage may be increased if necessary to 0.5 mcg/day. For pediatric patients less than 3 years of age, the recommended initial dosage of calcitriol is 10 to 15 ng/kg/day.