250 mg or 500 mg tablet: Elemental Maxcal tablets are used for the prevention and treatment of Maxcal deficiency in patients where dietary intake is insufficient. Conditions associated with Maxcal deficiency include hypoparathyroidism, achlorhydria, chronic diarrhea, vitamin D deficiency, steatorrhea, sprue, pregnancy and lactation, menopause, pancreatitis, renal failure, alkalosis, and hyperphosphatemia. Maxcal 500 mg is increasingly used for managing hyperphosphatemia in patients with chronic renal failure, including those undergoing CAPD and hemodialysis. Some patients may not tolerate adequate doses for complete phosphate control and may require additional measures such as dietary phosphate restriction or low-dose aluminum hydroxide. Maxcal 500 mg preparations may provide short-term relief of dyspeptic symptoms but are not recommended for long-term treatment of peptic ulcer disease.

1000 mg tablet: Elemental Maxcal tablets are indicated for the management of acid-related conditions and for rapid relief of acid indigestion, heartburn, sour stomach, and stomach discomfort.

Calcium carbonate reacts with gastric acid to form calcium chloride, water, and carbon dioxide. Two grams of calcium carbonate can neutralize approximately 100 ml of hydrochloric acid, increasing gastric pH above 6. This rise in pH reduces the activity of pepsin in gastric secretions. Approximately up to 30% of orally administered calcium may be absorbed.

250 mg or 500 mg tablet: Calcium Carbonate is always used orally and when used as an antacid the recommended doses for adults are equivalent to 540–2000 mg Calcium Carbonate per day, doses for children being half of those for adults. As a dietary supplement, such as for the prevention of osteoporosis, 1250–3750 mg Calcium Carbonate (500–1500 mg calcium) daily is recommended in general, but again this will need to be tailored to the individual patient depending on any specific disease such as Calcium deficiency, malabsorption or parathyroid function. In pregnancy and lactation the recommended daily dose of calcium is 1200–1500 mg. In chronic renal failure the doses used vary from 2.5–9.0 gm Calcium Carbonate per day and need to be adjusted according to the individual patient. To maximize effective phosphate binding in this context the Calcium Carbonate should be given with meals.

1000 mg tablet: 2000–3000 mg tablet when symptoms occur; may be repeated hourly if needed or as directed by the physician.

• Hypercalcemia and hyperparathyroidism
• Hypercalciuria and nephrolithiasis
• Zollinger–Ellison syndrome
• Concomitant use with digoxin (requires careful monitoring of serum calcium levels)

If hypercalcemia develops, discontinuation of the drug is usually sufficient to normalize serum calcium levels. Calcium salts should be used cautiously in patients with sarcoidosis, renal or cardiac disease, and in those receiving cardiac glycosides.

Oral administration of Calcium Carbonate may cause gastrointestinal irritation and constipation. Hypercalcemia is uncommon with calcium alone but may occur when high doses are used, particularly in patients with chronic renal failure.

Calcium-containing products have been widely used during pregnancy as supplements or antacids. Calcium Carbonate can also be safely used during lactation.

Use in children: Calcium Carbonate has been extensively studied in infants and children with chronic renal failure and is considered both safe and effective.

Use in elderly: In elderly patients, particularly those with renal impairment, constipation may be more pronounced. Therefore, regular monitoring of serum calcium and phosphate levels is recommended.

Minerals in bone formation, Specific mineral preparations

Store in a cool, dry place at controlled room temperature.