This combination tablet is indicated for the treatment and prevention of:

• Osteoporosis
• Osteomalacia
• Tetany
• Hypoparathyroidism
• Disorders of osteogenesis

This combination tablet is also used as a supplement in cases of inadequate calcium intake during childhood diet, rickets, pregnancy & lactation, and in elderly patients. Other indications include pancreatitis, phosphate binding in chronic renal failure, etc.

Each tablet contains: Calcium Carbonate USP 1250 mg (Coral source) equivalent to 500 mg of elemental Calcium & Vitamin D USP 200 IU.

Each DX tablet contains: Calcium Carbonate USP 1500 mg (Coral source) equivalent to 600 mg of elemental Calcium & Vitamin D USP 400 IU.

Each effervescent tablet contains: Calcium Carbonate (Coral source) USP 1500 mg equivalent to 600 mg of elemental Calcium and Vitamin D3 400 IU as Cholecalciferol USP.

Adequate calcium levels in the blood are essential for a wide range of bodily functions, and the body cannot tolerate deficiency even for short periods. Clinical evidence suggests that calcium is useful for the prevention and treatment of osteoporosis and related fractures. Vitamin D is also essential for healthy bones as it facilitates calcium absorption from the gastrointestinal tract and stimulates bone formation. Clinical studies show that calcium and vitamin D have synergistic effects on bone growth, as well as in the prevention of osteoporosis and fractures. In this preparation, calcium carbonate is sourced from coral origin. Coral calcium has a chemical structure very similar to human bone composition. It is comparable to other sources but may ensure better absorption. Vitamin D3 aids in calcium absorption from the GI tract and helps maintain calcium balance in the body.

One tablet once or twice daily with plenty of water or as directed by the physician. Taking in full stomach ensures better absorption. Dissolve 1 effervescent tablet in a glass of water to drink orally. Stir the solution with spoon before drinking. Taking in full stomach ensures better absorption.

Thiazide diuretics reduce urinary calcium excretion. Due to an increased risk of hypercalcaemia, serum calcium should be regularly monitored during concomitant use. Systemic corticosteroids reduce calcium absorption; therefore, higher doses of calcium may be required during combined use. Concomitant use of ion-exchange resins such as cholestyramine or laxatives such as paraffin oil may reduce gastrointestinal absorption of vitamin D. Calcium carbonate may interfere with the absorption of tetracycline antibiotics. For this reason, tetracycline should be taken at least 2 hours before or 4–6 hours after calcium intake. Hypercalcaemia may increase the toxicity of cardiac glycosides during calcium and vitamin D therapy. Patients should be monitored with ECG and serum calcium levels. When used with bisphosphonates or sodium fluoride, calcium should be taken at least 3 hours apart, as absorption may be reduced. Oxalic acid (spinach, rhubarb) and phytic acid (whole grains) may inhibit calcium absorption by forming insoluble salts. Calcium products should not be taken within 2 hours of such foods.

• Hypercalcaemia and hyperparathyroidism
• Hypercalciuria and nephrolithiasis
• Hypersensitivity to any component of the product
• Severe renal impairment
• Concomitant digoxin therapy (requires careful monitoring of serum calcium levels)

Oral calcium carbonate may irritate the gastrointestinal tract and may cause constipation. Hypercalcaemia is rare with calcium alone but may occur in patients with chronic renal failure receiving high doses. Other possible side effects include allergic reactions, irregular heartbeat, nausea, vomiting, loss of appetite, dry mouth, and drowsiness. Vitamin D supplementation has occasionally been associated with skin rash.

During pregnancy, daily intake should not exceed 1500 mg calcium and 600 IU cholecalciferol (15 mcg vitamin D). High-dose vitamin D has shown reproductive toxicity in animal studies. Overdose of calcium and vitamin D during pregnancy should be avoided, as persistent hypercalcaemia may adversely affect fetal development. There is no evidence that vitamin D is teratogenic at therapeutic doses in humans. Calcium & Vitamin D3 tablets may be used during pregnancy in cases of deficiency. They may also be used during breastfeeding. Calcium and vitamin D pass into breast milk, which should be considered when giving additional vitamin D to the infant.

During long-term therapy, serum calcium and renal function (serum creatinine) should be regularly monitored. This is especially important in elderly patients, those receiving cardiac glycosides or diuretics, and patients prone to kidney stone formation. In case of hypercalcaemia or renal impairment, the dose should be reduced or treatment discontinued. Vitamin D should be used cautiously in renal impairment, with monitoring of calcium and phosphate levels due to risk of soft tissue calcification. In severe renal insufficiency, cholecalciferol is not normally metabolised, and other forms of vitamin D should be used. Caution is required in sarcoidosis due to increased conversion of vitamin D to its active form. Serum and urinary calcium must be monitored. In immobilised osteoporotic patients, there is an increased risk of hypercalcaemia. The vitamin D content should be considered when prescribing other vitamin D–containing products. Additional calcium or vitamin D should only be used under medical supervision with regular monitoring.

Overdose may lead to hypervitaminosis D and hypercalcaemia. Symptoms include anorexia, thirst, nausea, vomiting, constipation, abdominal pain, muscle weakness, fatigue, mental disturbances, excessive thirst and urination, bone pain, nephrocalcinosis, nephrolithiasis, and cardiac arrhythmias. Severe cases may result in coma or death. Persistent hypercalcaemia may cause irreversible renal damage and soft tissue calcification. Management of hypercalcaemia: Discontinue calcium, thiazide diuretics, lithium, vitamin A, and cardiac glycosides. Gastric emptying may be considered in patients with reduced consciousness. Treatment includes rehydration and, depending on severity, loop diuretics, bisphosphonates, calcitonin, and corticosteroids. Serum electrolytes, renal function, urine output, ECG, and central venous pressure should be monitored in severe cases.

Specific mineral & vitamin combined preparations.

Store below 30°C, protect from light and moisture. Keep out of the reach of children.