Calcium-D3 Nicomed forte lemon, chewable tablets 60 pcs

Calcium-D3 Nicomed forte regulates calcium and phosphorus metabolism in the body (bones, teeth, nails, hair, muscles). It reduces resorption (resorption) and increases bone density, filling the lack of calcium and vitamin D3 in the body, it is necessary for the mineralization of teeth.

Calcium is involved in the regulation of nerve conduction, muscle contractions and is a component of the blood clotting system.

Vitamin D3 increases the absorption of calcium in the intestine.

The use of calcium and vitamin D3 inhibits increased production of parathyroid hormone (PTH), which is a stimulant of increased bone resorption (leaching of calcium from bones).

Pharmacokinetics

Calcium

Intake. Normally, the amount of calcium absorbed in the gastrointestinal tract is about 30% of the dose taken.

Distribution and metabolism. 99% of calcium in the body is concentrated in the hard structure of the bones and teeth. The remaining 1% is in intra- and extracellular fluids. About 50% of the total calcium in the blood is in the physiologically active ionized form, of which about 10% is complexed with citrate, phosphate or other anions; the remaining 40% is associated with proteins, primarily with albumin.

Excretion. Calcium is excreted by the intestines, kidneys and sweat glands. Renal excretion depends on glomerular filtration and tubular reabsorption of calcium.

Vitamin D3

Intakeover. Vitamin D3 is readily absorbed in the small intestine (about 80% of the dose taken).

Distribution and metabolism. Colecalciferol and its metabolites circulate in the blood, bound to specific globulin. Colecalciferol is converted in the liver by hydroxylation to 25-hydroxycolecalciferol. It is then converted in the kidneys to the active form 1,25-hydroxycolecalciferol. 1,25-hydroxycalciferol is the metabolite responsible for increasing calcium absorption. Unmetabolized vitamin D3 is deposited in fat and muscle tissue.

Excretion. Vitamin D3 is excreted by the intestine and the kidneys.

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Indications

Composition

1 lemon-flavored chewable tablet contains:

Active ingredients:

Calcium carbonate 1250 mg (corresponding to 500 mg of calcium)

p> Colecalciferol (vitamin D3) 400 IU

Auxiliary substances:

Sorbitol

Isomalt

Povidone

Magnesium stearate

Aspartame

Lemon oil

Mono- and diglycerides of fatty acids

How to take, the dosage

Over the mouth, chewed or crushed, mostly with meals.

For prevention of osteoporosis

– 1 tablet 2 times a day or 2 tablets once a day

In complex therapy of osteoporosis

– 1 tablet 2-3 times a day.

To replenish calcium and vitamin D deficiency: 2 tablets a day for adults and children over 12 years of age, 1 tablet a day for children 3-12 years of age or as directed by a physician.

Special patient groups

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Duration of treatment. When used for prevention and in treatment of osteoporosis the duration of treatment is determined by the doctor individually.

When using for replenishment of calcium and vitamin D3 deficiency, the average duration of treatment course is at least 4-6 weeks. The number of repeated courses within a year is determined individually.

Interaction

Hypercalcemia may potentiate toxic effects of cardiac glycosides when used simultaneously with calcium and vitamin D preparations. Monitoring of ECG and serum calcium content is necessary.

Calcium preparations may decrease absorption of tetracyclines from the gastrointestinal tract. Therefore tetracyclines should be taken at least 2 hours before or 4-6 hours after taking Calcium-D3 Nicomed Forte.

In order to prevent reduction of absorption of bisphosphonates it is recommended to take them at least one hour before taking Calcium-D3 Nicomed Forte.

The GCS decrease the absorption of calcium, so treatment with glucocorticosteroids may require increasing the dose of Calcium-D3 Nicomed Forte.

Concomitant use of thiazide-type diuretics increases the risk of hypercalcemia because they increase the tubular reabsorption of calcium. In concomitant use of thiazide diuretics serum calcium content should be monitored regularly.

Calcium reduces the effectiveness of levothyroxine by reducing its absorption. The time period between taking levothyroxine and Calcium-D3 Nicomed Forte should be at least 4 hours.

The absorption of antibiotics of the quinolone group is reduced with concomitant use of calcium preparations. Therefore, quinolone antibiotics should be taken 2 hours before or 6 hours after taking Calcium-D3 Nicomed Forte.

Entake of food containing oxalates (sorrel, rhubarb, spinach) and phyticine (cereals) reduces the absorption of calcium, so do not take Calcium-D3 Nicomed Forte within two hours after taking sorrel, rhubarb, spinach, cereals

Special Instructions

When long-term therapy, serum calcium and creatinine should be monitored. Monitoring is especially important in elderly patients with concomitant treatment with cardiac glycosides and diuretics and in patients with an increased tendency to form kidney stones. In cases of hypercalcemia or signs of impaired renal function, the dose should be reduced or treatment stopped.

Vitamin D should be used with caution in patients with renal insufficiency. In this case it is necessary to control the content of calcium and phosphate in serum. Also, the risk of soft tissue calcinosis should be considered.

In order to avoid an overdose, additional intake of vitamin D from other sources must be considered.

Calcium and vitamin D3 should be used with caution in immobilized patients with osteoporosis because of the risk of hypercalcemia.

Simultaneous use with antibiotics of the tetracycline or quinolone group is generally not recommended, or should be used with caution.

Contraindications

With caution: pregnancy; period of lactation.

Overdose

Symptoms of overdose (hypercalcemia): anorexia, thirst, polyuria, muscle weakness, nausea, vomiting, constipation, abdominal pain, increased fatigue, bone pain, mental disorders, nephrocalcinosis, urolithiasis and, in severe cases, cardiac arrhythmias. With long-term use of excessive doses (over 2500 mg of calcium) – kidney damage, soft tissue calcinosis.

If signs of overdose are found, stop taking calcium and vitamin D as well as thiazide diuretics and cardiac glycosides, and consult a physician.

Treatment: gastric lavage, fluid replacement, use of loop diuretics (e.g., furosemide), GCS, calcitonin, bisphosphonates.

Plasma electrolytes, renal function and urine output should be monitored. In severe cases, central venous pressure (CVP) should be measured and ECG should be monitored.

Pregnancy use

Calcium-D3 Nicomed is used during pregnancy to replenish calcium and vitamin D deficiency in the body.

The daily dose during pregnancy should not exceed 1500 mg of calcium and 600 IU of vitamin D3.

Hypercalcemia that develops in overdose during pregnancy can have adverse effects on the developing fetus.

Calcium-D3 Nicomed is used during lactation.

Vitamin D and its metabolites can penetrate into breast milk, so the intake of calcium and vitamin D from other sources in the mother and baby must be considered.