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    Calcium Citrate

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    Oct.03.2024

    Calcium Citrate

    Indications/Dosage

    Labeled

    • hypocalcemia
    • nutritional supplementation
    • osteoporosis prophylaxis
    • Calcium citrate contains 21% elemental calcium, which is equivalent to 210 mg (10.5 mEq) of elemental calcium per gram of calcium citrate.[53981]

    Off-Label

      † Off-label indication

      For the treatment of hypocalcemia

      NOTE: Base dose on clinical condition and serum calcium concentration. Serum concentrations of ionized calcium may be necessary to guide dosage adjustments in some persons, especially those with hypoalbuminemia.[68050] [68051]

      NOTE: The calcium citrate salt is recommended in persons who have achlorhydria or who are taking a proton-pump inhibitor, in order to achieve sufficient absorption of calcium.[54032] [62317] [68050]

      Oral dosage

      Adults

      1,900 to 3,800 mg PO 2 to 4 times daily (800 to 3,200 mg/day elemental calcium), initially. Titrate dose based on symptom control and target calcium concentrations. Usual Max: 43,000 mg/day (9,000 mg/day elemental calcium).[54032] [62317] [68050] [68051] [68052] [68055]

      Oral dosage

      Adult Females 51 years and older

      1,200 mg/day elemental calcium PO (approximately 5,700 mg calcium citrate) is the recommended dietary allowance (RDA).[52900] Guidelines for the prevention osteoporosis in postmenopausal females recommend a target daily intake of 1,200 mg/day of elemental calcium given with a regimen including vitamin D to promote general bone health.[66837] [67122] [67123] There is insufficient evidence to determine if daily supplementation with calcium at doses greater than 1,000 mg and vitamin D at doses greater than 10 mcg (400 international units) prevents fractures in community-dwelling postmenopausal females.[67140]

      Adult Females 19 to 50 years

      1,000 mg/day elemental calcium PO (approximately 4,800 mg calcium citrate) is the recommended dietary allowance (RDA).[52900]

      Adult Males 71 years and older

      1,200 mg/day elemental calcium PO (approximately 5,700 mg calcium citrate) is the recommended dietary allowance (RDA).[52900]

      Adult Males 19 to 70 years

      1,000 mg/day elemental calcium PO (approximately 4,800 mg calcium citrate) is the recommended dietary allowance (RDA).[52900]

      Adults 18 years

      1,300 mg/day elemental calcium PO (approximately 6,200 mg calcium citrate) is the recommended dietary allowance (RDA).[52900]

      Therapeutic Drug Monitoring

      Ionized calcium concentrations are the preferred measure to determine true hypocalcemia. If total serum calcium concentrations are obtained, calcium concentrations should be adjusted if hypoalbuminemia or hyperalbuminemia is present. The corrected calcium concentration may be estimated from the following formula [53997][54032]:

      • Corrected calcium (mg/dL) = serum calcium (mg/dL) + 0.8 [4- serum albumin (g/dL)]

      Maximum Dosage Limits

      • Adults

        Generally, 43,000 mg/day (approximately 9,000 mg/day elemental calcium) PO for hypocalcemia; tolerable upper intake level as a nutrient is 12,000 mg/day (approximately 2,500 mg/day elemental calcium).

      • Geriatric

        Generally, 43,000 mg/day (approximately 9,000 mg/day elemental calcium) PO for hypocalcemia; tolerable upper intake level as a nutrient is 12,000 mg/day (approximately 2,500 mg/day elemental calcium).

      • Adolescents

        Safety and efficacy have not been established.

      • Children

        Safety and efficacy have not been established.

      • Infants

        Safety and efficacy have not been established.

      • Neonates

        Safety and efficacy have not been established.

      Patients with Hepatic Impairment Dosing

      Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

      Patients with Renal Impairment Dosing

      Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

      † Off-label indication
      Revision Date: 10/03/2024, 02:58:00 AM

      References

      52900 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: The National Academies Press, 2011.53981 - Straub DA. Calcium supplementation in clinical practice: A review of forms, doses, and indications. Nutr Clin Pract 2007;22(3):286-296.53997 - Umpaichitra V, Bastian W, Castells S. Hypocalcemia in children: Pathogenesis and management. Clin Pediatr (Phila) 2001;40(6):305-312.54032 - Reber PM, Heath H, III. Hypocalcemic emergencies. Med Clin North Am 1995;79:93-106.62317 - Shoback D. Hypoparathyroidism. N Engl J Med 2008; 359:391-403.66837 - Camacho PM, Petak SM, Binkley N, et al. American Association of Clinical Endocrinologists/American College of Endocrinology clinical practice guidelines for the diagnosis and treatment of postmenopausal osteoporosis-2020 update. Endocr Pract 2020;26(Suppl 1):1-46.67122 - Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28:973-997.67123 - Osteoporosis Prevention, Screening, and Diagnosis: ACOG Clinical Practice Guideline No 1. Obstet Gynecol 2021;138:494-506.67140 - US Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK, et al. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: US Preventive Services Task Force Recommendation Statement. JAMA 2018 ;319:1592-1599.68050 - Pepe J, Colangelo L, Biamonte F, et al. Diagnosis and management of hypocalcemia. Endocrine 2020;69:485-495.68051 - Fong J, Khan A. Hypocalcemia: Updates in diagnosis and management for primary care. Can Fam Physician 2012;58:158-162.68052 - Bilezikian JP, Khan A, Potts JT Jr, et al. Hypoparathyroidism in the adult: epidemiology, diagnosis, pathophysiology, target organ involvement, treatment, and challenges for future research. J Bone Miner Res 2011;26:2317-2337.68055 - DiMaio S, Soliman AT, DeSanctis V, et al. Current treatment of hypoparathyroidism: theory versus reality waiting guidelines for children and adolescents. Acta Biomed 2018;89:122-131.

      How Supplied

      Calcium Oral tablet

      Calcium Citrate 250mg Tablet (58487-0028) (Freeda Vitamins, Inc.) null

      Calcium Oral tablet

      Calcium Citrate 200mg Caplet (null) (21st Century HealthCare, Inc.) null

      Calcium Oral tablet

      Calcium Citrate 200mg Tablet (35046-0001) (Windmill Health Products, LLC) null

      Calcium Oral tablet

      Calcium Citrate 950mg Tablet (00761-0195) (Basic Vitamins) null

      Calcium Oral tablet

      Calcium Citrate 950mg Tablet (00904-5062) (Major Pharmaceuticals Inc, a Harvard Drug Group Company) (off market)

      Calcium Oral tablet

      Calcium Citrate 950mg Tablet (10135-0252) (Marlex Pharmaceuticals) (off market)

      Calcium Oral tablet

      Calcium Citrate 950mg Tablet (00182-4151) (Teva Pharmaceuticals USA) (off market)

      Calcium Oral tablet

      Calcium Citrate 250mg Caplet (43292-0556) (Magno-Humphries Labs, Inc.) null

      Description/Classification

      Description

      Calcium citrate is an acidic calcium salt containing 21% elemental calcium. It is used for nutritional supplementation to maintain bone health and for the maintenance treatment of hypocalcemia.[53981] Calcium is the most abundant cation and the fifth most common inorganic element in the human body. Calcium is essential for the maintenance of the nervous, muscular, and skeletal systems, and for cell membrane and capillary permeability. Its role in bone structure and muscle contraction is well known, but calcium is also important for blood coagulation, nerve conduction, and electrical conduction in the myocardium. In general, calcium salts are used to treat or prevent calcium depletion.[53994] Calcium is recognized as an important agent in preventing osteoporosis, especially in postmenopausal women.[23671][53994] Calcium citrate, due to its acidic base, is the supplement of choice for patients with achlorhydria because it requires less production of stomach acids, allowing better absorption. Calcium citrate has been shown to be more bioavailable than calcium carbonate when given with meals.[53981]

      Classifications

      • Vitamins, Minerals, and Dietary or Nutritional Supplements
        • Vitamin and Mineral Supplements
          • Calcium Supplements (new)
            • Oral Calcium Supplements
      Revision Date: 10/03/2024, 02:58:00 AM

      References

      23671 - Reid IR, Ames RW, Evans MC, et al. Effect of calcium supplementation on bone loss in postmenopausal women. N Engl J Med 1993;328:460-4.53981 - Straub DA. Calcium supplementation in clinical practice: A review of forms, doses, and indications. Nutr Clin Pract 2007;22(3):286-296.53994 - Calcium gluconate 10% injection solution package insert. Lake Zurich, IL: Fresenius Kabi USA, LLC; 2023 Jun.

      Administration Information

      General Administration Information

      For storage information, see the specific product information within the How Supplied section.

      Route-Specific Administration

      Oral Administration

      Oral Solid Formulations

      • Administer with or without food. Follow each dose with adequate fluids.
      • Because calcium-containing products may interfere with the absorption of other medicines, separate administration of calcium from other medications according to recommendations for the potentially interacting medication.[53981]

      Clinical Pharmaceutics Information

      From Trissel's 2‚Ñ¢ Clinical Pharmaceutics Database
        Revision Date: 10/03/2024, 02:58:00 AM

        References

        53981 - Straub DA. Calcium supplementation in clinical practice: A review of forms, doses, and indications. Nutr Clin Pract 2007;22(3):286-296.

        Adverse Reactions

        Mild

        • anorexia
        • drowsiness
        • nausea
        • polyuria
        • vomiting

        Severe

        • coma
        • milk-alkali syndrome

        Moderate

        • confusion
        • constipation
        • delirium
        • hypercalcemia
        • hypertension
        • nephrolithiasis
        • premature ventricular contractions (PVCs)

        Hypercalcemia may occur with excess intake of calcium. It rarely occurs if appropriate doses of calcium are administered to otherwise healthy patients; however, patients with renal failure, patients receiving vitamin D, patients with electrolyte imbalance (i.e., hyponatremia, hyperkalemia), and patients with prolonged immobility can develop hypercalcemia readily. Signs and symptoms of hypercalcemia include anorexia, constipation, nausea/vomiting, drowsiness, hypertension, polyuria, and premature ventricular contractions (PVCs). Severe hypercalcemia (calcium more than 12 mg/dL) may result in confusion, delirium, stupor, and coma. Concentrations more than 15 mg/dL may be life-threatening.[53742]

         

        A rare, but serious, side effect of calcium therapy is calcific nephrolithiasis.[54027]

         

        Milk-alkali syndrome, characterized by hypercalcemia and metabolic alkalosis and, if left untreated, renal failure, can occur during prolonged therapy with oral calcium salts that are alkaline, such as calcium citrate.[54029]

        Revision Date: 10/03/2024, 02:58:00 AM

        References

        53742 - Roberts KE. Pediatric fluid and electrolyte balance: Critical care case studies. Crit Care Nurs Clin N Am 2005;17:361-373.54027 - Emkey RD, Emkey GR. Calcium metabolism and correcting calcium deficiencies. Endocrinol Metab Clin North Am 2012;41(3):527-556.54029 - Whiting SJ, Wood R, Kim K. Calcium supplementation. J Am Acad Nurse Pract 1997;9(4):187-192.

        Contraindications/Precautions

        Absolute contraindications are italicized.

        • hypercalcemia
        • breast-feeding
        • hypercalciuria
        • hyperparathyroidism
        • nephrolithiasis
        • pregnancy
        • renal failure
        • sarcoidosis
        • vitamin D toxicity

        Calcium salts are contraindicated in patients with hypercalcemia.[53994]

        Calcium citrate should be used cautiously, if at all, in patients with vitamin D toxicity or hyperparathyroidism. Hypercalcemia is likely to occur in either of these conditions.[53995] [53997]

        Calcium citrate should be used with caution in patients with preexisting hypercalciuria or nephrolithiasis, especially if renal calculi are present.[53981] [54027]

        Calcium supplements should be used with caution in patients with chronic renal failure due to the increased risk of developing hypercalcemia.[53742]

        Calcium citrate should be used with caution in patients with sarcoidosis as hypercalcemia is more likely to occur in these patients.[54025]

        Adverse effects have not been reported with the normal daily intake of calcium within the recommended dietary allowance for a pregnant female. The use of calcium citrate in excess of the recommended dietary allowance during normal pregnancy should be avoided unless, in the judgment of the physician, potential benefits outweigh the risks involved.[31028]

        Calcium supplements appear to be safe and effective to use during breast-feeding to help meet maternal nutritional requirements. Human breast milk naturally contains calcium and other minerals; maternal calcium intake appears to have no significant effect on the amount of calcium normally found in human milk.[27966] [31028] Consider the benefits of breast-feeding, the risk of infant drug exposure, and the risk of an untreated or inadequately treated condition.

        Revision Date: 10/03/2024, 02:58:00 AM

        References

        27966 - Lawrence RA. Chapter 9: Diet and dietary supplements for the mother and infant. In: Breastfeeding- A Guide for the Medical Profession. 5th ed. St. Louis MO: Mosby, Inc.; 1999.31028 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine (IOM). Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. The National Academy of Sciences Press, Washington DC; 199753742 - Roberts KE. Pediatric fluid and electrolyte balance: Critical care case studies. Crit Care Nurs Clin N Am 2005;17:361-373.53981 - Straub DA. Calcium supplementation in clinical practice: A review of forms, doses, and indications. Nutr Clin Pract 2007;22(3):286-296.53994 - Calcium gluconate 10% injection solution package insert. Lake Zurich, IL: Fresenius Kabi USA, LLC; 2023 Jun.53995 - Hsu SC, Levine MA. Perinatal calcium metabolism: physiology and pathophysiology. Semin Neonatol 2004;9(1):23-36.53997 - Umpaichitra V, Bastian W, Castells S. Hypocalcemia in children: Pathogenesis and management. Clin Pediatr (Phila) 2001;40(6):305-312.54025 - Burke RR, Rybicki BA, Rao DS. Calcium and vitamin D in sarcoidosis: how to assess and manage. Semin Respir Crit Care Med 2010;31:474-484.54027 - Emkey RD, Emkey GR. Calcium metabolism and correcting calcium deficiencies. Endocrinol Metab Clin North Am 2012;41(3):527-556.

        Mechanism of Action

        Calcium is the primary component of skeletal tissue, providing structural integrity and support for individual growth. Bone undergoes constant remodeling and turnover. Mineral release during the process of bone resorption buffers hydrogen ions, whereas the formation of bone generates hydrogen ions. Thus, bone serves as a calcium depot and as a reservoir for electrolytes and buffers. Inhibition of bone resorption is primarily the function of the hormone, calcitonin. The control of plasma calcium concentration is primarily maintained by parathyroid hormone, thyroxine, and 1,25 dihydroxycholecalciferol. Ionized calcium is the physiologically active form. Basic metabolic functions involve the cardiac, neuromuscular, structural, and blood coagulation systems.[53742][53997][54027]

        Revision Date: 10/03/2024, 02:58:00 AM

        References

        53742 - Roberts KE. Pediatric fluid and electrolyte balance: Critical care case studies. Crit Care Nurs Clin N Am 2005;17:361-373.53997 - Umpaichitra V, Bastian W, Castells S. Hypocalcemia in children: Pathogenesis and management. Clin Pediatr (Phila) 2001;40(6):305-312.54027 - Emkey RD, Emkey GR. Calcium metabolism and correcting calcium deficiencies. Endocrinol Metab Clin North Am 2012;41(3):527-556.

        Pharmacokinetics

        Calcium citrate is administered orally. Approximately 98% of the body's calcium is stored in the bone, primarily as the hydroxyapatite. Constant bone remodeling and turnover of the skeleton release calcium into the systemic circulation which is then re-accumulated by the bone daily. Calcium is 40% bound to plasma proteins, primarily albumin, and 10% is in a chelated form. Approximately 50% of serum calcium is ionized, which is considered the physiologically active form. The ultrafiltratable calcium (nonprotein-bound) is distributed to the protein-poor regions of the body, such as the cerebrospinal and extracellular fluids. Calcium is primarily excreted in the feces and bile (80%). Urinary excretion accounts for the remainder (20%). However, approximately 99% of filtered calcium is reabsorbed by the kidney with less than 1% excreted.[54032] Parathyroid hormone, calcitonin, and 1,25 dihydroxycholecalciferol are primarily responsible for controlling calcium equilibrium. Insulin, thyroxine, growth hormone, androgens, estrogens, adrenal corticosteroids, and inorganic phosphate also contribute.[53985][53995][53997]

         

        Affected cytochrome P450 isoenzymes: none

        Route-Specific Pharmacokinetics

        Oral Route

        Absorption of calcium is optimal when it is taken in a dose of 500 mg or less. Disintegration of tablet forms may differ between manufacturers, which may affect absorption. Optimal calcium absorption may require supplemental vitamin D in individuals with inadequate vitamin D intake, impaired renal function, or those with inadequate exposure to sunlight. Bioavailability studies of calcium citrate compared to calcium carbonate have reported variable results. One study reported similar bioavailability between the 2 formulations (approximately 28% for 500-mg dose and 36% for 1000-mg dose). Another study reported better bioavailability with calcium citrate when given with food. Calcium citrate offers better absorption under achlorhydria conditions; therefore, this supplement is recommended in patients receiving proton-pump inhibitors or H2 blockers.[53981]

        Revision Date: 10/03/2024, 02:58:00 AM

        References

        53981 - Straub DA. Calcium supplementation in clinical practice: A review of forms, doses, and indications. Nutr Clin Pract 2007;22(3):286-296.53985 - Calcium chloride 10% injection syringe package insert. Lake Forest, IL: Hospira, Inc.; 2023 May.53995 - Hsu SC, Levine MA. Perinatal calcium metabolism: physiology and pathophysiology. Semin Neonatol 2004;9(1):23-36.53997 - Umpaichitra V, Bastian W, Castells S. Hypocalcemia in children: Pathogenesis and management. Clin Pediatr (Phila) 2001;40(6):305-312.54032 - Reber PM, Heath H, III. Hypocalcemic emergencies. Med Clin North Am 1995;79:93-106.

        Pregnancy/Breast-feeding

        pregnancy

        Adverse effects have not been reported with the normal daily intake of calcium within the recommended dietary allowance for a pregnant female. The use of calcium citrate in excess of the recommended dietary allowance during normal pregnancy should be avoided unless, in the judgment of the physician, potential benefits outweigh the risks involved.[31028]

        breast-feeding

        Calcium supplements appear to be safe and effective to use during breast-feeding to help meet maternal nutritional requirements. Human breast milk naturally contains calcium and other minerals; maternal calcium intake appears to have no significant effect on the amount of calcium normally found in human milk.[27966] [31028] Consider the benefits of breast-feeding, the risk of infant drug exposure, and the risk of an untreated or inadequately treated condition.

        Revision Date: 10/03/2024, 02:58:00 AM

        References

        27966 - Lawrence RA. Chapter 9: Diet and dietary supplements for the mother and infant. In: Breastfeeding- A Guide for the Medical Profession. 5th ed. St. Louis MO: Mosby, Inc.; 1999.31028 - Institute of Medicine (IOM), Food and Nutrition Board. Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine (IOM). Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. The National Academy of Sciences Press, Washington DC; 1997

        Interactions

        Level 2 (Major)

        • Baloxavir Marboxil
        • Delafloxacin
        • Edetate Calcium Disodium, Calcium EDTA
        • Eltrombopag
        • Estramustine
        • Ethotoin
        • Moxifloxacin
        • Sulfacetamide; Sulfur
        • Trientine

        Level 3 (Moderate)

        • Abacavir; Dolutegravir; Lamivudine
        • Alendronate
        • Alendronate; Cholecalciferol
        • Aliskiren; Hydrochlorothiazide, HCTZ
        • Amiloride; Hydrochlorothiazide, HCTZ
        • Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ
        • Atenolol; Chlorthalidone
        • Atracurium
        • Azilsartan; Chlorthalidone
        • Benazepril; Hydrochlorothiazide, HCTZ
        • Bictegravir; Emtricitabine; Tenofovir Alafenamide
        • Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
        • Bismuth Subsalicylate; Metronidazole; Tetracycline
        • Bisoprolol; Hydrochlorothiazide, HCTZ
        • Cabotegravir
        • Cabotegravir; Rilpivirine
        • Calcifediol
        • Calcitonin
        • Calcitriol
        • Calcium Phosphate, Supersaturated
        • Candesartan; Hydrochlorothiazide, HCTZ
        • Captopril; Hydrochlorothiazide, HCTZ
        • Cardiac glycosides
        • Chlorothiazide
        • Chlorthalidone
        • Ciprofloxacin
        • Cisatracurium
        • Demeclocycline
        • Digoxin
        • Dolutegravir
        • Dolutegravir; Lamivudine
        • Dolutegravir; Rilpivirine
        • Doxercalciferol
        • Doxycycline
        • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
        • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
        • Enalapril; Hydrochlorothiazide, HCTZ
        • Eprosartan; Hydrochlorothiazide, HCTZ
        • Etidronate
        • Fosinopril; Hydrochlorothiazide, HCTZ
        • Hydrochlorothiazide, HCTZ
        • Hydrochlorothiazide, HCTZ; Moexipril
        • Ibandronate
        • Ibritumomab Tiuxetan
        • Irbesartan; Hydrochlorothiazide, HCTZ
        • Levofloxacin
        • Levothyroxine
        • Levothyroxine; Liothyronine (Porcine)
        • Levothyroxine; Liothyronine (Synthetic)
        • Liothyronine
        • Lisinopril; Hydrochlorothiazide, HCTZ
        • Lithium
        • Losartan; Hydrochlorothiazide, HCTZ
        • Metolazone
        • Metoprolol; Hydrochlorothiazide, HCTZ
        • Minocycline
        • Neuromuscular blockers
        • Ofloxacin
        • Olmesartan; Amlodipine; Hydrochlorothiazide, HCTZ
        • Olmesartan; Hydrochlorothiazide, HCTZ
        • Omadacycline
        • Pancuronium
        • Parathyroid Hormone
        • Paricalcitol
        • Phosphorated Carbohydrate Solution
        • Phosphorus
        • Potassium Phosphate
        • Potassium Phosphate; Sodium Phosphate
        • Quinapril; Hydrochlorothiazide, HCTZ
        • Risedronate
        • Rocuronium
        • Sarecycline
        • Sodium Fluoride
        • Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous
        • Spironolactone; Hydrochlorothiazide, HCTZ
        • Succinylcholine
        • Telmisartan; Hydrochlorothiazide, HCTZ
        • Teriparatide
        • Tetracycline
        • Tetracyclines
        • Thiazide diuretics
        • Thyroid hormones
        • Triamterene; Hydrochlorothiazide, HCTZ
        • Valsartan; Hydrochlorothiazide, HCTZ
        • Vecuronium
        • Vitamin D analogs

        Level 4 (Minor)

        • Amlodipine
        • Amlodipine; Atorvastatin
        • Amlodipine; Benazepril
        • Amlodipine; Celecoxib
        • Amlodipine; Olmesartan
        • Amlodipine; Valsartan
        • Atenolol
        • Calcipotriene
        • Calcipotriene; Betamethasone
        • Calcium-channel blockers
        • Clevidipine
        • Cod Liver Oil
        • Conjugated Estrogens
        • Conjugated Estrogens; Bazedoxifene
        • Conjugated Estrogens; Medroxyprogesterone
        • Desogestrel; Ethinyl Estradiol
        • Dienogest; Estradiol valerate
        • Diltiazem
        • Drospirenone; Estetrol
        • Drospirenone; Estradiol
        • Drospirenone; Ethinyl Estradiol
        • Drospirenone; Ethinyl Estradiol; Levomefolate
        • Elagolix; Estradiol; Norethindrone acetate
        • Esterified Estrogens
        • Esterified Estrogens; Methyltestosterone
        • Estradiol
        • Estradiol; Levonorgestrel
        • Estradiol; Norethindrone
        • Estradiol; Norgestimate
        • Estradiol; Progesterone
        • Estrogens
        • Estropipate
        • Ethinyl Estradiol; Norelgestromin
        • Ethinyl Estradiol; Norethindrone Acetate
        • Ethinyl Estradiol; Norgestrel
        • Ethynodiol Diacetate; Ethinyl Estradiol
        • Etonogestrel; Ethinyl Estradiol
        • Felodipine
        • Isradipine
        • Levamlodipine
        • Levonorgestrel; Ethinyl Estradiol
        • Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate
        • Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate
        • Nicardipine
        • Nifedipine
        • Nimodipine
        • Nisoldipine
        • Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate
        • Norethindrone; Ethinyl Estradiol
        • Norethindrone; Ethinyl Estradiol; Ferrous fumarate
        • Norgestimate; Ethinyl Estradiol
        • Perindopril; Amlodipine
        • Relugolix; Estradiol; Norethindrone acetate
        • Segesterone Acetate; Ethinyl Estradiol
        • Telmisartan; Amlodipine
        • Trandolapril; Verapamil
        • Verapamil
        • Vitamin A
        Abacavir; Dolutegravir; lamiVUDine: (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing calcium if given under fasting conditions. When taken with food, dolutegravir and supplements containing calcium can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] Alendronate: (Moderate) Separate administration of alendronate and calcium-containing supplements by at least 30 minutes. Calcium will interfere with the absorption of alendronate. [28644] [52249] Alendronate; Cholecalciferol: (Moderate) Separate administration of alendronate and calcium-containing supplements by at least 30 minutes. Calcium will interfere with the absorption of alendronate. [28644] [52249] Aliskiren; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] aMILoride; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] amLODIPine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Atorvastatin: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Benazepril: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Celecoxib: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Olmesartan: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Valsartan: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] amLODIPine; Valsartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Atenolol: (Minor) Calcium antacids (e.g., calcium carbonate) and supplements (e.g., other oral calcium salts) have been reported to reduce the mean peak concentrations by 51% and the AUC of atenolol by 32%. In another study, antacids reduced the AUC of atenolol by 33%. Separate doses of atenolol and calcium-containing antacids or supplements by at least 2 hours to minimize this potential interaction,. However, most clinicians consider the interaction of atenolol with antacids to be of minor clinical significance, since clinical efficacy (heart rate and blood pressure parameters) appear to be unchanged under usual intermittent clinical use. [4382] [4384] Atenolol; Chlorthalidone: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Minor) Calcium antacids (e.g., calcium carbonate) and supplements (e.g., other oral calcium salts) have been reported to reduce the mean peak concentrations by 51% and the AUC of atenolol by 32%. In another study, antacids reduced the AUC of atenolol by 33%. Separate doses of atenolol and calcium-containing antacids or supplements by at least 2 hours to minimize this potential interaction,. However, most clinicians consider the interaction of atenolol with antacids to be of minor clinical significance, since clinical efficacy (heart rate and blood pressure parameters) appear to be unchanged under usual intermittent clinical use. [4382] [4384] Atracurium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] Azilsartan; Chlorthalidone: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Baloxavir Marboxil: (Major) Do not administer baloxavir with products that contain calcium. Polyvalent cations, such as calcium, can chelate with baloxavir, reducing its absorption. [63687] Benazepril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Bictegravir; Emtricitabine; Tenofovir Alafenamide: (Moderate) Administer bictegravir with food at the same time as oral calcium supplements. If bictegravir is taken on an empty stomach, it should be given at least 2 hours before or 6 hours after calcium supplements. Routine administration of bictegravir under fasting conditions simultaneously with, or 2 hours after, calcium supplements is not recommended. Calcium is a polyvalent cation that can bind bictegravir in the GI tract. Taking these drugs simultaneously without food results in reduced bioavailability of bictegravir. In drug interaction studies, simultaneous administration of bictegravir with another calcium supplement under fasted conditions decreased the mean AUC of bictegravir by approximately 33%. [62852] Bismuth Subcitrate Potassium; metroNIDAZOLE; Tetracycline: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] Bismuth Subsalicylate; metroNIDAZOLE; Tetracycline: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] Bisoprolol; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Cabotegravir: (Moderate) Administer oral calcium at least two hours before or four hours after taking oral cabotegravir. Calcium is a polyvalent cation that can bind cabotegravir in the GI tract. Taking these drugs simultaneously may result in reduced oral bioavailability of cabotegravir. [66315] Cabotegravir; Rilpivirine: (Moderate) Administer oral calcium at least two hours before or four hours after taking oral cabotegravir. Calcium is a polyvalent cation that can bind cabotegravir in the GI tract. Taking these drugs simultaneously may result in reduced oral bioavailability of cabotegravir. [66315] Calcifediol: (Moderate) Monitor serum calcium concentrations during concomitant use of high doses of calcium and vitamin D analogs; a dosage adjustment of the vitamin D analog may be needed. Hypercalcemia may be exacerbated by concomitant administration. [28490] [30153] [60895] Calcipotriene: (Minor) There is evidence that calcipotriene can be absorbed in amounts that are sufficient to produce systemic effects, including elevated serum calcium; hypercalcemia has been observed in normal prescription use. Use calcipotriene cautiously with other agents that can produce hypercalcemia (e.g., calcium salts or supplements including calcium carbonate). [31986] Calcipotriene; Betamethasone: (Minor) There is evidence that calcipotriene can be absorbed in amounts that are sufficient to produce systemic effects, including elevated serum calcium; hypercalcemia has been observed in normal prescription use. Use calcipotriene cautiously with other agents that can produce hypercalcemia (e.g., calcium salts or supplements including calcium carbonate). [31986] Calcitonin: (Moderate) Calcitonin is given to hypercalcemic patients to reduce serum calcium concentrations. For the treatment of hypercalcemia, calcium supplements should be avoided. Calcium salts, including calcium carbonate, can elevate serum calcium concentrations and antagonize the effects of the calcitonin for this condition. For the treatment of osteoporosis adequate intake of calcium salts are necessary in conjunction with calcitonin. An increase in serum calcium concentrations helps to reduce bone resorption and loss of bone mass, and offsets the effect of calcitonin in lowering serum calcium levels. [27980] Calcitriol: (Moderate) Monitor serum calcium concentrations during concomitant use of high doses of calcium and vitamin D analogs; a dosage adjustment of the vitamin D analog may be needed. Hypercalcemia may be exacerbated by concomitant administration. [28490] [30153] [60895] Calcium Phosphate, Supersaturated: (Moderate) The concomitant use of oral sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous preparations in conjunction with antacids containing calcium (e.g., calcium carbonate, calcium salts) may bind the phosphate in the stomach and reduce its absorption. If the patient requires multiple mineral supplements or concurrent use of antacids, it is prudent to separate the administration of sodium phosphate salts from calcium containing products by at least one hour. [7800] Calcium-channel blockers: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Candesartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Captopril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Cardiac glycosides: (Moderate) Monitor for signs and symptoms of digoxin toxicity during concomitant calcium use. Hypercalcemia may predispose persons to digoxin toxicity. If IV calcium is administered rapidly in a person receiving digoxin, serious arrhythmias may occur. Monitor ECG and calcium concentrations closely during IV calcium and digoxin administration. [28272] [53985] Chlorothiazide: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Chlorthalidone: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Ciprofloxacin: (Moderate) Administer oral ciprofloxacin at least 2 hours before or 6 hours after oral products that contain calcium. Ciprofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain calcium. [43411] [43570] Cisatracurium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] Clevidipine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Cod Liver Oil: (Minor) Doses in excess of 1,500 to 2,000 mcg per day of Vitamin A may lead to bone loss and will counteract the effects of supplementation with calcium salts. [8242] [8257] Conjugated Estrogens: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Conjugated Estrogens; Bazedoxifene: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Conjugated Estrogens; medroxyPROGESTERone: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Delafloxacin: (Major) Administer oral delafloxacin at least 2 hours before or 6 hours after oral products that contain calcium. Delafloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with fluoroquinolone bioavailability include antacids and multivitamins that contain calcium. [62028] Demeclocycline: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] Desogestrel; Ethinyl Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Dienogest; Estradiol valerate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Digoxin: (Moderate) Monitor for signs and symptoms of digoxin toxicity during concomitant calcium use. Hypercalcemia may predispose persons to digoxin toxicity. If IV calcium is administered rapidly in a person receiving digoxin, serious arrhythmias may occur. Monitor ECG and calcium concentrations closely during IV calcium and digoxin administration. [28272] [53985] dilTIAZem: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Dolutegravir: (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing calcium if given under fasting conditions. When taken with food, dolutegravir and supplements containing calcium can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] Dolutegravir; lamiVUDine: (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing calcium if given under fasting conditions. When taken with food, dolutegravir and supplements containing calcium can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] Dolutegravir; Rilpivirine: (Moderate) Administer dolutegravir 2 hours before or 6 hours after taking supplements containing calcium if given under fasting conditions. When taken with food, dolutegravir and supplements containing calcium can be taken at the same time. Simultaneous administration under fasted conditions may result in reduced bioavailability of dolutegravir. [55594] Doxercalciferol: (Moderate) Monitor serum calcium concentrations during concomitant use of high doses of calcium and vitamin D analogs; a dosage adjustment of the vitamin D analog may be needed. Hypercalcemia may be exacerbated by concomitant administration. [28490] [30153] [60895] Doxycycline: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] Drospirenone; Estetrol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Drospirenone; Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Drospirenone; Ethinyl Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Drospirenone; Ethinyl Estradiol; Levomefolate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Edetate Calcium Disodium, Calcium EDTA: (Major) Because edetate disodium chelates and lowers serum calcium, oral or parenteral calcium salts should not be administered concomitantly. [7090] Elagolix; Estradiol; Norethindrone acetate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Eltrombopag: (Major) Eltrombopag chelates polyvalent cations (e.g., calcium, aluminum, and magnesium) in food, mineral supplements, and antacids. In a clinical study, systemic exposure to eltrombopag was decreased by 70% when it was administered with a polyvalent cation-containing antacid. Administer eltrombopag at least 2 hours before or 4 hours after any oral products containing polyvalent cations, such as aluminum salts, (like aluminum hydroxide), calcium salts, (including calcium carbonate), and magnesium salts. [40392] Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Moderate) Separate administration of elvitegravir and calcium by at least 2 hours. Due to the formation of ionic complexes in the gastrointestinal tract, simultaneous administration results in lower elvitegravir plasma concentrations. [51664] [58001] Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Separate administration of elvitegravir and calcium by at least 2 hours. Due to the formation of ionic complexes in the gastrointestinal tract, simultaneous administration results in lower elvitegravir plasma concentrations. [51664] [58001] Enalapril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Eprosartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Esterified Estrogens: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Esterified Estrogens; methylTESTOSTERone: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estradiol; Levonorgestrel: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estradiol; Norethindrone: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estradiol; Norgestimate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estradiol; Progesterone: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estramustine: (Major) Administration of estramustine with calcium impairs the oral absorption of estramustine significantly, due to formation of a calcium-phosphate complex. Calcium-containing drugs must not be taken simultaneously with estramustine. Patients should be instructed to take estramustine with water at least 1 hour before or 2 hours after calcium supplements. [47275] Estrogens: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Estropipate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Ethinyl Estradiol; Norelgestromin: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Ethinyl Estradiol; Norethindrone Acetate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Ethinyl Estradiol; Norgestrel: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Ethotoin: (Major) Oral absorption of phenytoin can be reduced by calcium salts. Calcium salts can form complexes that are nonabsorbable. Separating the administration of phenytoin and calcium salts by at least 2 hours to help avoid this interaction. A similar interaction may occur with ethotoin. [23674] Ethynodiol Diacetate; Ethinyl Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Etidronate: (Moderate) Separate administration of oral etidronate and calcium-containing supplements by at least 2 hours. Calcium will interfere with the absorption of oral etidronate. [28655] Etonogestrel; Ethinyl Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Felodipine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Fosinopril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] hydroCHLOROthiazide, HCTZ; Moexipril: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Ibandronate: (Moderate) Separate administration of oral ibandronate and calcium-containing supplements by at least 1 hour. Calcium will interfere with the absorption of oral ibandronate. [29558] Ibritumomab Tiuxetan: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] Irbesartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Isradipine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Levamlodipine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] levoFLOXacin: (Moderate) Administer oral products that contain calcium at least 2 hours before or 2 hours after orally administered levofloxacin. Levofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Chelation of divalent cations with levofloxacin is less than with other quinolones. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain calcium. [27973] [40284] [40285] [40286] [40287] [65562] Levonorgestrel; Ethinyl Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Levonorgestrel; Ethinyl Estradiol; Ferrous Bisglycinate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Levonorgestrel; Ethinyl Estradiol; Ferrous Fumarate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Levothyroxine: (Moderate) Thyroid hormones should be administered at least 4 hours before or after the ingestion of oral calcium supplements. Calcium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of thyroid hormones with oral calcium supplements. [27979] [43943] [44355] [53562] Levothyroxine; Liothyronine (Porcine): (Moderate) Thyroid hormones should be administered at least 4 hours before or after the ingestion of oral calcium supplements. Calcium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of thyroid hormones with oral calcium supplements. [27979] [43943] [44355] [53562] Levothyroxine; Liothyronine (Synthetic): (Moderate) Thyroid hormones should be administered at least 4 hours before or after the ingestion of oral calcium supplements. Calcium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of thyroid hormones with oral calcium supplements. [27979] [43943] [44355] [53562] Liothyronine: (Moderate) Thyroid hormones should be administered at least 4 hours before or after the ingestion of oral calcium supplements. Calcium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of thyroid hormones with oral calcium supplements. [27979] [43943] [44355] [53562] Lisinopril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Lithium: (Moderate) Monitor serum calcium concentrations closely if concomitant use of calcium and lithium is necessary. Concomitant use may increase the risk of hypercalcemia. [53985] Losartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] metOLazone: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Metoprolol; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Minocycline: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] Moxifloxacin: (Major) Administer oral moxifloxacin at least 4 hours before or 8 hours after oral products that contain calcium. Moxifloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain calcium. [27973] [28423] [40284] [40285] [40286] [40287] Neuromuscular blockers: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] NiCARdipine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] NIFEdipine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] niMODipine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Nisoldipine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Norethindrone Acetate; Ethinyl Estradiol; Ferrous fumarate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Norethindrone; Ethinyl Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Norethindrone; Ethinyl Estradiol; Ferrous fumarate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Norgestimate; Ethinyl Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Ofloxacin: (Moderate) Administer oral products that contain calcium at least 2 hours before or 2 hours after ofloxacin. Ofloxacin absorption may be reduced as quinolone antibiotics can chelate with divalent or trivalent cations. Examples of compounds that may interfere with quinolone bioavailability include antacids and multivitamins that contain calcium. [30738] Olmesartan; amLODIPine; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Olmesartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Omadacycline: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] Pancuronium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] Parathyroid Hormone: (Moderate) Monitor serum calcium concentrations closely if concomitant use of calcium and parathyroid hormone is necessary. Concomitant use may increase the risk of hypercalcemia. [53985] Paricalcitol: (Moderate) Monitor serum calcium concentrations during concomitant use of high doses of calcium and vitamin D analogs; a dosage adjustment of the vitamin D analog may be needed. Hypercalcemia may be exacerbated by concomitant administration. [28490] [30153] [60895] Perindopril; amLODIPine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Phosphorated Carbohydrate Solution: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] Phosphorus: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] Potassium Phosphate: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] Potassium Phosphate; Sodium Phosphate: (Moderate) The oral absorption of phosphorus is reduced by ingestion of pharmacologic doses of calcium carbonate or other phosphate-lowering calcium salts (e.g., calcium acetate). There is, however, no significant interference with phosphorus absorption by oral dietary calcium at intakes within the typical adult range. If the patient requires multiple calcium supplements or a calcium-containing antacid, it may be wise to separate the administration of phosphorus salts from calcium-containing products. In some instances the administration of calcium salts or calcium carbonate is used therapeutically (e.g., uremia) to decrease serum phosphorus levels, so the administration of phosphorus supplements would dynamically counteract the intended use of calcium in these settings, assuming hypophosphatemia is not present. Appropriate calcium-phosphorus ratios in vivo are important for proper calcium homeostasis in tissues and bone; if the serum ionized calcium concentration is elevated, the concomitant use of calcium salts and phosphorus salts may increase the risk of calcium deposition in soft tissue. [31028] [57713] [57714] [57715] Quinapril; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Relugolix; Estradiol; Norethindrone acetate: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Risedronate: (Moderate) Separate administration of oral risedronate and calcium-containing supplements by at least 2 hours. Calcium will interfere with the absorption of oral risedronate. [29352] [42080] Rocuronium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] Sarecycline: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] Segesterone Acetate; Ethinyl Estradiol: (Minor) Estrogens can increase calcium absorption. Use caution in patients predisposed to hypercalcemia or nephrolithiasis. [6395] Sodium Fluoride: (Moderate) Absorption of sodium fluoride may be reduced by concomitant use of antacids that contain magnesium, aluminum, or calcium. An interval of at least 2 hours is advisable between administration of sodium fluoride and antacids. [6085] Sodium Phosphate Monobasic Monohydrate; Sodium Phosphate Dibasic Anhydrous: (Moderate) The concomitant use of oral sodium phosphate monobasic monohydrate; sodium phosphate dibasic anhydrous preparations in conjunction with antacids containing calcium (e.g., calcium carbonate, calcium salts) may bind the phosphate in the stomach and reduce its absorption. If the patient requires multiple mineral supplements or concurrent use of antacids, it is prudent to separate the administration of sodium phosphate salts from calcium containing products by at least one hour. [7800] Spironolactone; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Succinylcholine: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] Sulfacetamide; Sulfur: (Major) Because edetate disodium chelates and lowers serum calcium, oral or parenteral calcium salts should not be administered concomitantly. [7090] Telmisartan; amLODIPine: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Telmisartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Teriparatide: (Moderate) Monitor serum calcium concentrations closely if concomitant use of calcium and teriparatide is necessary. Concomitant use may increase the risk of hypercalcemia. [53985] Tetracycline: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] Tetracyclines: (Moderate) Divalent or trivalent cations readily chelate with tetracycline antibiotics, forming insoluble compounds. The oral absorption of these antibiotics will be significantly reduced by other orally administered compounds that contain calcium salts, particularly if the time of administration is within 60 minutes of each other. Calcium salts and tetracyclines should not be administered within 1 to 2 hours of each other, although doxycycline chelates less with calcium than other tetracyclines. [4691] [6707] Thiazide diuretics: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Thyroid hormones: (Moderate) Thyroid hormones should be administered at least 4 hours before or after the ingestion of oral calcium supplements. Calcium salts have been reported to chelate oral thyroid hormones within the GI tract when administered simultaneously, leading to decreased thyroid hormone absorption. Some case reports have described clinical hypothyroidism resulting from coadministration of thyroid hormones with oral calcium supplements. [27979] [43943] [44355] [53562] Trandolapril; Verapamil: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Triamterene; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Trientine: (Major) In general, oral mineral supplements should not be given since they may block the oral absorption of trientine. However, iron deficiency may develop, especially in children and menstruating or pregnant women, or as a result of the low copper diet recommended for Wilson's disease. If necessary, iron may be given in short courses, but since iron and trientine each inhibit oral absorption of the other, 2 hours should elapse between administration of trientine and iron doses. [10005] [41825] Valsartan; hydroCHLOROthiazide, HCTZ: (Moderate) Monitor serum calcium concentration during concomitant calcium and thiazide diuretic use due to the risk for hypercalcemia. Thiazide diuretics may decrease urinary calcium excretion and cause intermittent and slight increases in serum calcium. [48850] [63883] Vecuronium: (Moderate) Concomitant use of neuromuscular blockers and calcium may result in resistance to neuromuscular blockade. Calcium antagonizes the potentiating effect of magnesium on neuromuscular blockade. Also, calcium triggers acetylcholine release, and therefore, may both reduce the sensitivity to neuromuscular blockers and decrease the duration of neuromuscular blockade. [65345] Verapamil: (Minor) Monitor blood pressure during concurrent use of calcium and calcium-channel blockers. Concomitant use may reduce the response to calcium-channel blockers. [53985] [69004] Vitamin A: (Minor) Doses in excess of 1,500 to 2,000 mcg per day of Vitamin A may lead to bone loss and will counteract the effects of supplementation with calcium salts. [8242] [8257] Vitamin D analogs: (Moderate) Monitor serum calcium concentrations during concomitant use of high doses of calcium and vitamin D analogs; a dosage adjustment of the vitamin D analog may be needed. Hypercalcemia may be exacerbated by concomitant administration. [28490] [30153] [60895]
        Revision Date: 10/03/2024, 02:58:00 AM

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        Monitoring Parameters

        • serum albumin
        • serum calcium

        US Drug Names

        • Calcitrate
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