Calcium Carbonate

Aka: Calcium Carbonate, Tums, Caltrate, Os-Cal, Viactiv, Rolaids

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II. Indications

  1. Osteoporosis Prevention
    1. See Calcium Supplementation
  2. Peptic Ulcer Disease
    1. See Antacid

III. Dosing: Calcium Carbonate

  1. Background
    1. Calcium Carbonate is 40% elemental Calcium (20 meq elemental Ca++ per Calcium Carbonate gram)
  2. Formulations
    1. Tums: 200 mg/tab elemental Calcium (extra strength 400 mg/tab)
    2. Viactiv: 500 mg/chew elemental Calcium (also contains Vitamin D 500 mg, Vitamin K 40 mcg)
    3. Os-Cal: 500 mg/tab elemental Calcium (also contains Vitamin D, from 200 mg to 800 mg depending on preparation)
    4. Caltrate: 600 mg/tab elemental Calcium (also contains Vitamin D 200 mg)
  3. Administration
    1. Take with meals or citrus juice
    2. Absorption reduced with Fasting or achlorhydria
  4. Dose
    1. Osteoporosis Prevention
      1. See Calcium Supplementation

IV. Dosing: Combination Agents

  1. Calcium Carbonate and Magnesium Hydroxide (Tablets contain 700 mg/300 mg)
    1. Adults: 2 to 4 tabs four times daily as needed for use as Antacid
    2. Unknown safety in pregnancy and Lactation

V. Background: Calcium Supplementation

  1. Advantages
    1. Calcium Carbonate has the most elemental Calcium (40%) of the Calcium supplements
    2. Calcium Carbonate Tablet 650 mg contains 250 mg elemental Calcium
    3. Calcium Carbonate is the least expensive Calcium preparation
  2. Disadvantages
    1. Only 35% of Calcium supplements are absorbed (contrast with much better Dietary Calcium absorption)
    2. Constipation

VI. Adverse Effects

  1. Constipation
  2. Metabolic Alkalosis (longterm use)
  3. Hypercalcemia
  4. Milk-Alkali Syndrome
    1. Rare complication of combining chronic use of Calcium Supplementation with milk or bicarbonate

VII. Drug Interactions

  1. Calcium Carbonate decreases absorption of drugs better absorbed at lower gastric pH
    1. Levothyroxine
    2. Tetracycline
    3. Fluoroquinolones

VIII. Resources

  1. Calcium Carbonate Chewable Antacid
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=27d9b505-08bd-4261-a59d-6ddc4031be32

IX. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 90
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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