Interacting drugs - summary

+ Calcium salts

 Thiazide diuretics

 hypercalcemia resulting from renal tubular reabsorption, or bone release of calcoium by thiazides amplified by exogenous calcium

Calcium salts +

Atenolol

 mean peak plasma levels and bioavailabilty of Atenolol decreased, possibly resulting decreased beta blockers

Digitalis glycosides

 ionotropic and toxic effects are synergistic: arrhythmias occur, especially if calcium is given IV.

Avoid IV calcium in patients on digitalis glycosides; if necessary give slowly in small amounts

Sod polystrene sulfonate

co-admin. in patients with renal impairment result in an unprecedented matabolic alkalosis and a reduction of the binding of potassium

Verapramil

 clinical effects & toxicity of Veraprmil reversed

IM administrations- mildlocal reactions may occur.(calcium gluconate).

Local necrosis and abcess formation may occur with calcium gluconate and severe necrosis and sloughing with IM or SC administration of calcium chloride.

IV administration- rapid Iv administration may cause bradycardia, sensee ofoppression,tingling, metalic ,calcium or chalky taste, or -heta waves.

Rapiid IV calcium gluconate may cause vasodilation,decreased blood pressure, cardiac arrhythmias, syncope and cardiac arrest.

Calcium chloride injections cause peripheral vasodialtion and a local burning sensation blood pressure may fall moderately.

Hypercalcaemia and hyperthyroidism.

Hypercalciuria and nephrilithiasis,

Zollinger-Ellision syndrome.

Special precautions:

Monitor Ca excretion levels and adjust dosage in mild hypercalciuria,mild or moderate renal insufficiency, urinary calculi .

Increase fluid intake in patients with history of stone formation.

Avoid high Vitamn D dosage during calcium therapy unless specially indicated.

Cardiovascular effects- it is  praticularly important to prevent a high concentration of calcium from reaching the heart because of the danger of cardica syncope.

Drug/lab interactions- transcient elevation ofplasma 11-hydroxy-corticosteroid levels (Glenn-Nelson technique) may occur when IV calcium is administered but levels return to control values after 1 hour.

In addition IV calcium gluconate can produce false-negative values for serum and urinary magnesium.

Warnings

Extravastion- calcium chloride and gluconate can cause severe necrosis, sloughing and abcess formation with IM or SC administration.

Take great care to avoid extrvastion or aciidental injection into perivascuar tissues.

Hypocalcemia of renal insufficiency- clacium chloridee is an acidyfing salt and is therefore usually undesirable for treating condition.

Pregnancy- use only when needed.

Lactation- Calcium gluconate- excercise caution only when administering to a pregnant woman.

Indication-

Calcium defeciency state

Dosage-

Recommended daily allowance- RDAs- Adults - 25 to > 51 years - 800mg . Dietary supplement - the usual dose is 500 mg to 2g 2 to 4 times daily

Missed dose-

1. If you are taking dietary supplement on a regular schedule and you miss a dose,take it as soon as possible and then go back to your dosing schedule.

Calcium supplements- include-

Calcium carbonate, Calcium citrate, Clacium gluconate, Calcium lactate, Dibasic calcium phosphate, Tribasic calcium phosphate. Parentral- Calcium acetate, Calcium chloride, Calcium glubionate, Calcium gluceptate, Calcium gluconate Calcium glycerophosphate

1. Notify physician, if, anorexia, nausea, vomiting, constipation, abdominal pain, dry mouth, thirst, polyuria, occurs.

2. Take with or following meals to enhance absorption.

3. Take with a large glass of water.

4. Pregnancy- it is important that you are receiving enough calcium when you become pregnant and you continue to receive the right amount of calcium throughiut your pregnancy However, taking large amounts of a dietary supplement during pregnancy may be harmful to the mother or the fetus and should be avoided.

5. Breast feeding- it is especially important that you receive the right amount of calcium so that your baby also would get the calcium needed to grow properly. However, taking large amounts of dietary supplement while breast feeding may be harmful to the mother and the baby and should be avoided

6. Elderly- problems with elderly patients have not been reported

7. Medicines other than dietary supplements- tell your doctor if you are taking any of the following -

Calcium containg medicines other- taking excess calcium may cause to much calcium in the blood or urine and lead to medical problems

Celluose sodium phosphate- use with calcium supplement may decrease the effects of cellulose sodium phosphate

Digitalis glycosides- use with calcium supplement by injection may increase the chance of irregular heart beats

Etidronate- use with calcium supplement may decrease the effects of etidronate , ethidronate should not be used within 2 hours of calcium supplements

Gallium nitrate- use with calcium supplement may cause gallium nitrate to not work properly

Magnesium sulfate- use with calcium supplement may cause either medicine to be less effective

Phenytoin- use with calcium suplement may decrease the effects of both medicines , calcium supplements should not be taken together within 1 to 3 hours of phenytoin

Tetracycline- taken by mouth- use calcium supplements may decrease the efects of tetracycline, calcium supplements should not be taken within 1 to 2 hours of tetracycline

8. Other medical problems- tell your doctor if you have any other medical problems- Diarhea or Stomach or intestinal problems- extra calcium or specific calcium preparations may be necessary in these conditions-

Heart disease- calcium by injection may increase the chance of irregular heart beat

Hypercalcemia- or Hyperparathyroidism or Sarcoidosis - calcium supplements may increase the chance of hypercalcemia

Hypoparathyroidism- use of calcium phosphate may cause high blod levels of phosporus which could increase the chance of side effects.

Kidney disesase- too much calcium may increase the chance of kidney stones

9. Missed dose- If you taking this dietary supplement on aregular basis and you miss a dose, take it as soon as possible, then go back to your regular dosing schedule.

Pharmacology:

Calcium is the fifth most abundant element in the body; the major fraction of bone. It is essential for the functional integrity of the nervous and muscular systems, for normal cardiac function, for cell permeability and blood coagulation.

Diets high in dietary fiber have been shown to decrease absorption of calcium due to decreased transit time in the GI tract and complexing of fiber with the calcium

Pregnancy-

Use only when needed.

Lactation-

Calcium gluconate- excercise caution only when administering to a pregnant woman.