calcium citrate

Contraindicated in:

Hypercalcemia;
Renal calculi;
Ventricular fibrillation.

Use Cautiously in:

Patients receiving digitalis glycosides;
Severe respiratory insufficiency;
Renal disease;
Cardiac disease.

Adv. Reactions/Side Effects ⬆ ⬇

CV: arrhythmias, bradycardia

GI: constipation, nausea, vomiting

GU: calculi, hypercalciuria

Neuro: headche, tingling

Interactions ⬆ ⬇

Drug-drug:

Hypercalcemia increases the risk of digoxin toxicity.
Chronic use with antacids in renal insufficiency may lead to milk-alkali syndrome.
Ingestion by mouth decreases the absorption of orally administered tetracyclines, fluoroquinolones, phenytoin, and iron salts.
Excessive amounts may decrease the effects of calcium channel blockers.
Decreases absorption of risedronate (do not take within 2 hr of calcium supplements).
May decrease the effectiveness of atenolol.
Concurrent use with diuretics (thiazide) may result in hypercalcemia.
May decrease the ability of sodium polystyrene sulfonate to decrease serum potassium.

Drug-Food:

Cereals, spinach, or rhubarb may decrease the absorption of calcium supplements.
Calcium acetate should not be given concurrently with other calcium supplements.

Availability ⬆ ⬇

Tablets: 250 mg^OTC (53 mg elemental calcium); 950 mgOTC (200 mg elemental calcium)
Granules: 760 mg/teaspoonful (equivalent to 161 mg elemental calcium per teaspoonful)

Route/Dosage ⬆ ⬇

1 gram of calcium citrate contains 211 mg elemental calcium (10.6 mEq calcium). Doses are expressed in terms of elemental calcium.
PO (Adults ): Prevention of hypocalcemia, treatment of depletion, osteoporosis: 1–2 g/day in 3–4 divided doses.
PO (Children ): Supplementation: 45–65 mg/kg/day in 4 divided doses.
PO (Infants ): Neonatal hypocalcemia: 50–150 mg/kg in 4–6 divided doses (not to exceed 1 g/day).

US Brand Names ⬆ ⬇

Cal-Citrate 250, Citrical, Citrical Liquitab

Action ⬆ ⬇

Essential for nervous, muscular, and skeletal systems.
Maintain cell membrane and capillary permeability.
Act as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle.
Essential for bone formation and blood coagulation.
Treatment of hyperphosphatemia in end-stage renal disease.

Therapeutic effects:

Replacement of calcium in deficiency states. Control of hyperphosphatemia in end-stage renal disease without promoting aluminum absorption.

Classifications ⬆ ⬇

Therapeutic Classification: mineral and electrolyte replacements/supplements

Pharmacokinetics ⬆ ⬇

Absorption: Absorption from the GI tract requires vitamin D.

Distribution: Readily enters extracellular fluid. Crosses the placenta and enters breast milk.

Metabolism/Excretion: Excreted mostly in the feces; 20% eliminated by the kidneys.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

(effects on serum calcium)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	unknown
IV	immediate	immediate	0.5–2 hr

Patient/Family Teaching ⬆ ⬇

Do not administer concurrently with foods containing large amounts of oxalic acid (spinach, rhubarb), phytic acid (brans, cereals), or phosphorus (milk or dairy products). Administration with milk products may lead to milk-alkali syndrome (nausea, vomiting, confusion, headache). Do not take within 1–2 hr of other medications if possible.
- Instruct patients on a regular schedule to take missed doses as soon as possible, then go back to regular schedule.
- Advise patient to avoid excessive use of tobacco or beverages containing alcohol or caffeine.
Calcium Supplement: Encourage patients to maintain a diet adequate in vitamin D (see Food Sources for Specific Nutrients).
Osteoporosis: Advise patients that exercise has been found to arrest and reverse bone loss. Patient should discuss any exercise limitations with health care professional before beginning program.

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Indications ⬇

Contraind./Precautions ⬆ ⬇