Calcium 500mg Chewable Tablets
It is used to help growth and good health.It is used to prevent or treat soft, brittle bones (osteoporosis).It is used to treat or prevent low calcium levels.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Mineral and Vitamin Supplement
Pharmacologic Class
Calcium Supplement, Vitamin D Analog
Pregnancy Category
Not formally categorized (Essential Nutrient)
FDA Approved
Jan 1970
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medication is a combination of calcium and vitamin D, two essential nutrients. Calcium is crucial for strong bones and teeth, and also helps your nerves, muscles, and heart work properly. Vitamin D helps your body absorb calcium and is also important for bone health and immune function. This chewable tablet helps ensure you get enough of these nutrients, especially if your diet is lacking.
How to Use This Medicine
Taking Your Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. Take your medication with food and chew it thoroughly before swallowing. Note that some brands of this medication can be swallowed whole or dissolved in your mouth; if you're unsure, consult your pharmacist.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry location, avoiding the bathroom. Keep all medications in a secure place, out of reach of children and pets. When disposing of unused or expired medication, do not flush it down the toilet or pour it down the drain unless instructed to do so. Instead, consult your pharmacist for guidance on proper disposal or inquire about potential drug take-back programs in your area.
Missing a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To use this medication correctly, follow your doctor's instructions and read all the information provided. Take your medication with food and chew it thoroughly before swallowing. Note that some brands of this medication can be swallowed whole or dissolved in your mouth; if you're unsure, consult your pharmacist.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry location, avoiding the bathroom. Keep all medications in a secure place, out of reach of children and pets. When disposing of unused or expired medication, do not flush it down the toilet or pour it down the drain unless instructed to do so. Instead, consult your pharmacist for guidance on proper disposal or inquire about potential drug take-back programs in your area.
Missing a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take with food to improve absorption, especially for calcium carbonate.
- Chew tablets thoroughly before swallowing.
- Do not exceed the recommended dose without consulting your doctor.
- Maintain a balanced diet rich in calcium and vitamin D (e.g., dairy products, fortified foods, fatty fish).
- Engage in regular weight-bearing exercise (e.g., walking, jogging) to support bone health.
- Ensure adequate sun exposure (10-15 minutes, 2-3 times per week) for natural vitamin D production, while being mindful of skin cancer risk.
- Avoid taking calcium supplements at the exact same time as certain medications (e.g., iron, thyroid hormones, some antibiotics) to prevent absorption issues. Separate doses by at least 2-4 hours.
Available Forms & Alternatives
Available Strengths:
- Calcium Carb 1250mg/5ml Susp
- Calcium Chloride 10% Inj, 10ml
- Calcium Oyster Shell 500mg Tablets
- Calcium 500mg Tablets
- Calcium Acetate 667mg Capsules
- Calcium 600+d (400u) Tablets
- Calcium 600mg Tablets
- Calcium 600mg + D Tablets
- Calcium 500 W/vit D3 Tablets
- Calcium Citrate 250mg Tablets
- Calcium Antacid 500mg Chw Tablets
- Calcium Carb 500mg Chewtablets
- Calcium Acetate 667mg Tablets
- Calcium Carb 648mg Tablets
- Calcium 500mg W/ Vit D Chw Tablets
- Calcium Citrate W/ Vit D Tablets
- Calcium/d3 600mg-200iu Tablets
- Calcium 500mg Chewable Tablets
- Calcium Gluconate 10% Inj, 50ml
- Calcium Antacid 750mg Chw Tablets
- Calcium Citrate 200mg Tablets
- Calcium Citrate+d3 Tablets
- Calcium Gluconate 10% Inj, 10ml
- Calcium Glu/nacl 1gm/100ml Soln
- Cal Glu/nacl 2000mg/100ml Inj 100ml
- Cal Glu/nacl 1gm/50ml Inj, 50ml
- Calcium Gluc 100mg/ml Inj, 50ml
- Calcium Gluconate 10% Inj, 100ml
- Calcium Gluc 100mg/ml Inj, 100ml
- Calcium Gluc 100mg/ml Inj, 10ml
Dosing & Administration
Adult Dosing
Standard Dose:
1-2 tablets (500-1000 mg elemental calcium, plus associated Vitamin D) once or twice daily with food, or as directed by a healthcare professional.
Dose Range:
500 - 2500 mg
Condition-Specific Dosing:
osteoporosisPrevention:
1000-1200 mg elemental calcium daily (from diet and supplements) with adequate Vitamin D (600-800 IU daily).
calciumDeficiency:
Dosage individualized based on serum calcium levels and dietary intake.
Pediatric Dosing
Neonatal:
Not established (Consult pediatrician for specific needs)
Infant:
Not established (Consult pediatrician for specific needs)
Child:
Dosage varies by age and weight; typically 500-1000 mg elemental calcium daily with adequate Vitamin D (e.g., 400-600 IU) for children 4-18 years, under medical supervision.
Adolescent:
1000-1300 mg elemental calcium daily with adequate Vitamin D (e.g., 600 IU) for bone health.
Dose Adjustments
Renal Impairment:
Mild:
Use with caution; monitor serum calcium and phosphate.
Moderate:
Use with caution; monitor serum calcium and phosphate closely. May require dose adjustment or avoidance if hypercalcemia develops.
Severe:
Contraindicated in severe hypercalcemia. Use with extreme caution; monitor serum calcium, phosphate, and parathyroid hormone (PTH) frequently. Dose adjustment likely required.
Dialysis:
Use with extreme caution; often requires specific calcium binders and active vitamin D analogs, not typically this combination supplement. Risk of hypercalcemia and vascular calcification.
Hepatic Impairment:
Mild:
No specific adjustment typically needed for calcium. Vitamin D activation may be impaired in severe liver disease.
Moderate:
No specific adjustment typically needed for calcium. Vitamin D activation may be impaired; monitor vitamin D levels.
Severe:
No specific adjustment typically needed for calcium. Vitamin D activation may be significantly impaired; monitor vitamin D levels and consider activated forms if deficiency persists.
Pharmacology
Mechanism of Action
Calcium is an essential mineral vital for bone formation and maintenance, nerve impulse transmission, muscle contraction, blood coagulation, and cellular signaling. Vitamin D (specifically D3, cholecalciferol) is a fat-soluble vitamin that is metabolized in the liver to 25-hydroxyvitamin D (calcifediol) and then in the kidneys to the active form, 1,25-dihydroxyvitamin D (calcitriol). Calcitriol promotes the absorption of calcium and phosphate from the gastrointestinal tract, regulates serum calcium and phosphate levels, and plays a crucial role in bone mineralization and remodeling.
Pharmacokinetics
Absorption:
Bioavailability:
Calcium: Varies (20-40% for calcium carbonate, higher for citrate). Vitamin D: 50-80% (fat-soluble).
Tmax:
Calcium: 1-4 hours. Vitamin D: 4-5 hours (for cholecalciferol).
FoodEffect:
Calcium absorption is enhanced by food, especially for calcium carbonate. Vitamin D absorption is enhanced by dietary fat.
Distribution:
Vd:
Calcium: Approximately 0.35 L/kg (extracellular fluid). Vitamin D: Large volume, stored in adipose tissue and muscle.
ProteinBinding:
Calcium: Approximately 40-45% bound to plasma proteins (albumin). Vitamin D: >99% bound to vitamin D binding protein (DBP) and albumin.
CnssPenetration:
Calcium: Limited. Vitamin D: Limited, but active metabolites can cross.
Elimination:
HalfLife:
Calcium: Variable, depends on physiological state. Vitamin D (cholecalciferol): 15-30 days (terminal half-life); active metabolite (calcitriol): 4-6 hours.
Clearance:
Calcium: Primarily renal excretion, also fecal. Vitamin D: Biliary excretion of metabolites.
ExcretionRoute:
Calcium: Fecal (unabsorbed), Renal (filtered and reabsorbed). Vitamin D: Biliary/Fecal (metabolites), Renal (minor).
Unchanged:
Calcium: Minimal. Vitamin D: Minimal.
Pharmacodynamics
OnsetOfAction:
Calcium: Immediate (for acute effects like muscle contraction), but bone effects are long-term. Vitamin D: Days to weeks for significant changes in serum 25-OH D levels and calcium absorption.
PeakEffect:
Calcium: Not applicable for chronic supplementation. Vitamin D: Weeks to months for maximal effect on bone mineral density.
DurationOfAction:
Calcium: Sustained with regular intake. Vitamin D: Weeks to months due to storage and slow elimination of metabolites.
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
If you experience any of the following severe side effects, contact your doctor immediately or seek emergency medical attention. Although rare, some individuals may be at risk for life-threatening reactions when taking this medication. Be aware of the following symptoms that may indicate a serious side effect:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high calcium levels, including:
+ Weakness
+ Confusion
+ Fatigue
+ Headache
+ Nausea and vomiting
+ Constipation
+ Bone pain
Other Possible Side Effects
As with any medication, side effects can occur. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for guidance:
Upset stomach or vomiting
Constipation
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
If you experience any of the following severe side effects, contact your doctor immediately or seek emergency medical attention. Although rare, some individuals may be at risk for life-threatening reactions when taking this medication. Be aware of the following symptoms that may indicate a serious side effect:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing
+ Tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Signs of high calcium levels, including:
+ Weakness
+ Confusion
+ Fatigue
+ Headache
+ Nausea and vomiting
+ Constipation
+ Bone pain
Other Possible Side Effects
As with any medication, side effects can occur. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms, contact your doctor for guidance:
Upset stomach or vomiting
Constipation
Reporting Side Effects
This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Signs of too much calcium (hypercalcemia): severe constipation, nausea, vomiting, loss of appetite, unusual tiredness, muscle weakness, frequent urination, increased thirst, confusion.
- Signs of kidney stones: severe pain in your side or back, blood in your urine, fever, chills, painful urination.
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
Certain health conditions, including:
+ High calcium levels
+ High vitamin D levels
+ Kidney stones
+ Low phosphate levels
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure safe treatment, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Natural products and vitamins you are using
* Any health problems you have
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced as a result of the allergy.
Certain health conditions, including:
+ High calcium levels
+ High vitamin D levels
+ Kidney stones
+ Low phosphate levels
This list is not exhaustive, and it is crucial to discuss all your health problems and medications with your doctor.
To ensure safe treatment, provide your doctor and pharmacist with a comprehensive list of:
All prescription and over-the-counter (OTC) medications you are taking
Natural products and vitamins you are using
* Any health problems you have
Before starting, stopping, or changing the dose of any medication, including this one, consult with your doctor to confirm it is safe to do so.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. If you have a known allergy to tartrazine (also referred to as FD&C Yellow No. 5), consult with your doctor before taking this drug, as some formulations may contain this ingredient.
When taking this medication, be aware that it may interfere with the absorption of other oral medications. To minimize potential interactions, discuss with your doctor the best timing for taking other medications by mouth in relation to this drug.
Adhere to the dietary plan recommended by your doctor to ensure optimal management of your condition. If you have phenylketonuria (PKU), a condition where the body cannot break down the amino acid phenylalanine, inform your doctor, as some products may contain phenylalanine.
If you are pregnant, planning to become pregnant, or are breastfeeding, it is crucial to discuss the potential benefits and risks of this medication with your doctor. This conversation will help you understand the implications for both you and your baby, allowing for an informed decision about your treatment.
When taking this medication, be aware that it may interfere with the absorption of other oral medications. To minimize potential interactions, discuss with your doctor the best timing for taking other medications by mouth in relation to this drug.
Adhere to the dietary plan recommended by your doctor to ensure optimal management of your condition. If you have phenylketonuria (PKU), a condition where the body cannot break down the amino acid phenylalanine, inform your doctor, as some products may contain phenylalanine.
If you are pregnant, planning to become pregnant, or are breastfeeding, it is crucial to discuss the potential benefits and risks of this medication with your doctor. This conversation will help you understand the implications for both you and your baby, allowing for an informed decision about your treatment.
Overdose Information
Overdose Symptoms:
- Severe hypercalcemia symptoms (nausea, vomiting, constipation, abdominal pain, muscle weakness, fatigue, confusion, polyuria, polydipsia, bone pain, kidney stones, cardiac arrhythmias in severe cases).
- In children, failure to thrive, irritability.
What to Do:
If you suspect an overdose, seek immediate medical attention or call a poison control center (e.g., 1-800-222-1222 in the US). Treatment may involve hydration, diuretics, and other measures to lower serum calcium.
Drug Interactions
Major Interactions
- Digoxin (with high calcium doses/hypercalcemia: increased risk of arrhythmias)
- Thiazide diuretics (increased risk of hypercalcemia)
- Dofetilide (calcium can alter QT interval, theoretical risk)
- Levothyroxine (calcium can impair absorption)
Moderate Interactions
- Tetracycline antibiotics (e.g., doxycycline, minocycline: calcium forms insoluble chelates, reducing absorption)
- Fluoroquinolone antibiotics (e.g., ciprofloxacin, levofloxacin: calcium forms insoluble chelates, reducing absorption)
- Bisphosphonates (e.g., alendronate, risedronate: calcium can impair absorption)
- Iron supplements (calcium can impair iron absorption)
- Zinc supplements (high calcium intake can impair zinc absorption)
- Phenytoin, Phenobarbital, Carbamazepine (may increase vitamin D metabolism, leading to deficiency)
- Corticosteroids (may decrease calcium absorption and increase calcium excretion)
- Orlistat, Cholestyramine (may reduce absorption of fat-soluble vitamin D)
- Mineral oil (may reduce absorption of fat-soluble vitamin D)
- Phosphate binders (e.g., sevelamer, lanthanum: may reduce calcium absorption)
Minor Interactions
- Spinach, rhubarb, whole grains (contain oxalates/phytates that can reduce calcium absorption)
Monitoring
Baseline Monitoring
Serum Calcium (total and ionized)
Rationale: To establish baseline levels and identify pre-existing hypercalcemia or hypocalcemia.
Timing: Prior to initiation of high-dose or long-term supplementation.
Serum 25-hydroxyvitamin D (25-OH D)
Rationale: To assess baseline vitamin D status and guide appropriate dosing.
Timing: Prior to initiation of high-dose or long-term supplementation.
Renal Function (BUN, Creatinine, eGFR)
Rationale: To assess kidney function, as renal impairment affects calcium and vitamin D metabolism and excretion.
Timing: Prior to initiation, especially in elderly or those with risk factors for kidney disease.
Routine Monitoring
Serum Calcium (total)
Frequency: Every 3-6 months initially, then annually for long-term use, or as clinically indicated.
Target: 8.5-10.2 mg/dL (2.1-2.55 mmol/L)
Action Threshold: >10.5 mg/dL (hypercalcemia); investigate cause, reduce dose, or discontinue.
Serum 25-hydroxyvitamin D (25-OH D)
Frequency: Every 6-12 months, or as clinically indicated to ensure sufficiency.
Target: 30-100 ng/mL (75-250 nmol/L)
Action Threshold: <20 ng/mL (deficiency); >100 ng/mL (potential toxicity).
Renal Function (BUN, Creatinine)
Frequency: Annually, or more frequently in patients with renal impairment or risk factors.
Target: Within normal limits for age/sex.
Action Threshold: Significant decline in eGFR or increase in creatinine; reassess calcium/vitamin D dosing.
24-hour Urine Calcium (if hypercalciuria risk)
Frequency: Periodically, if history of kidney stones or hypercalcemia.
Target: <250 mg/24h (women), <300 mg/24h (men)
Action Threshold: >250-300 mg/24h; investigate cause, reduce dose, or discontinue.
Symptom Monitoring
- Symptoms of hypercalcemia: nausea, vomiting, constipation, abdominal pain, excessive thirst, frequent urination, muscle weakness, fatigue, confusion, bone pain.
- Symptoms of kidney stones: severe back or side pain, blood in urine, fever, chills, vomiting.
Special Patient Groups
Pregnancy
Calcium and Vitamin D are essential nutrients during pregnancy for fetal bone development and maternal health. Recommended daily allowances should be met through diet and supplementation if necessary. Excessive intake should be avoided.
Trimester-Specific Risks:
First Trimester:
Essential for early development; generally safe at recommended doses.
Second Trimester:
Continued importance for fetal skeletal development; generally safe at recommended doses.
Third Trimester:
Crucial for rapid fetal bone mineralization; generally safe at recommended doses. High doses may pose theoretical risks of hypercalcemia in mother/fetus.
Lactation
Calcium and Vitamin D are essential for breastfeeding mothers and infants. They are excreted into breast milk. Supplementation is generally safe and often recommended to meet maternal needs and ensure adequate levels in breast milk. Excessive intake should be avoided.
Infant Risk:
Low risk at recommended maternal doses. High maternal doses could theoretically lead to hypercalcemia in the infant, but this is rare.
Pediatric Use
Essential for bone growth and development. Dosing must be carefully adjusted based on age, weight, and dietary intake to avoid deficiency or toxicity. Consult a pediatrician for appropriate dosing.
Geriatric Use
Often recommended due to increased risk of osteoporosis, calcium and vitamin D deficiency, and reduced calcium absorption. However, monitor for hypercalcemia and renal function, as older adults may be more susceptible to adverse effects.
Clinical Information
Clinical Pearls
- Calcium carbonate should be taken with food for optimal absorption, while calcium citrate can be taken with or without food.
- Divide large doses of calcium (e.g., >500-600 mg elemental calcium) throughout the day to maximize absorption.
- Chewable tablets are convenient for individuals who have difficulty swallowing pills.
- Advise patients to separate calcium/vitamin D supplements from certain medications (e.g., thyroid hormones, tetracycline/fluoroquinolone antibiotics, bisphosphonates) by at least 2-4 hours to prevent drug interactions.
- Educate patients on symptoms of hypercalcemia and to report them to their healthcare provider.
- Regular monitoring of serum calcium and vitamin D levels is important, especially in patients with underlying conditions or those taking high doses.
Alternative Therapies
- Dietary calcium (dairy products, fortified foods, leafy greens)
- Dietary vitamin D (fatty fish, fortified foods, sun exposure)
- Prescription vitamin D (e.g., ergocalciferol, cholecalciferol high-dose)
- Other osteoporosis medications (e.g., bisphosphonates, denosumab, teriparatide, romosozumab) for specific indications.
Cost & Coverage
Average Cost:
$5 - $25 per 60-120 tablets
Generic Available:
Yes
Insurance Coverage:
Often Over-The-Counter (OTC), generally not covered by insurance unless prescribed for a specific medical condition (e.g., severe osteoporosis, hypoparathyroidism) and sometimes only specific prescription-strength formulations.
General Drug Facts
If your symptoms or health condition do not improve or worsen over time, it is essential to contact your doctor for further evaluation and guidance. To ensure safe and effective treatment, never share your medication with others or take someone else's medication. Some medications may have additional patient information leaflets, so it is a good idea to consult with your pharmacist for more information. If you have any questions or concerns about your medication, do not hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When reporting the overdose, be prepared to provide details about the medication taken, the amount consumed, and the time it occurred.