calcium salts (Cal-Citrate, Tums)

Calcium is an important mineral required for the proper functioning of many organs and tissues. Calcium is needed for the heart, skeletal muscles, and nervous system to work properly. Additionally, calcium plays an important role in blood coagulation (stops bleeding).

Our bones store calcium which can be released depending on our body's needs. Calcium is naturally found in many of the foods we eat. Calcium supplements are needed when we are unable to get enough calcium from the foods we eat.

Calcium is available in various forms as salts combined with other elements which differ in the amount of calcium they contain. Because of the various forms in which calcium exists, different formulations of calcium supplements are not interchangeable on an mg per mg basis; they do not contain the same amounts of calcium. In order to compare forms of calcium, elemental calcium (i.e., the amount of calcium excluding the other elements with which the calcium is combined) can be expressed in milliequivalents (mEq) or (mg) with 1 mEq equal to approximately 20 mg). Listed below are the commonly used calcium salts and their respective calcium content.

• Calcium acetate: 250 mg (12.5 mEq) per gram
• Calcium carbonate: 400 mg (20 mEq) per gram
• Calcium chloride: 270 mg (13.5 mEq) per gram
• Calcium citrate: 210 mg (10.5 mEq) per gram
• Calcium Glubionate: 64 mg (3.2 mEq) per gram
• Calcium gluconate: 93 mg (4.65 mEq) per gram
• Calcium lactate: 130 mg (6.5 mEq) per gram

Brand names for calcium salts are Cal-Citrate, Cal-Lac, Calcionate, Calciquid, Calcitrate, Calcium Acetate, Calcium Chloride, Calciym Citrate, Calcium Gluceptate, Calcium Gluconate, Calcium Lactate, Calphosan, Calphron, Citracal, Citracal Liquitab, Citrus Calcium, Eliphos, Neo-Calglucon, Phos Cal, PhosLo, Phoslyra, Ridactate, Rolaids, Oysco, and Oyster Shell, Tums.

Calcium salts are available in generic form over the counter (OTC) without a prescription.

• Calcium supplements are used in individuals who are unable to get enough calcium from their regular diet. Severe deficiency can result in low levels of calcium in the blood (hypocalcemia).
• Calcium supplements are commonly used to prevent osteoporosis (bone loss).
• Injectable calcium may be used to treat patients in cardiac arrest or those with life threatening cardiac arrhythmias (abnormal heartbeats).
• Injectable calcium may be used to treat severe hyperkalemia (abnormally high levels of blood potassium), or hypermagnesemia (abnormally high levels of blood magnesium).
• Calcium salts also are used as antacids.

Common side effects of calcium salts include:

• Anorexia
• Constipation
• Flatulence
• Dizziness
• Flushing
• Abnormal heartbeats
• Nausea
• Vomiting

Other side effects include:

• Rashes
• Itching
• Sweating

Doses of calcium supplements are different for different patients. Dosing depends on age, reason for taking the calcium, formulation used, and other patient specific factors.

General recommendations to prevent calcium deficiency are as follows:

• Adults ≥ 51 years of age 1200 mg by mouth per day (range 1000-1500 mg per day)
• Postmenopausal women 1200 mg by mouth per day
• Adults 19-50 years of age 1000 mg by mouth per day
• Children and adolescents 9-18 years 1300 mg by mouth per day
• Children 4-8 years of age 1000 mg by mouth per day
• Infants 6-12 months of age 200 to 260 mg by mouth per day (from all sources including breast milk, formula, and solid food)
• Neonates and infants < 6 months of age 200 mg by mouth per day (sources of calcium should only include breast milk, formula, or food)

• Injectable calcium should be avoided in patients taking cardiac glycosides such as digoxin (Lanoxin) because the combination increases the risk for the development of arrhythmias (abnormal heart rhythms).
• Calcium salts may interfere with the absorption of oral phenytoin (Dilantin). Therefore, administration of phenytoin and calcium salts should be separated by at least 2 hours.
• Calcium salts also may interfere with the absorption of some antibiotics. Administration of tetracyclines or quinolone antibiotics and calcium salts should be separated by at least 2 hours.
• Calcium salts may decrease the absorption of thyroid hormones. Levothyroxine (Synthroid) and other thyroid hormones must be taken at least 4 hours before or after calcium supplements.

• Adequate intake of calcium is important to maintain a healthy pregnancy, and for the proper growth and development of the fetus. No evidence of harm has been reported with the normal daily intake of calcium within the recommended dose limits. All pregnant women should seek the advice of their doctor or pharmacists to ensure that their daily intake of calcium is adequate.
• Calcium supplementation is thought to be safe and effective when used during breastfeeding. Breast milk naturally contains calcium, and calcium supplementation does not have any significant effect on the amount of calcium normally found in human milk.

What preparations of calcium salts are available?

• Calcium acetate oral capsules: 667 mg
• Calcium acetate oral solution: 667 mg/5 ml
• Calcium acetate oral tablets: 667 mg
• Calcium chloride solution for injection 10%
• Calcium citrate oral tablets: 200 and, 950 mg
• Calcium gluconate oral tablets: 50, 500, and 650 mg
• Calcium gluconate solution for injection: 10%
• Calcium carbonate oral tablets: 500, 750, and 1000 mg

How should I keep calcium salts stored?

• Tablets should be stored at room temperature, away from heat, moisture, and direct sunlight. All medications should be kept away from children and pets.