Calcium Sandoz Forte effervescent tablets 500 mg 20 pcs.

Calcium Sandoz Forte effervescent tablets 500 mg 20 pcs.

The combination of calcium carbonate + calcium lactogluconate may reduce the absorption of estramustine, etidronate and possibly other bisphosphonates, phenytoin, quinolones, oral tetracycline antibiotics and fluoride preparations. The interval between taking effervescent calcium carbonate + calcium lactogluconate tablets and the above drugs should be at least 3 hours. Simultaneous administration of vitamin D and its derivatives increases calcium absorption. When prescribed in high doses along with vitamin D and its derivatives, calcium may reduce the effect of verapamil and possibly other calcium channel blockers. With the simultaneous use of effervescent calcium carbonate + calcium lactogluconate tablets and tetracycline drugs, the absorption of the latter may be impaired. For this reason, tetracycline preparations should be taken at least 2 hours before or 4-6 hours after ingesting calcium preparations. Thiazide diuretics reduce urinary calcium excretion, therefore, when used concomitantly with calcium carbonate + calcium lactogluconate effervescent tablets, regular monitoring of serum calcium concentrations should be carried out, as there is a risk of developing hypercalcemia. Systemic corticosteroids reduce calcium absorption. If they are used simultaneously, it may be necessary to increase the dose of effervescent calcium carbonate + calcium lactogluconate tablets. When ingesting effervescent calcium carbonate + calcium lactogluconate tablets in patients receiving cardiac glycosides, the toxicity of cardiac glycosides may increase due to the development of hypercalcemia. Such patients should regularly take an ECG and monitor the level of calcium in the blood serum. If a bisphosphonate or sodium fluoride is taken orally, these drugs should be taken at least 3 hours before taking calcium carbonate + calcium lactogluconate effervescent tablets, since absorption from the gastrointestinal tract (GIT) of the bisphosphonate or sodium fluoride may be reduced. Calcium absorption from the gastrointestinal tract may be reduced by concomitant intake of certain foods containing oxalic acid (eg, spinach, rhubarb) or phytic acid (in all grains) due to the formation of insoluble complexes with calcium ions. Patients should not take calcium carbonate + calcium lactogluconate effervescent tablets 2 hours before or after meals rich in oxalic or phytic acid.

Complivit Calcium D3 forte

Double 3 dose of vitamin D3 and calcium to strengthen bones in adulthood!

• Contains double3 dose of vitamin D3 and calcium for better absorption in adulthood1
• Helps strengthen bones, maintain muscle strength for beautiful posture and easy gait
• Designed for the prevention and complex therapy of osteoporosis

To ensure the absorption of calcium and metabolic processes in bone tissue, vitamin D is required. The content of vitamin D in the body depends on many factors. Vitamin D synthesis occurs in the skin under the influence of ultraviolet rays and depends on skin pigmentation, latitude of the region, length of day, time of year, weather conditions and the area of ​​skin not covered by clothing. In winter, in countries located at northern latitudes, most of the ultraviolet radiation is absorbed by the atmosphere and the synthesis of vitamin D in the skin is practically absent8.

Vitamin D is an important vitamin that is involved in regulating many other processes in the body 1,4-8. It is involved in the regulation of muscle tone, in maintaining the body's antitumor defense, glucose and insulin metabolism, blood pressure levels, and thyroid function. Another important function of vitamin D is its participation in maintaining immunity. Vitamin D is a potential immunomodulator and is involved in the regulation of the body's immune response to various infectious diseases.

With age, after 50 years, there is a decrease in the skin's ability to produce vitamin D. Combined with decreased sun exposure, this leads to a decrease in serum vitamin D levels, which contributes to the development of osteoporosis and, as a result, an increased risk of fractures.

Osteoporosis is the leading cause of fractures in men and women over age fifty and is a growing problem. Every third woman over the age of 45–50 and almost half of all men and women over 65 are faced with the problem of brittle bones. And the frequency of vitamin D3 deficiency among the Russian population reaches 83%.1

According to the latest recommendations,2 people over 50 years of age need to take 1000-1200 mg of calcium and 800 IU of vitamin D3 to prevent osteoporosis and its consequences.

Just two Complivit® Calcium D3 forte tablets contain 1000 mg of Calcium and twice as much Vitamin D3: 800 IU. To replenish the daily requirement of calcium and vitamin D3, as well as for the prevention and complex treatment of osteoporosis and its complications (fractures).

Compound

Calcium 500 mg (as carbonate) + 400 IU Vitamin D3

Release forms

Chewable tablets with mint flavor, No. 30, No. 60, No. 100, No. 120

Indications for use

Prevention and complex therapy of osteoporosis and its complications (fractures).

Prevention and treatment of calcium and/or vitamin D3 deficiency.

Complivit® Calcium D3 forte is approved for use in adults and children over 3 years of age.

Boncalcid forte No. 60 capsules

Description.

Hard gelatin capsules No. 0 are cylindrical in shape with hemispherical ends, a white body and a red-brown cap.

Dosage form:

capsules.

Compound:

one capsule contains cholecalciferol (in the form of cholecalciferol type 100 CWS) - 133.4 IU, calcium (in the form of calcium carbonate) - 166.7 mg. Excipient: potato starch. Composition of the capsule shell: gelatin, glycerin, purified water, titanium dioxide, sodium lauryl sulfate, dyes: charming red E-129, quinoline yellow E-104, brilliant blue E-133.

Pharmacotherapeutic group:

Mineral supplements. Calcium, combinations with vitamin D and/or other drugs. ATX code A12AX.

Pharmacological properties

Pharmacodynamics.

Boncalcid forte is a combination drug that regulates the metabolism of calcium and phosphorus. Calcium is a vital mineral element necessary to maintain the balance of electrolytes in the body and the adequate functioning of regulatory mechanisms. Calcium carbonate is involved in the formation of bone tissue, is necessary for the mineralization of teeth, regulation of nerve conduction, muscle contractions, maintaining stable cardiac activity and is a component of the blood coagulation system. Calcium (in ionized form and in the form of complexes) plays a key role in cell division and differentiation, conduction of nerve impulses and in the contraction-relaxation cycle (together with tropin) of smooth and striated muscles, transmembrane ion reactions involving selective calcium channels, activity neuroselective organs, the production and effects of a number of hormones, enzymes and other protein, as well as non-protein biologically active substances. The participation of calcium in such diverse processes is explained by its universal function as a secondary messenger (transmitter) that transmits and implements a biological signal in various types of cells. Vitamin D3 stimulates the absorption of calcium and phosphorus in the intestines, the reabsorption of calcium and phosphorus in the kidneys, the transport of calcium through membranes and cells, the development of the immune system, cell proliferation and differentiation, the synthesis of lipids and a number of hormones, the functional activity of the cardiovascular system and gastrointestinal tract , reduces the level of parathyroid hormone in the blood. It is necessary for the normal functioning of the parathyroid glands and takes part in the synthesis of ATP. Vitamin D3 and its active metabolites have a multifaceted effect on bone tissue: they increase the absorption of calcium in the intestine, stimulating the synthesis of calcium-binding proteins; increase calcium reabsorption in the renal tubules; activate bone remodeling processes by increasing the synthesis of collagen I and matrix proteins, by activating the synthesis of osteoblasts; improve bone quality by influencing osteoclast activity; regulate the secretion of parathyroid hormone by two mechanisms: directly suppressing the proliferation of parathyroid cells and through increasing the level of calcium in the blood; stimulate the differentiation of cells - precursors of bone and cartilage tissue; have a positive effect on neuromuscular conduction through the regulation of calcium channels and the activity of protein kinase A. The use of a combination drug containing calcium and vitamin D3 is justified, since vitamin D3 increases the absorption of calcium in the intestine and the combined use of calcium and vitamin D3 prevents an increase in the production of parathyroid hormone (PTH ), which is a stimulator of increased bone resorption (leaching of calcium from bones). Thus, Boncalcid forte regulates the exchange of calcium and phosphates, reduces resorption and increases bone density, compensates for the lack of calcium and vitamin D3 in the body, enhances the absorption of calcium in the intestines and the reabsorption of phosphates in the kidneys, and promotes bone mineralization.

Pharmacokinetics.

Calcium. Calcium absorption occurs in the duodenum, jejunum and large intestine. This process is carried out with the participation of two mechanisms: active absorption and passive diffusion, with the participation of which less than 10% of the element supplied with food is absorbed. The main regulator of active absorption is a vitamin D metabolite, calcitriol, which stimulates the biosynthesis of calcium-binding proteins in intestinal enterocytes. After being absorbed into the systemic circulation, calcium is distributed among organs and systems and primarily enters bone tissue. Under physiological conditions, the excretion of calcium from the body (except for the part excreted in feces that is not absorbed in the intestine) is approximately 250–300 mg per day, which includes 140–180 mg that has not undergone reabsorption in the kidneys and enters the urine, as well as 80–100 mg, excreted into the intestines with bile and pancreatic secretions. Calcium absorption increases during pregnancy and lactation. Penetrates the placental barrier and is excreted in breast milk. Cholecalciferol. Absorption of cholecalciferol occurs in the small intestine in the presence of bile. Usually 50-70% of the taken dose of the vitamin is absorbed. Incomplete absorption is observed with obstructive jaundice and severe steatorrhea. The maximum concentration is reached after 8-18 hours. From the bloodstream, about 70% of vitamin D3 is absorbed by the liver, where it is metabolized. The resulting metabolite (25-hydroxycholecalciferol) is transported to the kidneys, where the formation of biologically active compounds occurs, among which 1,25-dihydroxycholecalciferol (1,25 (OH)2 D3) and 24,25-dihydroxycholecalciferol (24, 25 (OH)2D3). The metabolism of cholecalciferol is disrupted in chronic renal failure, with the prescription of protein synthesis inhibitors (actinomycin, glucocorticoids), with long-term use of phenobarbital and diphenine. Vitamin D3 has cumulative properties. It accumulates in the liver in non-parenchymal cells, from where it is transported to hepatocytes, where it is metabolized. Penetrates the placental barrier and is excreted in breast milk. T1/2 from blood plasma is up to several days and may be longer in case of impaired renal function. In elderly patients, renal function may decrease, which should be taken into account when dosing the drug. In patients with chronic liver failure, hypocalcemia may be a consequence of a decrease in the synthesis in the liver of 25-hydroxycholecalciferol as a substrate for the formation of 1,25-dihydroxycholecalciferol in the kidneys, that is, a vitamin D hormone that increases the intestinal absorption of ionized calcium. Chronic renal failure is accompanied by a decrease in the synthesis of vitamin D hormone, which in some patients causes hypocalcemia. In patients with nephrotic syndrome, urinary loss of 25-hydroxycholecalciferol leads to hypocalcemia. Hypocalcemia due to loss of 25-hydroxycholecalciferol can be caused by a blockade of its physiological circulation between the intestinal lumen and the liver, due to a decrease in intestinal absorption.

Indications for use

As a therapeutic and prophylactic agent, Boncalcid Forte is used: - in conditions of calcium and vitamin D3 deficiency in the body associated with malnutrition, when the dietary intake of calcium and cholecalciferol is insufficient; — with the body’s increased need for calcium and vitamin D3 during pregnancy and breastfeeding, as well as in children over 12 years of age during a period of intensive growth; - for the prevention of osteoporosis (menopausal, senile, steroid, idiopathic, etc.) and its complications (bone fractures), as an addition to any specific therapy for osteoporosis.

Directions for use and doses

Adults and children over 12 years of age are prescribed 2-3 capsules 2 times a day, morning and evening, mainly during meals. Dosage regimen for children under 12 years of age in accordance with doctor's recommendations. Duration of treatment: When used for prevention and in complex therapy of osteoporosis, the duration of treatment is determined by the doctor individually. When used to replenish calcium and vitamin D3 deficiency, the average duration of treatment is at least 4-6 weeks. The number of repeat courses during the year is determined individually. Patients with impaired liver function: No dose adjustment is required. Patients with impaired renal function: Boncalcid forte should not be used in cases of severe renal failure. Elderly patients: The dose is the same as for adults. A possible decrease in renal function should be taken into account.

Precautionary measures

During long-term therapy, serum calcium and creatinine levels should be monitored. Monitoring is especially important in elderly patients during concomitant treatment with cardiac glycosides and diuretics (see section “Interaction with other drugs”) and in patients with an increased tendency to form kidney stones. In cases of hypercalcemia or signs of renal impairment, reduce the dose or discontinue treatment. Vitamin D should be taken with caution in patients with renal failure. In this case, it is necessary to monitor the calcium and phosphate levels in the blood serum. The risk of soft tissue calcification must also be considered. To avoid overdose, additional vitamin D intake from other sources must be taken into account. Calcium and vitamin D3 should be used with caution in immobilized patients with osteoporosis due to the risk of hypercalcemia. Vitamin D should be taken with caution in patients with sarcoidosis because they have abnormal vitamin D metabolism and may develop hypercalcemia, kidney stones and renal failure. Calcium concentrations in the blood and urine should be checked regularly in such patients. Concomitant use with tetracycline or quinolone antibiotics is usually not recommended or should be done with caution. The use of large doses of vitamin D3 is not advisable, since the vitamin in these cases inhibits the formation of biologically active compounds of vitamin D3. At the same time, the percentage of unconverted vitamin D3 in the body increases, which undergoes oxidation and thereby increases the risk of D-hypervitaminosis. The gelatin capsule shell contains dyes that can cause allergic reactions.

Pregnancy and lactation.

When prescribing the drug during pregnancy, it should be taken into account that the daily dose of calcium should not exceed 1500 mg, and cholecalciferol - 600 IU. An overdose during pregnancy can lead to disruption of the mental and physical development of the child. Cholecalciferol and its metabolites can be excreted in breast milk. This should be taken into account if the child receives additional vitamin D.

Interaction with other drugs

Hypercalcemia may potentiate the toxic effects of cardiac glycosides when used concomitantly with calcium and vitamin D3 supplements. Monitoring of ECG and serum calcium levels is necessary. Calcium supplements may reduce the absorption of tetracyclines from the gastrointestinal tract. Therefore, tetracycline drugs should be taken at least 2 hours before or 4-6 hours after taking Boncalcid forte. To prevent decreased absorption of bisphosphonate drugs, it is recommended to take them at least an hour before taking Boncalcid forte. Glucocorticosteroids reduce calcium absorption, so treatment with glucocorticosteroids may require an increase in the dose of Boncalcid forte. With simultaneous use of thiazide diuretics, the risk of hypercalcemia increases, because they increase tubular reabsorption of calcium. When thiazide diuretics are used concomitantly, serum calcium levels should be regularly monitored. Furosemide and other loop diuretics, on the contrary, increase calcium excretion by the kidneys. Calcium reduces the effectiveness of levothyroxine by reducing its absorption. The period of time between doses of levothyroxine and Boncalcid forte should be at least 4 hours. The absorption of quinolone antibiotics is reduced when used simultaneously with calcium supplements. Therefore, quinolone antibiotics should be taken 2 hours before or 6 hours after taking Boncalcid forte. The activity of cholecalciferol may be decreased when used concomitantly with phenytoin or barbiturates. Cholestyramine and laxatives based on mineral or vegetable oil reduce the absorption of vitamin D3. Ingestion of foods containing oxalates (sorrel, rhubarb, spinach) and phytin (cereals) reduces the absorption of calcium, so you should not take Boncalcid forte within two hours after eating sorrel, rhubarb, spinach, cereals.

Side effect

From the digestive system: constipation or diarrhea, flatulence, nausea, abdominal pain. Metabolic disorders: rarely - hypercalcemia and hypercalciuria. Other: allergic reactions.

Overdose

Symptoms of overdose: anorexia, thirst, polyuria, muscle weakness, nausea, vomiting, constipation, abdominal pain, fatigue, bone pain, mental disorders, nephrocalcinosis, urolithiasis and, in severe cases, cardiac arrhythmias. With long-term use of excessive doses (over 2500 mg of calcium) - kidney damage, soft tissue calcification. If signs of overdose are detected, it is necessary to stop taking calcium and vitamin D, as well as thiazide diuretics and cardiac glycosides. Treatment: gastric lavage, replacement of fluid loss, use of loop diuretics (for example, furosemide), glucocorticosteroids, calcitonin, bisphosphonates. It is necessary to monitor the content of electrolytes in the blood plasma, renal function and diuresis. In severe cases, it is necessary to measure central venous pressure (CVP) and monitor the electrocardiogram (ECG).

Contraindications

Contraindications for use are: hypersensitivity; hypercalcemia (including as a result of hyperparathyroidism (primary or secondary); hypercalciuria; hypervitaminosis D3; nephrolithiasis; decalcifying tumors such as myeloma, bone metastases, sarcoidosis; urolithiasis; osteoporosis due to immobilization; atherosclerosis; hypersensitivity to active substances or to any of the excipients.This dosage form is not prescribed to children under 6 years of age.

Release form

Hard gelatin capsules No. 0, cylindrical in shape with hemispherical ends, with a white body and a red-brown cap, 10 capsules in a blister pack, 6 blister packs in a pack.