Organic calcium salts: prospects for use in clinical practice

Characteristics of calcium carbonate

Calcium carbonate is a solid white crystal, odorless and tasteless, insoluble in water, ethanol and easily soluble in acids with the release of carbon dioxide. This is an inorganic chemical compound, a salt of carbonic acid and calcium. It occurs in nature in the form of minerals, differing in crystalline structure - the widespread calcite, aragonite and vaterite, is the main component of limestone, chalk and marble, one of the most common compounds on Earth.

What tests to take

It is difficult to detect calcium deficiency using a blood test, because the body does everything possible to maintain a constant level of ionized calcium in the blood. But it’s easy to be deficient or deficient in vitamin D by taking a blood test for 25-OH vitamin D.

To identify contraindications and evaluate the effectiveness of treatment with calcium preparations, you should take tests:

• Calcium and phosphorus in the blood
• Calcium in daily urine
• Blood creatinine
• 25-OH vitamin D

In the Lab4U laboratory this can be done with a discount of up to 50%.

Applications of calcium carbonate

Calcium carbonate (calcium carbonate, chalk, calcium carbonate) is used:

• in the paint and varnish industry, in the production of paints and finishing materials;
• in the chemical industry in the production of calcium carbide;
• in the glass industry in the production of glass;
• in construction in the production of putties, various sealants, etc.;
• in agriculture, as a lime fertilizer and for complex agrochemical cultivation of fields;
• as a filler for rubber compounds, paper, linoleum;
• in medicine as an antacid, antiulcer, and calcium deficiency remedy;
• in the cosmetic industry in the production of tooth powder, as a filler for cosmetics;
• in the food industry, as a food additive dye E170.

Table 1. Physico-chemical parameters of calcium carbonate

Electrical properties of fillers based on calcium carbonate (2 tables):

Table 2.

Table 3.

Table 4. Physical properties of various types of carbonates.

Organic calcium salts: prospects for use in clinical practice

A diet deformed in mineral composition, characterized by a deficiency of calcium, magnesium, potassium, zinc, selenium against the background of excessive consumption of sodium (table salt), simple sugars and saturated fats, stimulates the development of diabetes, obesity, osteoporosis, cardiovascular, cerebrovascular and oncological diseases, while data from experimental and clinical studies show that replenishing calcium deficiency significantly reduces the risk of developing these diseases. The effectiveness of correcting calcium deficiency depends on many additional factors, including the specific form of calcium, the patient’s drinking and movement patterns, and the presence of bad habits. Therefore, competent compensation of deficiency with special calcium preparations as part of a comprehensive prevention/therapy program is an important reserve for improving public health. The degree of calcium supply in the body should be determined taking into account the following biomedical data: questionnaires/diet diaries, scoring scales for clinical signs of calcium deficiency, measurements of calcium levels in blood plasma, results of densitometric measurements. Unfortunately, questionnaires and scoring scales are used very rarely in clinical practice. The symptoms of calcium deficiency are not entirely specific and are often mistaken for symptoms of other diseases, while questionnaires and a thorough analysis of clinical symptoms are fundamental for the early diagnosis of calcium deficiency. In practice, measurement of calcium levels in the blood and densitometry are much more often used, indicating an already formed and pronounced calcium deficiency. Approximately half of the total plasma calcium circulates in an unbound form (called “ionized calcium”), the rest of the plasma calcium is bound to albumin and other serum proteins. Normally, the level of total calcium is 2.2–2.6 mmol/l, unbound (ionized) calcium – 1.1–1.4 mmol/l. The biological effect of calcium is determined by the amount of unbound calcium, not total calcium, so hypocalcemia is diagnosed when unbound calcium levels fall below normal. Hypocalcemia may be associated with impaired parathyroid function, lack of vitamin D in the diet, lack of sufficient ultraviolet exposure, or impaired renal function. Low levels of vitamin D in the body can lead to lack of calcium absorption and secondary hyperparathyroidism (hypocalcemia and elevated parathyroid hormone levels) [2]. The physiological effects of hypocalcemia on the human body are caused by disturbances in fundamental calcium-dependent processes inside the cell. Calcium ion (Ca2+) plays a key role in the physiology of the cell and the entire organism. Calcium in the form of hydroxyapatite is the main building material of bone. There are more than 2000 Ca2+-dependent enzymes (the most famous example is hemostasis enzymes), the activity of which will be significantly reduced under conditions of calcium deficiency. In the most complex cascades of intracellular signaling, calcium acts as the most important signaling molecule (the so-called “second messenger”). Inside cells there are special compartments - calcium stores, which release it during intracellular signal transmission, muscle contraction and other calcium-dependent processes. At rest, in the absence of a signal, the intracellular concentration of ionized calcium is ~100 nm, and during the passage of a signal, muscle fiber contraction, etc. increases by 10–100 times. These intracellular calcium stores are necessary for the processes of contraction of all types of muscle cells, secretion of neurotransmitters, and maintenance of potential differences across neuron membranes. With calcium deficiency, the activity of all these processes will be disrupted, which necessitates the need to replenish calcium stores through food and special calcium preparations. It is well known that dairy products (milk, cheese) are a significant source of calcium. Good sources of calcium are also seaweed (kelp), almonds, hazelnuts, sesame seeds, pistachios, beans, figs, okra, rutabaga, and broccoli [3]. It would seem that compensation for calcium deficiency is most simply and effectively carried out precisely through the intake of certain types of food. However, this kind of belief is not scientifically substantiated. First of all, it should be noted that there are daily requirements for essential micronutrients established as a result of numerous clinical and pharmacokinetic studies. When calcium enters the body in an amount below the established daily requirement (800–1500 mg calcium/day), calcium deficiency will sooner or later occur. Filling this daily requirement for calcium with food has a number of significant features that are completely ignored by supporters of dogmas like “there is enough calcium in regular food,” whether intentionally or not. Firstly, the same product (for example, milk), depending on the manufacturer, may contain an amount of calcium that differs by 1.5–2 times, which does not guarantee that when consuming a particular product, the patient will receive all the calcium he needs. Secondly, even calcium-concentrating products contain milligrams of this macronutrient, which makes it necessary to consume a significant amount of these products daily: for example, 100 g of milk contains an average of 100 mg of calcium, 100 g of cottage cheese - 95 mg, 100 g of sour cream - 90 mg. Therefore, to replenish the daily requirement for calcium (say, 1000 mg/day), every day you need to drink 1 liter of milk, eat 1 kg of cottage cheese or 1100 g of sour cream. Not every person can have such a diet, even if they are in perfect health. Third, foods contain thousands of other substances in addition to essential nutrients, and these substances can have various, often very undesirable, effects on the body. For example, hard Swiss cheese can contain up to 600 mg of calcium per 100 g of product, so eating 150 g of cheese per day is enough. However, this amount of hard cheese contains up to 80 g of saturated fat, and this kind of “calcium” diet will contribute to the increased development of atherosclerosis. Some people are allergic to dairy products, and many are lactose intolerant, which prevents them from consuming unfermented dairy products in quantities sufficient to provide the body with calcium [4]. When consuming plant-based calcium-containing foods, the absorption of calcium from the gastrointestinal tract (GIT) may be reduced by simultaneous intake of foods containing oxalic and phytic acids (for example, spinach or rhubarb) due to the formation of insoluble calcium-oxalate and calcium-phytate complexes. Therefore, it is often much more practical, safe and economically profitable to use special calcium preparations in order to compensate for the nutritional deficiency of this macronutrient. The recommended daily dose of calcium is ~1000 mg/day. for adults, and this amount may well contain 1-2 tablets. Taking some form of calcium is often accompanied by vitamin D3 supplementation because its active forms turn on the expression of genes encoding proteins responsible for calcium absorption [5]. Taking calcium supplements is safe, because acute poisoning is possible only when calcium compounds are administered intravenously. For example, the oral mean lethal dose (LD50) in the experiment was 6.45 g/kg calcium carbonate [6] and 1.4 g/kg calcium chloride [7] - these are dosages that exceed the daily requirement for calcium by tens of times. A significant problem in compensating for dietary calcium deficiency is the choice of the most appropriate pharmacological substance and pharmaceutical form of calcium. To make a decision on choosing the most appropriate calcium preparation for a particular patient, the physician needs information about the pharmacokinetics and pharmacodynamics of various pharmacological calcium substances. This work analyzes the evidence base on the use of inorganic (carbonate, phosphate) and organic calcium salts (calcium citrate, calcium gluconate, calcium lactate, etc.); modern principles for correcting calcium deficiency were formulated. Calcium carbonate is the most common and one of the cheapest forms of calcium. It is widely used in medicine as a calcium dietary supplement or antacid [8] and contains 40% elemental calcium. The best absorption of this form of calcium occurs when taken together with food, and it largely depends on the acidity of the stomach (better absorption is observed at lower pH [8]). After all, calcium carbonate is insoluble in water, and its absorption in the body occurs exclusively through interaction with hydrochloric acid of gastric juice:

CaCO3 + 2HCl > CaCl2 + CO2^+ H2O

When calcium carbonate is taken orally in solid dosage forms (tablets, dragees, capsules), as well as in the form of powders, this reaction, which takes place with the formation of carbon dioxide, occurs in the stomach. In this case, part of the hydrochloric acid of the gastric juice, necessary for digesting food, is consumed. Taking 1000 mg of calcium carbonate (a typical dose of calcium carbonate tablets) produces 0.01 mole of carbon dioxide (equivalent to approximately 220 ml). Such a volume of carbon dioxide in the stomach will cause a feeling of fullness, gastrointestinal discomfort and belching of carbon dioxide. If there are erosive lesions in the stomach, stretching of the gastric mucosa due to the accumulation of carbon dioxide is extremely undesirable. With protein nutrition, the antacid effect of calcium carbonate mentioned above leads to a delay in food transit in the stomach. In patients with normal and especially with increased acidity of gastric juice, calcium carbonate can help replenish calcium deficiency. Double-blind randomized controlled trial of calcium carbonate for 24 months. showed the effectiveness of its use to replenish calcium needs in 257 healthy adolescents aged 12–15 years. Participants were randomly assigned to 4 groups and received chewable calcium carbonate tablets that provided them with elemental calcium (63 mg/day, 354 mg/day, 660 mg/day, 966 mg/day). Mineral content and bone mineral density (BMD) of the whole body and lumbar spine increased significantly at all doses of the drug (p < 0.05). Calcium intake more than 230 mg/day. within two years may improve bone mineral accumulation [9]. The antacid effect of calcium carbonate helps to reduce local anticancer immunity and serves as a cancrophilia factor. Thus, in an experimental study, animals were subjected to partial gastrectomy, a significant risk factor for spontaneous development of gastric cancer, and then randomized to receive sodium chloride or calcium carbonate. In the group taking sodium chloride, cancer developed in 3 of 18 animals (17%), and in the group taking calcium carbonate - in 11 of 18 (61%, p < 0.01). Further studies showed that the main cause of malignancy was the carbonate anion, and not the calcium cation: ingestion of sodium bicarbonate by animals led to malignancy in 13 out of 24 animals (54%, p <0.01) [10]. A large randomized trial conducted by the Women's Health Initiative found that taking estrogen with calcium carbonate increased the risk of colorectal cancer. So, when taking 1000 mg/day. calcium carbonate plus estrogens over several years increased the risk of colorectal polyps by 1.5 times (OR 1.50, 95% CI 0.96–2.33), while taking calcium carbonate alone reduced the risk by 29% (OR 0.71, 95% CI 0.46–1.09, p=0.018) [11]. The effectiveness of using calcium carbonate in clinical practice depends on the above-mentioned characteristics of the compound and the level of calcium intake of the individual patient. With low dietary intake, calcium carbonate may be ineffective and may not meet calcium needs. For example, in a randomized study of 125 pregnant women with low calcium intake (average 350 mg calcium/day), participants received calcium carbonate (1500 mg/day) or placebo from 20 weeks. pregnancy before childbirth. There was a paradoxical effect: those receiving calcium carbonate supplementation had significantly lower bone mineral content (BMC), bone surface area, and bone mineral density over 12 months. lactation (mean ±SE difference: BMC=–10.7±3.7%, p=0.005; BA=–3.8±1.9%, p=0.05; BMD=–6.9±2, 6%, p=0.01) [12]. Thus, in pregnant women with low calcium intake, calcium carbonate is often ineffective in preventing osteopenia. Therefore, despite the low cost of calcium carbonate, the need for safer and more effective pharmaceutical substances to compensate for calcium deficiency remains high. Calcium phosphate (microcrystalline hydroxyapatite) is one of several forms of calcium that are used as a dietary supplement, containing about 40% elemental calcium. Tricalcium phosphate is also used as a dietary supplement [13] and is found in cow's milk. The properties of calcium phosphates as a dietary supplement have not been well studied, and taking into account the low solubility of phosphate, its use as a substance to replenish calcium requirements is not recommended [14]. Calcium citrate is an exceptionally effective and safe form of calcium. Firstly, calcium from calcium citrate is absorbed regardless of food intake and the acidity of gastric juice. Secondly, the citrate anion itself has significant nutritional value, since citrate takes part in the central energy cycle of each cell - the Krebs cycle. Third, the chemical properties of calcium citrate make it a particularly useful source of calcium for people with hypochloridia (including elderly patients and patients using medications that reduce gastric acid secretion). Fourth, calcium citrate is highly soluble in water and is a form of calcium that does not increase the risk of kidney stones. The main factor that may discourage the selection of calcium citrate as a preferred source of calcium is the slightly higher cost of this drug compared to other sources [15]. Calcium citrate is the drug of choice for patients with achlorhydria and taking histamine type 2 receptor blockers or proton pump inhibitors [16]. Let us remember that low acidity often occurs in old age, when the need for the prevention of osteoporosis is greatest. Calcium citrate contains 21% elemental calcium, i.e. 1000 mg of calcium citrate will provide 210 mg of elemental calcium. Unlike calcium carbonate, which neutralizes the hydrochloric acid of the gastric juice to form carbon dioxide, calcium citrate does not interact with the hydrochloric acid of the stomach and does not cause a feeling of distension, bloating, or belching. Higher calcium absorption from calcium citrate compared to calcium absorption from calcium carbonate is observed in patients after gastric bypass surgery - in the postoperative period, calcium citrate increases the bioavailability of calcium by almost 2 times compared to calcium carbonate [17]. A meta-analysis of 15 clinical studies that compared the bioavailability of calcium carbonate with the bioavailability of calcium citrate included a total of 184 patients and showed a benefit from the use of calcium citrate. According to the results of this meta-analysis [18], in a sample of patients, calcium absorption from calcium citrate was significantly higher than from calcium carbonate: by 20% - on average for the sample, by 24% - among studies in category of evidence A, by 27% – when taken on an empty stomach and by 22% – when taken with meals. Thus, a meta-analysis of studies showed that calcium citrate is absorbed significantly better than calcium carbonate, by approximately 20–27% [18]. Other organic forms of calcium include calcium lactate and calcium gluconate, which are found in foods, such as calcium lactate, a component of ripened cheeses. Calcium lactate can be absorbed at different pH values, and this form of calcium can be taken separately from food; it is added to sugar-free chewing gum, which promotes the remineralization of tooth enamel [19]. Calcium lactate is a natural product of microbiota metabolism, involved in the food chain of positive intestinal flora, so replenishing the daily calcium requirement in the form of calcium lactate will lead to the full absorption of both calcium and lactate. Calcium lactate more successfully neutralized the negative effects of estrogen-containing drugs on BMD. Thus, study participants (postmenopausal women and patients who underwent oophorectomy) received estrogen monotherapy for 2 years and had confirmed hypocalcemia. Despite estrogen therapy, all patients experienced a significant progradient decrease in BMD. Patients were then randomized to receive relatively low doses of calcium lactate (600–800 mg/day) plus estrogens or estrogens alone for an additional 2 years. Changes in lumbar spine BMD before and after calcium lactate supplementation were measured using X-ray absorptiometry. BMD of the lumbar spine in women on estrogen monotherapy continued to decrease (by –0.4% over 2 years). In contrast, in women taking estrogens in combination with calcium lactate, BMD increased by 2.8% (p = 0.003) [20]. In summary, the available basic research and evidence-based medicine data have shown a number of distinct benefits of using calcium lactate, gluconate and calcium citrate. The introduction of drugs based on the above organic salts corresponds to the basic principle of clinical pharmacology - maximum effectiveness with maximum safety of drug use. Such a calcium preparation is Calcium Sandoz® Forte. Calcium Sandoz® Forte (reg. specification LP–000343) contains 3 calcium salts: calcium lactate, calcium gluconate and calcium carbonate. The drug is available in the form of effervescent tablets. 1 tablet contains an equimolar mixture of calcium lactate and calcium gluconate in the amount of 1132 mg, calcium carbonate - 875 mg (total 500 mg of elemental calcium) and citric acid. It should be emphasized that the tablets of the drug are used to prepare a drinking solution, which is consumed by the patient. During the preparation of an aqueous solution, a complete (100%) irreversible chemical interaction of calcium carbonate with citric acid occurs with the formation of calcium citrate and the volatilization of carbon dioxide formed during the reaction from the resulting solution:

3CaCO3 + 2C6H8O7 > Ca3(C6H5O7)2 + 3CO2^+ 3H2O

This chemical reaction is well known from general chemistry and is caused by the displacement of weaker carbonic acid by stronger citric acid [21]. Due to the fact that carbon dioxide is removed from the solution almost completely, this reaction proceeds irreversibly and all calcium carbonate is converted into organic calcium citrate. Citric acid is included in 1 tablet of the drug in the amount of 1662 mg, which is sufficient to completely dissolve calcium carbonate: in accordance with the above reaction equation, about 1200 mg of citric acid in the form of monohydrate is sufficient to dissolve 875 mg of calcium carbonate. When a tablet of Calcium Sandoz® Forte is dissolved in water, the resulting solution contains calcium cations surrounded by anions of organic acids (lactate, gluconate and citrate), which stabilize calcium ions in the solution and ensure high bioavailability of the ionized form of calcium. Experimental studies have shown comparable bioavailability of these calcium salts (Table 1). The properties of the mixture of salts based on Calcium Sandoz® Forte were studied in experimental and clinical studies. When studying the absorption of calcium from 4 different supplements when passing through a dynamic, computer-controlled model of the gastrointestinal tract, it was found that the bioavailability (absorption, absorption) of calcium decreased in the order Ca lactate-gluconate > Ca lactate > Ca citrate > Ca carbonate. For all organic salts (lactate gluconate, lactate, citrate), calcium bioavailability was the same regardless of food intake. The bioavailability of calcium from pure calcium carbonate (i.e. without added citric acid) was significantly higher when consumed with food and significantly lower when consumed with a glass of water [23]. Calcium absorption from 6 different sources (milk, carbonate, equimolar citrate/malate, phosphate, L-lactate and equimolar lactate/gluconate) was studied in a group of 10 postmenopausal women. Calcium absorption was determined using stable isotope technologies (44Ca isotope tag). Bioavailability (absorption) of calcium from these calcium sources during breakfast ranged from 25% for tricalcium diphosphate to 32% for calcium lactate gluconate. Without breakfast, calcium absorption was significantly higher (45%) [24]. You should also consider the established stereotype about the need to take vitamin D and calcium together. Often, a given calcium supplement contains both calcium (usually calcium carbonate) and vitamin D. The purpose of simultaneous administration is that vitamin D stimulates increased expression of calcium-transporting ion channels in various cell types. However, the biological effects of vitamin D, usually used in the form of cholecalciferol (vitamin D3), take time: it must be transformed into active forms in the liver and kidneys, which takes at least 2-3 hours. Then the active forms of vitamin D (25-hydroxyvitamin D, 1,25-dihydroxyvitamin D) must be transported to target cells and stimulate calcium channel expression processes. This process will take another 1–2 hours. At the same time, the peak concentration of calcium in the blood plasma after oral administration is reached within 1–2 hours, after which plasma calcium levels begin to fall. Obviously, in 1–2 hours, vitamin D3 will not have time to manifest its biological effects that promote calcium absorption. Therefore, from the point of view of pharmacokinetics, it seems more rational not to take calcium and vitamin D simultaneously, but separately. First, vitamin D is taken (preferably in active form), and after 3–4 hours a calcium supplement is taken. With this method of administration, the effect of vitamin D on calcium absorption will be maximum. In other words, taking vitamin D several hours before taking a calcium supplement, as it were, prepares the body's cells for more complete absorption of lactate, gluconate and calcium citrate. Conclusion Correction of calcium deficiency can be done using drugs based on various calcium salts. The pharmacological, experimental and clinical medicine data presented in this article indicate the prospects of using such organic calcium salts as lactate, gluconate and citrate. Calcium carbonate, which is currently widely used, despite its low cost and relative effectiveness, is contraindicated in patients with low gastric acidity, is undesirable while taking estrogen-containing drugs, and is not the best choice when accompanying pregnancy, especially if there is insufficient calcium intake from food.

References 1. Torshin I.Yu., Gromova O.A. 25 moments of molecular pharmacology. Ivanov: A-Grif, 2012. 756 p. 2. Murphy E. Williams. Hypocalcemia // Medicine. 2009. Vol. 37(9). R. 465–468. 3. USDA National Nutrient Database. https://www.nal.usda.gov/fnic/foodcomp/search. 4. Ross S.A., Taylor CL, Yaktine AL, Del Valle HB ed. Committee to Review Dietary Reference Intakes for Vitamin D and Calcium; Institute of Medicine. 2011. Dietary Reference Intakes for Calcium and Vitamin D. ISBN 978–0–309–16394–1. https://www.nap.edu/catalog.php?record_id=13050. 5. Combs G. The Vitamins. Academic Press. P. 161. ISBN 0–12–183490–5. 6. Lewis RJ Sax's Dangerous Properties of Industrial Materials (9 ed.). New York, NY: Van Nostrand Reinhold, 1996. P. 635. ISBN 0–471–37858–5. 7. Toxic and Hazardous Industrial Chemicals Safety Manual. Tokyo, Japan: The International Technical Information Institute. 1988. P. 101. 8. Lieberman HA, Lachman L., Schwartz JB Pharmaceutical Dosage Forms: Tablets. New York: Dekker, 1990. P. 153. ISBN 0–8247–8044–2. 9. Yin J., Zhang Q., Liu A., Du W., Wang X., Hu X., Ma G. Calcium supplementation for 2 years improves bone mineral accretion and lean body mass in Chinese adolescents // Asia Pac J Clin Nutr. 2010. Vol. 19(2). R. 52–160. 10. Ehrnstrom RA, Veress B., Arvidsson S., Sternby NH, Andersson T., Lindstrom CG Dietary supplementation of carbonate promotes spontaneous tumorigenesis in a rat gastric stump model // Scand J Gastroenterol. 2006. Vol. 41(1). R. 12–20. 11. Ding EL, Mehta S., Fawzi WW, Giovannucci EL Interaction of estrogen therapy with calcium and vitamin D supplementation on colorectal cancer risk: reanalysis of Women's Health Initiative randomized trial // Int J Cancer. 2008. Vol. 122(8). R. 1690–1694. 12. Jarjou LM, Laskey MA, Sawo Y., Goldberg GR, Cole TJ, Prentice A. Effect of calcium supplementation in pregnancy on maternal bone outcomes in women with a low calcium intake // Am J Clin Nutr. 2010. Vol. 92(2). R. 450–457. 13. Bonjour JP, Carrie AL, Ferrari S., Clavien H., Slosman D., Theintz G., Rizzoli R. Calcium–enriched foods and bone mass growth in prepubertal girls: a randomized, double–blind, placebo–controlled trial // J Clin Invest. 1997. Vol. 99(6). R. 1287–1294. 14. Straub DA Calcium supplementation in clinical practice: a review of forms, doses, and indications // Nutr Clin Pract. 2007. Vol. 22(3). R. 286–296. 15. Reinwald S., Weaver CM, Kester JJ The health benefits of calcium citrate malate: a review of the supporting science // Adv Food Nutr Res. 2008. Vol. 54. R. 219–346. 16. Heaney RP, Dowell MS, Bierman J., Hale CA, Bendich A. Absorbability and cost effectiveness in calcium supplementation // J Am Coll Nutr. 2001. Vol. 20(3). R. 239–246. 17. Tondapu P., Provost D., Adams-Huet B., Sims T., Chang C., Sakhaee K. Comparison of the absorption of calcium carbonate and calcium citrate after Roux-en-Y gastric bypass. Obes Surg. 2009. Vol. 19 (9). R. 1256–1261. 18. Sakhaee K., Bhuket T., Adams–Huet B., Rao DS Meta–analysis of calcium bioavailability: a comparison of calcium citrate with calcium carbonate // Am J Ther. 1999. Vol. 6 (6). R. 313–321. 19. Suda R., Suzuki T., Takiguchi R., Egawa K., Sano T., Hasegawa K. The effect of adding calcium lactate to xylitol chewing gum on remineralization of enamel lesions // Caries Res. 2006. Vol. 40 (1). R. 43–46. 20. Mizunuma H., Okano H., Soda M., Tokizawa S., Kagami I., Miyamoto S., Honjo S., Ibuki Y. Calcium supplements increase bone mineral density in women with low serum calcium levels during long–term estrogen therapy // Endocr J. 1996. Vol. 43(4). R. 411–415. 21. Nekrasov B.V. Fundamentals of General Chemistry, M.: 1969; 857. 22. Rosenthaler J. Absorption of calcium. In vivo experiments with mice and dogs (45)–calcium as marker. Sandoz Ltd. 4002 Basel Switzerland, February 1971. 23. Availability for absorption of calcium from four calcium supplements during passage through an in vitro gastrointestinal model (TIM–1). TNO Nutrition and Food Research Institute, Zeist, The Netherlands, 2003. 24. Brink EJ, van den Heuvel EG, Muijs T. Comparison of Six Different Calcium Sources and Meal Type on True Fractional Calcium Absorption in Postmenopausal Women // Current Topics in Nutraceutical Research. 2003. Vol. 1. N 1. R. 161–168.

Overdose

hyperkacemia may occur (taking more than 2 grams per day). Symptoms: general weakness, headaches , anorexia , lack of appetite, vomiting, constipation , thirst, lethargy, polyuria , pain in the joints and muscles, heart rhythm disturbances, kidney disease.

It is recommended to rinse the stomach, give the victim enterosorbents , and carry out symptomatic treatment.

Construction and chemical industries and calcium carbonate

The substance is used as a component of putties and various sealants in the production of glass, paper, household chemicals, paints (technical and artistic), and plastics. For the production of the latter, about 45-50% of all white chalk in the world is mined. As a filler and dye, it is used to produce polyvinyl chloride, polyolefins, and polyester fibers.

For agriculture, calcium carbonate is a means to cleanse the soil and restore its acid-base balance.

Use of E170 additive as an ingredient in food products

The food industry practically cannot do without white chalk, because it is completely harmless to humans and is approved for use by children. As a leavening agent, coloring agent, stabilizer, it is used to prepare:

• baby food;
• concentrated cream and milk;
• chocolate;
• hard cheeses.

The additive is also used to process grape juice.

Interaction

Combination use of the drug with tetracycline antibiotics can lead to a decrease in their effectiveness and plasma concentration.

When combining the drug with thiazide diuretics, there is a higher risk of developing metabolic alkalosis and hypercalcemia .

Calcium carbonate slows down the absorption processes of other drugs.

of indomethacin increases .

When combined with levothyroxine , it reduces the effect of taking an anabolic steroid.

Who are calcium supplements indicated for?

• In the treatment of pathological fractures due to osteoporosis
• Women over 50 years of age with vitamin D deficiency or deficiency
• If you have osteoporosis
• For women who have reached menopause to prevent osteoporosis
• If you have insufficient calcium intake from food:

The daily requirement for calcium in children under 3 years of age is 700 mg, for children 4-10 years of age and adults 1000 mg. An increased requirement of up to 1200 mg is observed in women in menopause or over 50 years of age and in men over 70 years of age. Adolescents during the growing period (10-16 years), pregnant and breastfeeding women should receive up to 1300 mg of calcium.

Cosmetics industry - in which products is the substance found?

White chalk is one of the components of creams, powders and foundations for the face, mattifying lotions, body creams and scrubs, blush, concealers, hair dyes, and children's cosmetics. The substance has the property of absorbing excess sebum, thereby removing oily shine and evening out skin tone. As a thickener and stabilizer, calcium carbonate improves the consistency of cosmetic products, promotes the absorption of excess water and prevents the appearance of lumps. As a weak abrasive component, it cleans and adds shine, which is why it is used in the production of toothpastes. Naturally, the coloring effect of white chalk is also used by manufacturers of cosmetics - with its help they give products a white color.

Drugs containing (Analogs)

Trade names of the product: Calcium carbonate , Vitacalcin , Additiva calcium , Scoralite , UPSAVIT Calcium . In combination with magnesium carbonate : Tums , Rennie , Rumney , Andrews antacid . In combination with colecalciferol, the drug is included in the following medications: Ideos , Revital Calcium D3 , Calcium-D3 Nycomed , Natekal D3 , Complivit calcium D3 . With magnesium hydroxide : Gastrik , Vitrum Mag . Complex products: Alfadol-Sa , Vitrum Beauty Lux , Vitrum Osteomag , Gaviscon , Kalcemin and so on.

Similar drugs:

• Maalox Oral suspension
• Almagel Neo Oral suspension
• Maalox Chewable tablets
• Phosphalugel Gel for oral administration
• Gaviscon Oral suspension
• Almagel A Oral suspension
• Gastrofarm Oral tablets
• Gaviscon Forte Oral suspension
• Sodium bicarbonate Solution for infusion
• Sodium hydrocarbonate Solution for infusion

** The Drug Directory is intended for informational purposes only. For more complete information, please refer to the manufacturer's instructions. Do not self-medicate; Before starting to use the drug Calcium carbonate, you should consult a doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal. Any information on the site does not replace medical advice and cannot serve as a guarantee of the positive effect of the drug.

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Indications for use

Calcium carbonate is prescribed:

• for diseases of the digestive tract with hyperacidity of gastric juice ( gastritis , gastric ulcer , acute duodenitis , symptomatic ulcer of any origin, gastrointestinal erosion heartburn , reflux esophagitis );
• patients with osteoporosis , including during postmenopause ;
• for caries and rickets in childhood;
• patients with osteomalacia and tetany ;
• pregnant women , during breastfeeding;
• during the period of intensive growth of the child;
• with hypocalcemia after long-term treatment with GCs, with renal osteodystrophy , hypoparathyroidism , slow calcium absorption;
• as part of a comprehensive allergy .