Calcium + Vitamin D3 + Multimineral

Calcium + Vitamin D3 + Multimineral belongs to the specific mineral & vitamin combined preparations group. Doctors prescribe it mainly for Prevention and treatment of osteoporosis, To maintain strong bone growth, For proper functioning of heart, muscle and nerves and As nutritional supplement. Dose, duration and suitability differ from patient to patient, so it should be taken only under a registered physician's advice.

Calcium + Vitamin D3 + Multimineral is used in the conditions listed below: • Prevention and treatment of osteoporosis • To maintain strong bone growth • For proper functioning of heart, muscle and nerves • As nutritional supplement • For bone development and regeneration of bone • Pregnancy & lactation • Deficiency state of Calcium, Vitamin D3, Magnesium, Zinc, Copper, Manganese & Boron

Specific mineral & vitamin combined preparations

Active ingredients per unit dose: • Each film-coated tablet contains- • Calcium Carbonate USP 1500 mg equivalent to 600 mg elemental Calcium • Cholecalciferol BP 2 mg equivalent to 200 IU Vitamin D3 • Magnesium Oxide USP 66.34 mg equivalent to 40 mg Magnesium • Manganese Sulfate Monohydrate USP 5.54 mg equivalent to 1.8 mg Manganese • Cupric Oxide 1.25 mg equivalent to 1 mg Copper • Boron Citrate 5 mg equivalent 0.25 mg Boron • Zinc Oxide USP 9.34 mg equivalent to 7.5 mg Zinc • Each effervescent tablet contains- • Calcium Carbonate USP 1500 mg equivalent to 600 mg Calcium • Cholecalciferol BP 4 mg equivalent to 400 IU Vitamin D3 • Magnesium BP 66.340 mg equivalent to 40 mg Magnesium • Manganese Sulphate Monohydrate BP 5.54 mg equivalent to 1.8 mg Manganese • Cupric Oxide Ph. Gr 1.252 mg equivalent to 1 mg Copper • Boron Citrate Ph. gr 5 mg equivalent to 0.25 mg Boron • Zinc Oxide BP 9.34 mg equivalent to 7.5 mg Zinc

How Calcium + Vitamin D3 + Multimineral works — key points: • Nutrition is the most important to prevent osteoporosis and other bone related diseases. • Calcium, Magnesium & Vitamin D3 are the macronutrients for bone. • Without Vitamin D3 very little Calcium is absorbed. • Like Calcium, Magnesium increases bone strength and rigidity. • Recent epidemiological studies showed that some micronutrients like Copper, Manganese, Zinc & Boron play an important role in bone health. • Deficiency of the micronutrients is noticed in patients with osteoporosis..

Recommended schedule as per the manufacturer's literature: • Adult : 1 film-coated tablet twice daily, preferably 1 tablet in the morning and 1 tablet in the evening or as directed by physician. It is best taken with or just after main meals with a full glass of water. • Children 3-7 years : 1 effervescent tablet daily. • 7 years to older : 1 to 2 effervescent tablet daily.

Reactions reported with Calcium + Vitamin D3 + Multimineral: • The use of calcium supplements has rarely given rise to mild gastro-intestinal disturbances such as constipation, flatulence, nausea, gastric pain, diarrhea. Following administration of vitamin-D3 supplements occasional skin rash has been reported. Hypercalciuria and in rare cases hypercalcaemia have been seen with long term treatment at high doses

Points to keep in mind while on Calcium + Vitamin D3 + Multimineral: • Patients with mild to moderate renal failure or mild hypercalciuria should be supervised carefully. • Periodic checks of plasma calcium levels and urinary calcium excretion should be made in patients with mild to moderate renal failure or mild hypercalciuria. • Urinary calcium excretion should also be measured. • In patients with a history of renal stones urinary calcium excretion should be measured to exclude hypercalciuria. • With long term treatment it is advisable to monitor serum and urinary calcium levels and kidney function, and reduce and stop treatment temporarily if urinary calcium exceeds 7.5 mmol/24 hours. • Allowances should be made for calcium and vitamin D3 supplements from other sources..

Avoid Calcium + Vitamin D3 + Multimineral in the following situations: • Absolute contraindications are hypercalcaemia resulting from myeloma, bone metastasis or other malignant bone disease, sarcoidosis; primary hyperparathyroidism and Vitamin-D 3 overdosage, Severe renal failure. Hypersensitivity to any of the tablet ingredients. Relative contraindications are osteoporosis due to prolonged immobilisation, renal stones, severe hypercalciuria

Watch for these combinations: • The risk of hypercalcemia should be considered in patients taking thiazide diuretics since these drugs can reduce urinary calcium excretion. Hypocalcaemia must be avoided in digitalized patients. Certain foods (e.g. those containing oxalic acid, phosphate or phytinic acid) may reduce the absorption of calcium. Concomitant treatment with phenytoin or barbiturates can decrease the effect of Vitamin-D 3 because of metabolic activation. Concomitant use of glucocorticoids can decrease the effect of Vitamin D3. The effects of digitalis and other cardiac glycosides may be attenuated with the oral administration of calcium combined with Vitamin-D 3 . Strict medical supervision is needed and, if necessary monitoring of ECG and calcium. Calcium salts may reduce the absorption of thyroxin, bisphosphonates, sodium fluoride, quinolone or tetracycline antibiotics or iron. It is advisable to allow a minimum period of four hours before taking the calcium

Use during pregnancy: If calcium and iron supplements are both required to be administered to the patient, they should be taken at different times. Overdoses of vitamin-D 3 have shown teratogenic effects in pregnant animals. In humans long term hypercalcaemia can lead to physical and mental retardation, aortic stenosis and retinopathy in a new born child.

Use while breastfeeding: During pregnancy and lactation treatment should always be under the direction of a physician. During pregnancy and lactation, requirements for calcium and vitamin-D 3 are increased but in deciding on the required supplementation allowances should be made for availability of these agents from other sources. Vitamin-D 3 and its metabolites pass into the breast milk..

Kidney and liver considerations: Patients with mild to moderate renal failure or mild hypercalciuria should be supervised carefully. Periodic checks of plasma calcium levels and urinary calcium excretion should be made in patients with mild to moderate renal failure or mild hypercalciuria. In patients with a history of renal stones urinary calcium excretion should be measured to exclude hypercalciuria. With long term treatment it is advisable to monitor serum and urinary calcium levels and kidney function, and reduce and stop treatment temporarily if urinary calcium exceeds 7.5 mmol/24 hours.

If too much is taken: Symptoms of overdosage may include nausea and vomiting, severe drowsiness, dry mouth, loss of appetite, metallic taste, stomach cramps, diarrhea, headache & constipation..

Storage: • Keep in a dry place away from light and heat. Keep out of the reach of children.