About Calcium-
Calcium supplements are salts of calcium used in a number of conditions.
Supplementation is generally only required when there is not enough calcium in the diet. By mouth they are used to treat and prevent low blood calcium, osteoporosis, and rickets. By injection into a vein they are used for low blood calcium that is resulting in muscle spasms and for high blood potassium or magnesium toxicity.
Uses-
Uses And Effectiveness -
Effective for Indigestion (dyspepsia). Taking calcium carbonate by mouth as an antacid is effective for treating indigestion.
High levels of potassium in the blood (hyperkalemia).
Giving calcium gluconate intravenously (by IV) can reverse heart problems caused by hyperkalemia , a condition in which there is too much potassium in the blood.
Low levels of calcium in the blood (hypocalcemia).
Taking calcium by mouth is effective for treating and preventing hypocalcemia. Also giving calcium intravenously (by IV) is effective for treating very low levels of calcium.
Kidney failure-
Taking calcium carbonate or calcium acetate by mouth is effective for controlling high phosphate levels in the blood in people with kidney failure. Calcium citrate is not effective for treating this condition. Taking calcium by mouth also seems to be helpful for reducing blood pressure in people with kidney failure.
Likely Effective for-
Bone loss in people taking drugs called corticosteroids.
Taking calcium along with vitamin D seems to reduce the loss of bone mineral in people using corticosteroid drugs for long term.
Overactive parathyroid (hyperparathyroidism).
Taking calcium by mouth reduces parathyroid hormone levels in people with kidney failure and parathyroid hormone levels that are too high.
Preventing tooth loss (tooth retention).
Taking calcium and vitamin D by mouth appears to help prevent tooth loss in older people.
Weak and brittle bones (osteoporosis).
Taking calcium by mouth is effective for preventing bone loss and treating osteoporosis. Most bone growth occurs in the teenage years. After that, bone strength in women remains about the same until age 30-40. After age 40, bone loss typically occurs at rates of 0.5% to 1% per year. In men, this bone loss occurs several decades later.
Bone loss is greater in people getting less than the recommended amount of calcium from their diet. This is very common among Americans. Bone loss in women over 40 can be reduced by taking calcium supplements. Some researchers estimate that taking calcium for 30 years after menopause might result in a 10% improvement in bone strength. Taking calcium alone or with vitamin D also helps prevent fractures in people with osteoporosis.
Premenstrual syndrome (PMS). There seems to be a link between low dietary calcium intake and symptoms of PMS. Consuming calcium daily seems to significantly reduce mood swings, bloating, food cravings, and pain. Also increasing the amount of calcium in one's diet seems to prevent PMS. Women consuming an average of 1283 mg/day of calcium from foods seem to have about a 30% lower risk of PMS than women who consume an average of 529 mg/day of calcium.
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Possibly Effective for-
Colon cancer, rectal cancer. Research suggests that high intake of calcium in the diet or as a supplement reduces the risk of colorectal cancer. But not all research agrees. People with low levels of vitamin D do not seem to benefit from calcium supplements. People who are overweight or obese also seem to be less likely to benefit from calcium supplements.
Increasing bone strength in the unborn baby. In pregnant women who eat a low amount of calcium as part of their diet, calcium supplementation increases the bone mineral density of the fetus. However, this does not appear to be beneficial for women with normal calcium levels.
High blood pressure. Taking calcium supplements seems to reduce blood pressure by a small amount (usually around 1-2 mmHg) in people with or without high blood pressure. Calcium seems to work best in salt-sensitive people and people who normally get very little calcium. Some research also suggests that taking calcium might reduce the risk of having high blood pressure.
Softening of the bones (osteomalacia). Osteomalacia is most commonly due to vitamin D deficiency, but very low calcium intake can also cause osteomalacia.
A pregnancy complication marked by high blood pressure and protein in the urine (pre eclampsia). Taking 1-2 grams of calcium by mouth daily seems to reduce the risk of pregnancy-related high blood pressure. Calcium appears to have the greatest effect in high-risk women, in women with low calcium levels, and when started by the 20th week of pregnancy.
Softening of bones in children, often due to vitamin D deficiency (rickets). Rickets is mostly commonly due to vitamin D deficiency, but very low calcium intake can also cause rickets.
Possibly Ineffective for-
Breast cancer.
Some research suggests that women who eat more calcium have a reduced risk for developing breast cancer. However, other research suggests that blood levels of calcium are not linked with breast cancer risk. Overall, most research suggests that taking calcium does not reduce the risk for breast cancer.
Fractures. Taking calcium alone or with vitamin D does not seem to prevent fractures in older people without osteoporosis.
Heart attack. Early research suggests that people who consume more calcium in their diet have a lower risk of having a heart attack. However, the effects of calcium SUPPLEMENTS on heart attack risk are not clear. Some research suggests that calcium supplements increase heart attack risk. Other research shows there is no effect. It may be that some people have an increased risk while others do not. For example, people who take calcium as a single supplement might have an increased risk. On the other hand, people who take calcium with vitamin D do not seem to have an increased risk. Also, people who take a calcium supplement and consume more than 805 mg/day of calcium as part of their diet might be at an increased risk, while people who take a supplement and consume less calcium in their diet might not.
Obesity-
While low calcium intake has been linked with an increased risk of being overweight or obese, most studies show that getting more calcium from supplements or the diet does not improve weight loss in obese or overweight people.
Death from any cause- Research shows that taking calcium supplementation does not reduce the overall risk of death.
Insufficient Evidence for-
Hardening of the arteries (atherosclerosis). Early research found that taking calcium for up to 3 years does not reduce the risk of atherosclerosis in older women.
Autism- Early research found a link between calcium supplementation during pregnancy and reduced autism in the offspring.
Cancer. Research shows that taking calcium alone does not reduce the risk of cancer. Taking calcium along with vitamin D might reduce the risk of cancer in some people, but results are conflicting. Some research shows that taking 1400-1500 mg of calcium daily plus 1100 IU of vitamin D3 (cholecalciferol) daily lowers the risk of developing cancer by 60% in healthy older women who have low blood levels of vitamin D before treatment.
But other research shows that taking 1500 mg of calcium daily plus 2000 IU of vitamin D3 (cholecalciferol) daily does not reduce the risk of developing cancer in healthy older women who have adequate levels of vitamin D before treatment. Furthermore, taking calcium supplements with vitamin D might reduce the risk of developing cancers of the blood or lymphatic system in older women.
Depression. Some early research has found no link between consuming calcium from the diet and the risk of having depression.
Diabetes. Some early research found that consuming more calcium from the diet or from supplements, either alone or in combination with vitamin D, lowers the risk of developing type 2 diabetes. However, other research found that the benefit might be due to the fact that the calcium was taken along with magnesium.
Menstrual cramps (dysmenorrhea). Research shows that taking calcium with a high dose of vitamin D does not reduce pain during painful periods. However, taking calcium without vitamin D might be beneficial.
Cancer of the lining of the uterus (endometrial cancer). Taking calcium supplements might reduce the risk of developing endometrial cancer. However, dietary calcium does not seem to have any benefit.
Fall prevention. Evidence suggests that calcium plus vitamin D might help prevent falls by decreasing body sway and helping to keep blood pressure normal. Calcium alone does not seem to have the effect. Interestingly, calcium plus vitamin D seems to prevent falls in women, but not in men.
Heart failure. Early research suggests that taking a calcium and vitamin D does not prevent heart failure in most women.
High cholesterol. Taking calcium supplements along with a low-fat or low-calorie diet seems to reduce low-density lipoprotein (LDL) or "bad" cholesterol and increase high-density lipoprotein (HDL) or "good" cholesterol by small amounts. Taking calcium alone, without the restricted diet, does not seem to lower cholesterol.
Vitamin B12 deficiency in people taking the drug metformin. Taking calcium supplements might reduce vitamin B12 deficiency caused by the diabetes drug metformin.
A group of symptoms that indicate kidney damage (nephrotic syndrome). Taking calcium supplements with vitamin D in children with nephrotic syndrome that is sensitive to steroid treatment does not improve bone mineral density or prevent a flare of nephrotic syndrome.
Lead poisoning. Some research suggests that taking calcium reduces blood lead levels by 11%. But not all research agrees.
A grouping of symptoms that increase the risk of diabetes, heart disease, and stroke (metabolic syndrome). Some evidence found that consuming more calcium from the diet and supplements, either alone or in combination with vitamin D, lowers the risk of developing metabolic syndrome.
Nonmelanoma skin cancer. Taking calcium doesn't seem to prevent nonmelanoma skin cancer in patients with colorectal cancer.
Ovarian cancer. The effect of calcium on the risk of developing ovarian cancer is unclear. Early research suggests that high blood levels of calcium or a high intake of calcium from the diet are linked to a reduced risk of ovarian cancer. However, other early research suggests that dietary calcium intake is not linked with the risk of ovarian cancer.
Depression after childbirth (postpartum depression). Early research suggests that taking calcium daily, beginning 11-21 weeks into pregnancy, reduces depression at 12 but not 6 weeks after delivery.
Swelling (inflammation) and sores inside the mouth (oral mucositis). Evidence suggests that using a mouth rinse containing calcium phosphate (Caphosol, EUSA Pharma) in combination with fluoride treatments reduces the duration of pain in people with mouth ulcers due to stem cell transplants.
Leg cramps in women who are pregnant. Early research shows that calcium can help prevent leg cramps in the second half of pregnancy.
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Prostate cancer- Research about how calcium affects the risk of prostate cancer has shown conflicting results. Some research suggests that taking calcium supplements daily decreases the risk of prostate cancer. However, other research suggests that there is not a link between calcium intake and the risk for developing prostate cancer.
Stroke-There is some evidence that increasing calcium intake in the diet might decrease the risk of stroke. Other evidence suggests that increasing calcium intake does not reduce the risk of stroke.
A condition caused by ingestion of too much fluoride (fluorosis)-
- Dizziness (vertigo).
- Lyme disease.
- Other conditions.
- More evidence is needed to rate the effectiveness of calcium for these uses.
Side Effects-
When taken by mouth-
Calcium is LIKELY SAFE for most people when taken by mouth and in recommended amounts (about 1000-1200 mg daily). Calcium can cause some minor side effects such as belching or gas. But calcium is POSSIBLY UNSAFE when taken by mouth in doses above the daily tolerable upper intake level (UL). The UL is 2000 mg for adults ages 19-50 years and 2000 mg for adults over 50 years.
Taking more than this amount of calcium daily can increase the chance of having serious side effects, such as milk-alkali syndrome, a condition that can lead to renal stones, kidney failure, and death. There is also concern that supplemental calcium can increase the risk of heart attack, but not all research agrees.
When given by IV-Calcium is LIKELY SAFE for most people when given intravenously (by IV) and appropriately.
Special Precautions and Warnings-
Pregnancy and breast feeding- Calcium is LIKELY SAFE when taken by mouth in recommended amounts during pregnancy and breast-feeding. There is not enough information available on the safety of using calcium intravenously (by IV) during pregnancy and breastfeeding. Calcium is POSSIBLY UNSAFE when taken during pregnancy by mouth in doses above the daily tolerable upper intake level (UL). The UL is 3000 mg under 18 years of age and 2500 mg for over 18 years of age.
Higher doses might increase the risk of seizures in the infant. Be sure to consider total calcium intake from both dietary and supplemental sources of calcium. This includes over-the-counter antacids. Try not to take more than 1000-1200 mg of calcium from supplements per day unless prescribed by your doctor. Some women may be prescribed calcium to prevent high blood pressure during pregnancy.
Children- Calcium is LIKELY SAFE for most children when taken by mouth in recommended amounts. The recommended amount varies based on age as follows: Age 1-3 years, 700 mg daily; 4-8 years, 1000 mg daily; 9-18 years, 1300 mg daily.
But calcium is POSSIBLY UNSAFE when taken by mouth in higher doses. Taking more than the recommended amount of calcium daily can increase the chance of having serious side effects. Children should be advised to continue consuming adequate amounts of calcium to meet daily requirements, but not excessive amounts of calcium.
Low acid levels in the stomach (achlorhydria)- People with low levels of gastric acid absorb less calcium if calcium is taken on an empty stomach. However, low acid levels in the stomach do not appear to reduce calcium absorption if calcium is taken with food. Advise people with achlorhydria to take calcium supplements with meals.
Too much calcium in the blood (as in parathyroid gland disorders and sarcoidosis)- Calcium should be avoided if you have one of these conditions.
Poor kidney function- Calcium supplementation can increase the risk of having too much calcium in the blood in people with poor kidney function.
Smoking- People who smoke absorb less calcium from the stomach.
Stroke- Early research suggests that older women who have had a stroke, taking calcium supplements for 5 or more years might increase the chance of developing dementia. More research is needed to determine if calcium supplements should be avoided for those who have had a stroke.
Interactions -
Major Interaction-
Do not take this combination
Ceftriaxone (Rocephin) interacts with CALCIUM.
Administering intravenous ceftriaxone and calcium can result in life-threatening damage to the lungs and kidneys. Calcium should not be administered intravenously within 48 hours of intravenous ceftriaxone.
Moderate Interaction-
Be cautious with this combination.
Antibiotics (Quinolone antibiotics) interacts with CALCIUM.
Calcium might decrease how much antibiotic your body absorbs.
Taking calcium along with some antibiotics might decrease the effectiveness of some antibiotics. To avoid this interaction, take calcium supplements at least 1 hour after antibiotics.
Some of these antibiotics that might interact with calcium include ciprofloxacin (Cipro), norfloxacin) (Chibroxin, Noroxin), sparfloxacin (Zagamenoxacin (Penetrex) and trovafloxacin (Trovan).
Antibiotics (Tetracycline antibiotics) interacts with CALCIUM-
Calcium can attach to some antibiotics called tetracyclines in the stomach. This decreases the amount of tetracyclines that can be absorbed.
Taking calcium with tetracyclines might decrease the effectiveness of tetracyclines. To avoid this interaction take calcium 2 hours before or 4 hours after taking tetracyclines.
Some tetracyclines include demeclocycline (Declomycin), minocycline (Minocin), and tetracycline (Achromycin, and others).
Bisphosphonates interacts with CALCIUM-
Calcium can decrease how much bisphosphate your body absorbs.
Taking calcium along with bisphosphates can decrease the effectiveness of bisphosphate. To avoid this interaction, take bisphosphonate at least 30 minutes before calcium or later in the day.
Some bisphosphonates include alendronate (Fosamax), etidronate (Didronel), risedronate (Actonel), tiludronate (Skelid), and others.
Calcipotriene (Dovonex) interacts with CALCIUM-
Calcipotriene (Dovonex) is a drug that is similar to vitamin D. Vitamin D helps your body absorb calcium. Taking calcium supplements along with calcipotriene (Dovonex) might cause the body to have too much calcium.
Digoxin (Lanoxin) interacts with CALCIUM-
Calcium can affect your heart. Digoxin (Lanoxin) is used to help your heart beat stronger. Taking calcium along with digoxin (Lanoxin) might increase the effects of digoxin (Lanoxin) and lead to an irregular heartbeat.
If you are taking digoxin (Lanoxin), talk to your doctor before taking calcium supplements.
Diltiazem (Cardizem, Dilacor, Tiazac) interacts with CALCIUM-
Calcium can affect your heart. Diltiazem (Cardizem, Dilacor, Tiazac) can also affect your heart. Taking large amounts of calcium along with diltiazem (Cardizem, Dilacor, Tiazac) might decrease the effectiveness of diltiazem (Cardizem, Dilacor, Tiazac).
Levothyroxine interacts with CALCIUM-
Levothyroxine is used for low thyroid function. Calcium can decrease how much levothyroxine your body absorbs.
Taking calcium along with levothyroxine might decrease the effectiveness of levothyroxine. Levothyroxine and calcium should be taken at least 4 hours apart.
Some brands that contain levothyroxine include Armour Thyroid, norfloxacin (Chibroxin, Noroxin), sparfloxacin (ZagamEltroxin, Estre, norfloxacin (Chibroxin, Noroxin), sparfloxacin (Zagamand others.
Sotalol (Betapace) interacts with CALCIUM-
Taking calcium with sotalol (Betapace) can decrease how much sotalol (Betapace) your body absorbs. Taking calcium along with sotalol (Betapace) might decrease the effectiveness of sotalol (Betapace). To avoid this interaction, take calcium at least 2 hours before or 4 hours after taking sotalol (Betapace).
Water pills (Thiazide diuretics) interacts with CALCIUM-
Some "water pills" increase the amount of calcium in your body.
Taking large amounts of calcium with some "water pills" might cause there to be too much calcium in the body. This could cause serious side effects, including kidney problems.
Some of these "water pills" include chlorothiazide (Diuril), hydrochlorothiazide (HydroDIURIL, Esidrix), indapamide (Lozol), metolazone (Zaroxolyn), and chlorthalidone (Hygroton)
Verapamil (Calan, Covera, Isoptin, Verelan) interacts with CALCIUM-
Calcium can affect your heart. Verapamil (Calan, Covera, Isoptin, Verelan) can also affect your heart.
Do not take large amounts of calcium if you are taking verapamil (Calan, Covera, Isoptin, Verelan).
LITHIUM interacts with CALCIUM-
Minor Interaction
Be watchful with this combination
Estrogens interacts with CALCIUM-
Estrogen helps your body absorb calcium. Taking estrogen pills along with large amounts of calcium might increase calcium in the body too much.
Estrogen pills include conjugated equine estrogens (Premarin), ethinyl estradiol, estradiol, and others.
Medications for high blood pressure (Calcium channel blockers) interacts with CALCIUM-
Some medications for high blood pressure affect calcium in your body. These medications are called calcium channel blockers. Getting calcium injections might decrease the effectiveness of these medications for high blood pressure.
Some medications for high blood pressure include nifedipine (Adalat, Procardia), verapamil (Calan, Isoptin, Verelan), diltiazem (Cardizem), isradipine (DynaCirc), felodipine (Plendil), amlodipine (Norvasc), and others.
Dosing-
The following doses have been studied in scientific research-
BY MOUTH-
For preventing low levels of calcium in the blood (hypocalcemia)- 1-2 grams elemental calcium daily is typically used. Sometimes it is taken with 800 IU of vitamin D.
For indigestion (dyspepsia)- 0.5-1.5 grams of calcium carbonate is used as needed.
To reduce phosphates in adults with kidney failure- 1-6.5 grams per day of calcium carbonate or calcium acetate has been used. The daily dose is divided up and taken between meals.
For preventing bone loss in people taking drugs called corticosteroids- Divided daily doses of 0.5-1 gram of elemental calcium daily.
For reducing parathyroid hormone levels in people with an overactive parathyroid (hyperparathyroidism)- 1.2-4 grams of calcium, usually as a carbonate salt. Often it is used in combination with a low-phosphate diet or 800 IU of vitamin D.
For weak and brittle bones (osteoporosis)- Most experts recommend taking 1000-1200 mg of calcium daily to prevent osteoporosis and broken bones.
For increasing bone strength in the unborn baby- 300-2000 mg/day, taken during the second and third trimesters.
For premenstrual syndrome (PMS)- 1-1.3 grams per day as calcium carbonate.
For preventing colon cancer, rectal cancer- Up to 2 grams daily.
For preventing a pregnancy complication marked by high blood pressure and protein in the urine (pre-eclampsia)- 1-2 grams elemental calcium daily as calcium carbonate.
For high blood pressure- Up to 0.4-2 grams daily for up to 4 years
For preventing tooth loss (tooth retention)- 500 mg of calcium along with 700 IU of vitamin D daily for 3 years.
INTRAVENOUS (BY IV)-
For low levels of calcium in the blood (hypocalcemia)- 100-200 mg of calcium is given as a bolus dose
For high levels of potassium in the blood (hyperkalemia)- 20 mL of 10% calcium gluconate is administered over 5-10 minutes in most adults. In adults taking digoxin, the dose is administered over 20-30 minutes.
CHILDREN-
BY MOUTH
For high blood pressure- 1.5 grams per day for 8 weeks has been used in adolescents.
INTRAVENOUS-
For levels of potassium in the blood (hyperkalemia)- 0.5 mL of 10% calcium gluconate is administered over 5-10 minutes.
Calcium carbonate and calcium citrate are the two most commonly used forms of calcium.
Calcium supplements are usually divided into two doses daily in order to increase absorption. It's best to take calcium with food in doses of 500 mg or less.
The Institute of Medicine publishes a recommended daily allowance (RDA) for calcium which is an estimate of the intake level necessary to meet the requirements of nearly all healthy individuals in the population.
The current RDA was set in 2010. The RDA varies based on age as follows- Age 1-3 years, 700 mg; 4-8 years, 1000 mg; 9-18 years, 1300 mg; 19-50 years, 1000 mg; Men 51-70 years, 1000 mg; Women 51-70 years, 1200 mg; 70+ years, 1200 mg; Pregnant or Lactating (under 19 years), 1300 mg; Pregnant or Lactating (19-50 years), 1000 mg.
The Institute of Medicine also sets the daily tolerable upper intake level (UL) for calcium based on age as follows- Age 0-6 months, 1000 mg; 6-12 months, 1500 mg; 1-3 years, 2500 mg; 9-18 years, 3000 mg; 19-50 years, 2500 mg; 51+ years, 2000 mg. Doses above these levels should be avoided.
Doses over the recommended daily intake level of 1000-1300 mg/day for most adults have been associated with an increased risk of heart attack. Until more is known, continue consuming adequate amounts of calcium to meet daily requirements, but not excessive amounts of calcium. Be sure to consider total calcium intake from both dietary and supplemental sources and try not to exceed 1000-1300 mg of calcium per day. To figure out dietary calcium, count 300 mg/day from non-dairy foods plus 300 mg/cup of milk or fortified orange juice.
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