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- Pharmacology For Calcium + Vitamin D3 + Vit B12
Calcium + Vitamin D3 + Vit B12 Pharmacology
Calcium + Vitamin D3 + Vit B12About Calcium + Vitamin D3 + Vit B12N/AMechanism of Action of Calcium + Vitamin D3 + Vit B12N/APharmacokinets of Calcium + Vitamin D3 + Vit B12N/AOnset of Action for Calcium + Vitamin D3 + Vit B12N/ADuration of Action for Calcium + Vitamin D3 + Vit B12N/AHalf Life of Calcium + Vitamin D3 + Vit B12N/ASide Effects of Calcium + Vitamin D3 + Vit B12N/AContra-indications of Calcium + Vitamin D3 + Vit B12N/ASpecial Precautions while taking Calcium + Vitamin D3 + Vit B12N/APregnancy Related InformationUse with cautionOld Age Related InformationN/ABreast Feeding Related InformationUse with cautionChildren Related InformationN/AIndications for Calcium + Vitamin D3 + Vit B121.Disorders of calcium metabolism
Interactions for Calcium + Vitamin D3 + Vit B12N/ATypical Dosage for Calcium + Vitamin D3 + Vit B12Oral: 1 tablet / day and if needed dose can be increased by 1 tablet every 2 week
Adult 1-2 ml deep IM daily.
Children: 1 ml deep IM daily
Schedule of Calcium + Vitamin D3 + Vit B12N/AStorage Requirements for Calcium + Vitamin D3 + Vit B12N/AEffects of Missed Dosage of Calcium + Vitamin D3 + Vit B12N/AEffects of Overdose of Calcium + Vitamin D3 + Vit B12N/A
CalciumAbout CalciumCalcium is necessary for cardiac function, muscle contraction, nervous activity, coagulation of blood and for maintaining structural integrity of cell membranes.
Plasma concentration of calcium is kept in normal range by three endocrine factors which control metabolism of calcium. These are (a) Parathyroid hormone, (b) Calcitonin, (c) Vitamin D. Calcium in plasma is bound to albumin, is complexed with anions (e.g. phosphate) and as diffusible ionic calcium. The physiological effects are exerted by ionic calcium. The predominant source of calcium is dairy products and the daily intake varies from 200 - 2500 mg. Adequate calcium intake is particularly important during periods of bone growth in childhood and adolescence and during pregnancy and lactation.
Patients with advanced renal insufficiency exhibit phosphate retention and some degree of hyperphosphataemia. The retention of phosphate plays a pivotal role in causing secondary hyperparathyroidism associated with osteodystrophy and soft tissue calcification. Calcium acetate, when taken with meals, combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the faeces.
Deficiency signs and symptoms: Osteoporosis, pathological fractures, brittle nails and hair.Mechanism of Action of CalciumCalcium is essential for maintaining the functional integrity of nervous, muscular, and skeletal system. It controls excitability of nerves and muscles and regulates permeability of cell membrane. It also regulates cell adhesion and maintains integrity of cell membrane. Calcium acts as intracellular messenger for hormones, autacoids, and transmitters. It is required for excitation-contraction coupling in all types of muscle and excitation-secretion coupling in exocrine and endocrine glands. It is essential for release of transmitters from nerve endings and other release reactions. It is also essential for impulse generation in heart and determines level of automaticity and
A-V conduction. Calcium is also required for blood-coagulation.
Pharmacokinets of CalciumAbsorption: Actively absorbed from gastrointestinal tract in an ionized form; and vitamin D in it`s active form is required for calcium absorption, Distribution: Distributed mainly in to skeletal tissue (99%) and 1% is distributed equally between the intracellular and extra cellular fluid. CSF levels are about half of the serum calcium levels, Metabolism: Not significantly metabolized in the body, Excretion: Excreted mainly through faeces and a small amount is excreted through urine.Onset of Action for CalciumN/ADuration of Action for CalciumN/AHalf Life of CalciumN/ASide Effects of Calcium1.Constipation
Contra-indications of Calcium1.Renal calculi
Special Precautions while taking Calcium1.Renal impairment
7.End stage renal failure
10.Prolonged use of therapeutic amounts.
Pregnancy Related InformationUse with cautionOld Age Related InformationUse with cautionBreast Feeding Related InformationMay be usedChildren Related InformationUse with cautionIndications for Calcium1.Hypocalcaemia
2.Calcium and vitamin D deficiency
3.Calcium deficiency during pregnancy and lactation
5.Prevention of osteoporosis in postmenopausal women
6.Chronic renal failure.
Interactions for CalciumN/ATypical Dosage for CalciumOral: 500mg to 2g daily in two to four divided doses.
Adults: 1g daily. Increases to 2g daily if required.
Prevention of osteoporosis: 1 to 1.5g daily.
Children: 45 to 65mg/kg daily.
Neonates: 50 to 150mg/kg and should not exceed 1g.
Schedule of CalciumN/AStorage Requirements for CalciumStore in a well closed container in a cool and dry place. Protect from light.
Effects of Missed Dosage of CalciumTake the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.Effects of Overdose of CalciumRemove calcium from stomach by induced emesis and gastric lavage. Provide symptomatic treatment and supportive measures.
Vitamin D3About Vitamin D3N/AMechanism of Action of Vitamin D3Vitamin D3 is a form of vitamin D. It is also called as Cholecalciferol.7-Dehydrocholesterol is the precursor of vitamin D3 and only forms the vitamin after being exposed to UV radiation.After exposure to the sun, cholecalciferol is sent to the liver to be hydroxylated where it becomes 25-Hydroxyvitamin D3.Next, it is sent to the kidney and once again hydroxylated becoming 1,25-Hydroxyvitamin D3. 1,25-Hydroxyvitmain D3 is the active form of vitamin D3, for this reason vitamin D is often referred to as a prohormone.Vitamin D exerts it`s action by influencing calcium homoeostasis. It increases the intestinal absorption of calcium and phosphate. It binds to the cytoplasmic Vitamin D receptor and translocates to the nucleus and thus increases the synthesis of specific m RNA and regulates protein synthesis. It increases the synthesis of a carrier protein for calcium called "calbindin" or calcium binding protein. Activation of Vitamin D receptor enhances endocytotic capture of calcium and it`s transport across duodenal mucosal cells in a vesicular form. Vitamin D promotes resorption of calcium and phosphate from bone by enhancing recruitment and differentiation of osteoclast precursors in the bone remodeling units. It helps in bone mineralization.Pharmacokinets of Vitamin D3Absorption: Well absorbed orally in the presence of bile salts, Malabsorption and steatorrhoea interfere with it`s absorption.
Distribution: Widely distributed in a protein bound form. It is stored in adipose tissue and liver.
Metabolism: It is hydroxylated in to both active and inactive metabolites and also metabolized in kidney.
Excretion: Metabolites are excreted mainly through bile.
Onset of Action for Vitamin D3N/ADuration of Action for Vitamin D3N/AHalf Life of Vitamin D3N/ASide Effects of Vitamin D31. Hypercalcaemia
9. Calcification of soft tissues (blood vessels, parenchymal organs including heart)
11. Renal stones
12. Growh retardation in children
17. Elevated liver enzymes
Contra-indications of Vitamin D31. Hypercalcaemia
2. Hypervitaminosis D
3. Renal osteodystrophy with hyperphosphatemia
4. Renal impairment
Special Precautions while taking Vitamin D31. Renal diseases
2. Renal stones
3. Cardiac diseases
5. Coronary diseases
Pregnancy Related InformationUse with cautionOld Age Related InformationUse with cautionBreast Feeding Related InformationUse with cautionChildren Related InformationUse with cautionIndications for Vitamin D31. Rickets and Osteomalacia
3. Fanconi`s syndrome
Interactions for Vitamin D3Antacids: Hypermagnesemia may develop in patients on renal dialysis who take magnesium containing antacids.
Digitalis glycosides: May precipitate cardiac arrhythmias due to hypercalcemia.
Verapamil: Atrial fibrillation may occur.
Cholestyramine: Intestinal absorption of Vitamin D may be reduced.
Mineral Oil: Prolonged use of mineral oil may result in reduced absoprtion of Vitamin D.
Phenytoin, Barbiturates: Half life of vitamin D may be reduced.
Thaizide diuretics: Hypoparathyroid patients on Vitamin D may develop hypercalcemia due to thiazide diuretics.
Typical Dosage for Vitamin D3Oral:
Nutritional Rickets and Osteomalacia: 25 to 125mcg daily in normal gastrointestinal absorption. In severe malabsorption; 250mcg to 7.5mg orally or 250mcg I.M.
Vitamin dependent Rickets: 250mcg to 1.5mg daily
Hypoparathyroidism: 625mcg to 5mg daily with calcium supplements
Fanconi`s syndrome: 1.25 to 5mg daily
Osteoporosis: 25 to 250mcg daily or 1.25mg once weekly with calcium and fluoride supplements.
Hypophosphatemia: 250mcg to 1.5mg along with phosphate supplements
Nutritional Rickets and Osteomalacia: 25 to 125mcg daily in normal gastrointestinal absorption. In severe malabsorption; 250mcg to 625mcg orally
Vitamin dependent Rickets: 75 to 125mcg daily.
Fanconi`s syndrome: 625mcg to 1.25mg daily
Hypophosphatemia: 1 to 2mg daily with phosphate supplements. Increase the dose in increments of 250 to 500mcg at intervals of 3 to 4months until desired therapeutic response is obtained.
Schedule of Vitamin D3N/AStorage Requirements for Vitamin D3Store in a well closed container in a cool place. Protect from light and excess heat. Keep out of reach of children.Effects of Missed Dosage of Vitamin D3Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.Effects of Overdose of Vitamin D3Provide supportive and symptomatic treatment. Stops the treatment and starting a low calcium diet. Increases the fluid intake and administer Loop diuretics like furosemide may be given with saline I.V. infusion to increase calcium excretion. Calcitonin may decrease hypercalcaemia.
Vit B12About Vit B12N/AMechanism of Action of Vit B12Vitamin B12 is an essential constituent for growth, cell reproduction, hematopoiesis, and nucleoprotein and myelin synthesis. Vitamin B12 is converted in to coenzyme B12 in the tissues which is essential for conversion of methyl-malonate to succinate and synthesis of methionine from homocystine. It is also associated with fat and carbohydrate metabolism and protein synthesis. Cells characterized by rapid division such as epithelial cells, bone marrow, and myeloid cells appear to have greatest requirement of Cyanocobalamin.Pharmacokinets of Vit B12Absorption: Absorbed irregularly after oral administration and absorption depends on Ca and intrinsic factor. It is also administered subcutaneously and intramuscularly.
Distribution: Distributed in to liver, bone marrow, and other tissues. It crosses the placenta and appears in breast milk.
Metabolism: It is metabolized in liver.
Excretion: In normal dosage it is reabsorbed from bile and a minute portion is excreted through urine but the extra drug is excreted through urine.
Onset of Action for Vit B12N/ADuration of Action for Vit B12N/AHalf Life of Vit B12N/ASide Effects of Vit B121. Anaphylaxis
2. Anaphylactoid reactions
3. Pain and burning sensation at injection site
6. Transient diarrhea
7. Peripheral vascular thrombosis
8. Pulmonary oedema
Contra-indications of Vit B121. Hypersensitivity to the drug
2. Leber`s disease
Special Precautions while taking Vit B121. Anemic patients with coexisting cardiac, pulmonary and hypertensive diseases.Pregnancy Related InformationMay be usedOld Age Related InformationMay be usedBreast Feeding Related InformationMay be usedChildren Related InformationUse with caution
NEONATES : Use with caution
Indications for Vit B121. Vitamin B12 deficiency
2. Pernicious Anaemia
3. Peripheral neuropathy (diabetic, alcoholic, and drug induced)
Interactions for Vit B12N/ATypical Dosage for Vit B12I.M., S.C.:
Pernicious Anaemia: 100mcg daily for 1 week followed by the same dose given on alternate days for 7 doses and then every 3 to 4days for another 3 weeks. This regimen should be followed by 100mcg monthly for life. Concurrently administer folic acid if required.
Vitamin B12 deficiency other than pernicious Anaemia: 30mcg daily for 5 to 10days depending up on the severity of the condition.
Maintenance dosage: 100 to 200mcg once monthly.
Children: 100mcg I.M. or S.C. over the course of 2 or more weeks.
Maintenance dosage: 60mcg monthly I.M. or S.C.
Schilling test flushing dose:
Adults and Children: 1000mcg I.M. in single dose
Recommended RDA (recommended dietary allowance) for Vitamin B12:
Infants up to 6months of age: 0.3mcg.
Children age 6 months to 1 year: 0.5mcg.
Children age 1 to 3: 0.7mcg.
Children age 4 to 6: 1mcg.
Children age 7 to 10: 1.4mcg.
Children age 11 to adult: 2mcg..
Pregnant women: 2.2mcg.
Breast feeding women: 2.6mcg.
Schedule of Vit B12CStorage Requirements for Vit B12Store at room temperature range of 15 to 30 degree C.in a light resistant well closed container in a dry place.Effects of Missed Dosage of Vit B12Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.Effects of Overdose of Vit B12Not applicable. Even in large doses Vitamin B12 isn`t usually toxic.
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