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Calcium

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Are there any interactions with medications?



Ceftriaxone (Rocephin)
Interaction Rating: Major Do not take this combination.

Administering intravenous ceftriaxone (Rocephin) 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 (Rocephin).



Dolutegravir (Tivicay)
Interaction Rating: Major Do not take this combination.

Dolutegravir (Tivicay) is a drug used to treat HIV. Taking calcium along with dolutegravir (Tivicay) can reduce blood levels of dolutegravir (Tivicay). Theoretically, this might decrease the effects of dolutegravir (Tivicay). To avoid this interaction, dolutegravir (Tivicay) should be taken 2 hours before or 6 hours after taking calcium.



Elvitegravir (Vitekta)
Interaction Rating: Major Do not take this combination.

Elvitegravir (Vitekta) is a drug used to treat HIV. Taking calcium along with elvitegravir (Vitekta) can reduce blood levels of elvitegravir (Vitekta). Theoretically, this might decrease the effects of elvitegravir (Vitekta). To avoid this interaction, elvitegravir (Vitekta) should be taken 2 hours before or 2 hours after taking calcium.



Aluminum salts
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Calcium citrate can increase how much aluminum your body absorbs when taken with aluminum hydroxide. This increase in aluminum levels might become toxic in people with kidney disease. However, not all forms of calcium cause this effect. Calcium acetate does not appear to increase aluminum absorption.



Antibiotics (Quinolone antibiotics)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Calcium might decrease how much antibiotic your body absorbs. Taking calcium along with some antibiotics known as "quinolones" might decrease their effectiveness. To avoid this interaction, take these drugs at least 2 hours before, or 4 to 6 hours after calcium supplements.

Some quinolone antibiotics that might interact with calcium include ciprofloxacin (Cipro), levofloxacin (Levaquin), ofloxacin (Floxin), moxifloxacin (Avelox), gatifloxacin (Tequin), gemifloxacin (Factive), and others.



Antibiotics (Tetracycline antibiotics)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

In the stomach, calcium can bind to some antibiotics called tetracyclines. 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 at least 2 hours before or 4 to 6 hours after taking tetracyclines.

Some tetracyclines include demeclocycline (Declomycin), minocycline (Minocin), and tetracycline (Achromycin, and others).



Bisphosphonates
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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, preferably, at a different time of day.

Some bisphosphonates include alendronate (Fosamax), etidronate (Didronel), ibandronate (Boniva), risedronate (Actonel), tiludronate (Skelid), and others.



Calcipotriene (Dovonex)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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, Eltroxin, Estre, Euthyrox, Levo-T, Levothroid, Levoxyl, Synthroid, Unithroid, and others.



Lithium
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Long-term lithium use can increase calcium levels in the blood. Taking lithium with calcium supplements might increase this risk of calcium levels becoming too high.



Raltegravir (Isentress)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

Raltegravir (Isentress) is a drug used to treat HIV. Taking calcium along with raltegravir (Isentress) for several months might reduce blood levels of raltegravir (Isentress) and decrease its effects. Taking a single dose of calcium along with raltegravir (Isentress) does not appear to affect blood levels of raltegravir (Isentress).



Sotalol (Betapace)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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).



Verapamil (Calan, Covera, Isoptin, Verelan)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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).



Water pills (Thiazide diuretics)
Interaction Rating: Moderate Be cautious with this combination.
Talk with your health provider.

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).



Estrogens
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Estrogen helps your body absorb calcium. Taking estrogen pills along with large amounts of calcium might increase calcium in the body too much.



Medications for high blood pressure (Calcium channel blockers)
Interaction Rating: Minor Be cautious with this combination.
Talk with your health provider.

Calcium channel blockers are a type of medicine used for high blood pressure. Calcium may decrease the effects of calcium channel blockers when given by IV. However, there is no evidence that taking calcium supplements or consuming foods containing calcium affects calcium channel blockers.

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 considerations for Calcium.

The following doses have been studied in scientific research:

BY MOUTH:
  • For preventing low calcium levels: 1-2 grams elemental calcium daily is typically used. Sometimes it is taken with 800 IU of vitamin D.
  • For heartburn: 0.5-1.5 grams of calcium carbonate is used as needed.
  • To reduce phosphates in adults with chronic renal 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 weak bones (osteoporosis) caused by corticosteroid use: Divided daily doses of 0.5-1 gram of elemental calcium daily.
  • For reducing parathyroid hormone levels (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 prevention of weak bones (osteoporosis): Most experts recommend taking 1000-1200 mg of calcium daily to prevent osteoporosis and broken bones.
  • For increasing fetal bone density in pregnant women with low dietary calcium intake: 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 colorectal cancer and recurrent colorectal benign tumors (adenomas): Up to 2 grams/day.
  • For high cholesterol: 1200 mg daily, alone or in combination with vitamin D, has been used in conjunction with a low-fat or calorie-restricted diet.
  • For preventing high blood pressure during pregnancy (pre-eclampsia): 1-2 grams elemental calcium daily as calcium carbonate.
  • For preventing colorectal cancer and recurrent colorectal benign tumors (adenomas): Calcium 1200-1600 mg/day.
  • For high cholesterol: 1200 mg daily with or without vitamin D 400 IU daily has been used in conjunction with a low-fat or calorie-restricted diet.
  • For high blood pressure: Up to 0.4-2 grams daily for up to 4 years.
  • For preventing high blood pressure during pregnancy (pre-eclampsia): 1-2 grams elemental calcium daily as calcium carbonate.
  • For preventing tooth loss in elderly people: 500 mg of calcium along with 700 IU of vitamin D daily for 3 years.
  • For weight loss: Calcium 800-1200 mg/day usually in combination with a calorie-restricted diet has been used. In some cases calcium is taken in combination with 400 IU of vitamin D.
INTRAVENOUS (BY IV):
  • For low calcium levels in the blood: 100-200 mg of calcium is given as a bolus dose.
  • For high potassium levels in the blood: 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 preventing fluoride poisoning: Calcium 125 mg twice daily, in combination with ascorbic acid and vitamin D.
  • High blood pressure: 1.5 grams per day for 8 weeks has been used in adolescents.
INTRAVENOUS:
  • For high potassium levels in the blood: 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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