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Calcium glubionate - a Dietary Calcium Supplement

When calcium intake may be insufficient or if requirements are high, calcium-containing OTC (over the counter) medication Calcium Glubionate is used as a dietary supplement to treat calcium deficiency.

Calcium Glubionate Dose in Adults

Calcium Glubionate as Dietary supplement:

Note: Every 5 mL consist of elemental calcium 115 mg

15 mL orally 3 times a day or
15 mL 4 times a day in pregnant and lactating women.

Calcium Glubionate Dose in Childrens

Adequate intake (AI) of calcium

1 - 6 months:
- 200 mg/day of elemental calcium orally.
7 - 12 months:
- 260 mg/day of elemental calcium orally.

Recommended daily allowance (RDA) of calcium:

1 - 3 years:
- 700 mg/day of elemental calcium orally.
4 - 8 years:
- 1,000 mg/day of elemental calcium orally.
9 - 18 years:
- 1,300 mg/day of elemental calcium orally.

Use in the treatment of Calcium dietary supplement:

Note: Every 5 ml consist of 1.8 gms of calcium which is equal to 115 mg of elemental calcium.

Infants:
- Five times a day, 5 mL. It can be taken with juice or infant formula milk.
Less than 4 years childern:
- 10 mL thrice a day
Children 4 years and Adults:
- 15 mL thrice a day.

Use in the treatment of Hypocalcemia:

Infants and Children:
- 45 - 65 mg/kg/day of elemental caclium in 4 divided doses
Dose as calcium glubionate:
- Infants and Children:
  - 600 - 2,000 mg/kg/day in four divided doses up to a maximum of 9 gms/day

Use in the treatment of Rickets:

Infants and Children:
- 30 to 75 mg/kg/day in three divided doses of elemental calcium orally
- Treatment should be initiated from a higher dose and titrated downwards over 2 - 4 weeks.

Pregnancy Risk Factor B

Calcium glubionate during pregnancy:

Calcium crosses the placental boundary
Pregnancy increases calcium absorption from the digestive tract.
Calcium requirements for pregnant and unpregnant women are identical.

Calcium glubionate use during breastfeeding:

Breastmilk contains calcium and it can be used during lactation.

Calcium Glubionate Dose in Renal Disease:

Dose adjustment is based on the patients’ serum calcium levels.
Patients with kidney disease require the concomitant administration of activated vitamin D (alfaclcidol or calcitriol)

Calcium Glubionate Dose in Liver Disease:

No dose adjustement is required in patients with liver disease.

Common Side Effects Of Calcium Glubionate Include:

Endocrine & metabolic:
- Increased thirst
Gastrointestinal:
- Anorexia
- Abdominal pain
- Constipation
- Vomiting
- Nausea
- Xerostomia
Renal:
- Polyuria

Contraindication to Calcium Glubionate Include:

Hypercalcemia is a condition that makes it more likely to occur.
These include primary hyperparathyroidism and multiple myeloma.
Metastatic bone disease, familial hypercalcemia and vitamin D toxicity.

Warnings and Precautions

Gastrointestinal effects:
- Calcium supplements can cause gastrointestinal upset. These include gas, constipation, and bloating.
Achlorhydria:
- Patients suffering from achlorhydria may have reduced calcium absorption. You should take it with food or use an alternate salt.
Calcium-containing Kidney stones:
- Patients with kidney stones should utilise calcium supplements cautiously.
Renal impairment
- People with impaired renal function should have their calcium, phosphorus and renal functions regularly checked.

Calcium glubionate: Drug Interaction

Note: Drug Interaction Categories:

Risk Factor C: Monitor When Using Combination
Risk Factor D: Consider Treatment Modification
Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).
Calcium Channel Blockers	Calcium salts can lessen calcium channel blockers' therapeutic effects.
Cardiac Glycosides	Cardiac Glycosides might have an arrhythmogenic effect that calcium salts can enhance.
DOBUTamine	Dobbutamine may be affected by calcium salts.
Multivitamins/Minerals (with ADEK, Folate, Iron)	It could elevate serum calcium salt levels.
Thiazide and Thiazide - Like Diuretics	Could reduce the excretion of calcium salts. Metabolic alkalosis may result from concurrent, ongoing usage.
Vitamin D Analogs	Calcium salts can make vitamin D analogues more poisonous or have negative consequences.
Risk Factor D (Regard therapy modification)
Alpha-Lipoic acid	The absorption of alpha-lipoic acid can be decreased by calcium salts. Calcium salts may not be absorbed as well when alpha-lipoic acid is present.
Bictegravir	Calcium salts have the potential to lower bictegravir serum levels. Treatment: In fed settings, bictegravir and emtricitabine can be administered with calcium salts. However, it is not advised for fasting to coadminister a calcium sodium salt with or two hours after it.
Bisphosphonate Derivatives	Polyvalent cation-containing items have the potential to reduce the serum concentration of bisphosphonate derivatives. The following oral drugs should not be used within the following time frames: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. There are two exceptions: pamidoate and zoledronic acid.
Deferiprone	The serum concentration of Deferiprone may be decreased by products that contain polyvalent cations. Management: Deferiprone should be administered separately from oral medications and supplements containing polyvalent cations for at least four hours.
Dolutegravir	Dolutegravir serum concentration may be decreased by calcium salts Dolutegravir should be administered at least 2 hours or 6 hours before oral calcium. Dolutegravir/rilpivirine should be administered either four or six hours before or after oral calcium salts. Dolutegravir and oral calcium can both be taken with meals.
Eltrombopag	The serum concentration of Eltrombopag may be decreased by products containing polyvalent cations. Administration: Take eltrombopag 2 hours or more before you take any polyvalent product.
Estramustine	The absorption of estramustine might be decreased by calcium salts.
Multivitamins/Fluoride (with ADE)	The serum concentration may rise after using calcium salts. Fluoride and multivitamin serum concentrations may be lowered by calcium salts (with ADE). Fluoride absorption may be impaired by calcium salts. Management: Avoid dairy products one hour before or two hours after fluoride administration. You should also avoid calcium-salt supplements and vitamins.
PenicillAMINE	Utilizing goods that include polyvalent cations can lower the serum levels of penicillAMINE. Treatment: Give oral polyvalent cation-containing products and penicillamines each at least an hour to work.
Supplements with phosphate	Calcium salts can decrease the absorption rate of phosphate supplements. Management: This only applies to oral phosphate or calcium administration. The interaction may be minimized by administering oral phosphate supplement as well as oral calcium salts as close as possible. Sodium Glycerophosphate pentahydrate is an exception.
Quinolones	Calcium salts can decrease Quinolones' absorption. Both agents can only be administered orally. LevoFLOXacin, Oral Inhalation; Moxifloxacin, Systemic.
Strontium Ranelate	Calcium salts may lower the serum levels of strontium ranelate. Treatment: To prevent any interactions, it is crucial to give strontium ranelate and oral calcium salts at least two hours apart.
Tetracyclines	Tetracycline levels in the serum can be lowered by calcium salts. Management: It is worth thinking about separating the administration of oral calcium and oral tetracyclines by a few hours if they cannot be avoided. Exceptions: Eravacycline. Avoid taking trientine or other oral medications containing polyvalent cations at the same time.
Thyroid Products	Thyroid Products may be affected by calcium salts. Management: Keep the thyroid product and oral calcium supplement separated for at least four hours.
Trientine	The serum concentration of Trientine may be decreased by products that contain polyvalent cations. If required, give oral iron supplements a two-hour gap between each dose. It is necessary to administer oral polyvalent cations separately.
Risk Factor X (Avoid Combination)
BaloxavirMarboxil	BaloxavirMarboxil serum concentration may be decreased by products that contain polyvalent Cation.
Calcium Acetate	Calcium Salts can increase the toxic/adverse effects of Calcium Acetate.

Monitor:

Serum total calcium levels or ionized calcium (preferred)
Serum Phosphate levels
Serum Magnesium
Parathyroid hormone levels, Bone density, and 25 OH vitamin D, (in specific patients)
Renal imaging & CNS imaging for nephrocalcinosis, nephrolithiasis, and basal ganglia calcifications (in specific patients).

How to administer Calcium Glubionate?

Take 1–3 hours after meals and after taking any other drugs with a glass of water or juice.
Iron supplements may be taken 1-2 hours after ingestion of calcium supplements.

Mechanism of action of Calcium Glubionate:

Calcium Glubionate can be used as a dietary addition.
It raises calcium levels and reduces calcium loss from bones.
It is necessary for optimal nerve and muscle performance via regulation of the activity potential.
It is also necessary for normal cardiac function.

It isabsorbedIn very small amounts, unless you take it in large doses with vitamin D.

AbsorptionIt is further affected by achlorhydria and renal osteodystrophy as well as malabsorption.

AbsorptionIt is doubled in pregnancy and increases in acidic environments.

It isdistributedIt is found mainly in the bones and teeth, and 40% bound to albumin. It is excreted in the feces as unabsorbed Calcium.