Calcefer
Generic Name
Calcium Carbonate + Ferrous Fumarate + Vitamin D3
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Description
Overview of the medicine
Calcefer is a combination supplement containing Calcium Carbonate, Ferrous Fumarate, and Vitamin D3. It is used to prevent and treat deficiencies of calcium, iron, and vitamin D, especially during pregnancy, lactation, adolescence, and in conditions like osteoporosis and anemia.
Uses & Indications
Dosage
Adults
Usually 1-2 tablets daily, or as directed by a physician.
Elderly
Similar to adult dosage, but caution with renal impairment. Consult physician.
Renal_impairment
Use with caution and monitor serum calcium and iron levels. Dosage adjustment may be necessary under medical supervision due to risk of hypercalcemia or iron accumulation.
How to Take
Take the tablet orally with a full glass of water, preferably with or after meals to minimize gastrointestinal upset and enhance absorption.
Mechanism of Action
Calcium is essential for bone formation and maintenance, muscle contraction, and nerve function. Iron is crucial for hemoglobin synthesis and oxygen transport. Vitamin D3 helps regulate calcium and phosphate homeostasis, promoting intestinal absorption of calcium and its deposition in bones.
Pharmacokinetics
Onset
Nutritional effects are gradual, observed over weeks to months.
Excretion
Calcium is excreted via feces and urine. Iron has minimal excretion, primarily through shedding of cells. Vitamin D metabolites are excreted primarily in bile and feces, with some in urine.
Half life
Calcium and Iron do not have a standard plasma half-life like drugs; they are homeostatically regulated. Vitamin D3 (cholecalciferol) has a half-life of about 24 hours, but its active metabolites have longer half-lives (e.g., calcifediol ~15 days).
Absorption
Calcium absorption varies and is enhanced by Vitamin D. Iron (ferrous fumarate) is absorbed mainly in the duodenum and upper jejunum, influenced by stomach acid and diet. Vitamin D3 is absorbed from the gastrointestinal tract.
Metabolism
Calcium is largely incorporated into bone or excreted. Iron is primarily recycled. Vitamin D3 is hydroxylated in the liver to calcifediol and then in the kidneys to calcitriol, the active form.
Side Effects
Contraindications
- Hypersensitivity to any component
- Hypercalcemia (high calcium levels)
- Hemochromatosis (iron overload disorder)
- Severe renal impairment (unless strictly monitored)
- Active peptic ulcer, regional enteritis, ulcerative colitis
Drug Interactions
Antacids & PPIs
May reduce iron absorption due to altered stomach pH.
Thiazide Diuretics
May increase risk of hypercalcemia.
Phenytoin & Barbiturates
May reduce Vitamin D effectiveness.
Bisphosphonates & Levothyroxine
Calcium can interfere with absorption. Separate administration by several hours.
Tetracyclines & Fluoroquinolones
Calcium and Iron can reduce the absorption of these antibiotics. Administer at least 2 hours before or 4-6 hours after.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture.
Overdose
Symptoms of overdose may include severe gastrointestinal upset, hypercalcemia (nausea, vomiting, confusion, kidney stones), and iron toxicity (abdominal pain, vomiting, diarrhea, lethargy, hypotension, metabolic acidosis, liver damage). Seek immediate medical attention if overdose is suspected. Treatment involves supportive care, gastric lavage, and specific antidotes if necessary.
Pregnancy & Lactation
Calcefer is often indicated during pregnancy and lactation to meet increased nutritional demands for calcium, iron, and vitamin D. However, it should be used under medical supervision to ensure appropriate dosage and avoid potential risks.
Side Effects
Contraindications
- Hypersensitivity to any component
- Hypercalcemia (high calcium levels)
- Hemochromatosis (iron overload disorder)
- Severe renal impairment (unless strictly monitored)
- Active peptic ulcer, regional enteritis, ulcerative colitis
Drug Interactions
Antacids & PPIs
May reduce iron absorption due to altered stomach pH.
Thiazide Diuretics
May increase risk of hypercalcemia.
Phenytoin & Barbiturates
May reduce Vitamin D effectiveness.
Bisphosphonates & Levothyroxine
Calcium can interfere with absorption. Separate administration by several hours.
Tetracyclines & Fluoroquinolones
Calcium and Iron can reduce the absorption of these antibiotics. Administer at least 2 hours before or 4-6 hours after.
Storage
Store in a cool, dry place below 30°C. Protect from light and moisture.
Overdose
Symptoms of overdose may include severe gastrointestinal upset, hypercalcemia (nausea, vomiting, confusion, kidney stones), and iron toxicity (abdominal pain, vomiting, diarrhea, lethargy, hypotension, metabolic acidosis, liver damage). Seek immediate medical attention if overdose is suspected. Treatment involves supportive care, gastric lavage, and specific antidotes if necessary.
Pregnancy & Lactation
Calcefer is often indicated during pregnancy and lactation to meet increased nutritional demands for calcium, iron, and vitamin D. However, it should be used under medical supervision to ensure appropriate dosage and avoid potential risks.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
24-36 months from manufacturing date
Availability
Available in pharmacies and drug stores
Approval Status
Approved (as dietary supplement combination)
Patent Status
Generic/Off-patent
Clinical Trials
Numerous clinical trials support the efficacy of calcium, iron, and vitamin D supplementation for various deficiency states. Specific trials for this exact combination may vary by manufacturer.
Lab Monitoring
- Serum Calcium levels
- Serum Iron, Ferritin, and Transferrin Saturation
- 25-hydroxyvitamin D levels
- Renal function (creatinine, BUN) for patients with kidney impairment
Doctor Notes
- Advise patients on proper administration (with food, separate from interacting drugs).
- Counsel on dietary sources of calcium, iron, and vitamin D.
- Monitor serum calcium, iron, and vitamin D levels periodically, especially in high-risk patients or those on long-term therapy.
Patient Guidelines
- Follow the prescribed dosage and do not exceed the recommended daily intake.
- Take with food to minimize stomach upset.
- Report any unusual or severe side effects to your doctor.
- Store away from children.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Driving Precautions
Calcefer is not known to impair the ability to drive or operate machinery.
Lifestyle Advice
- Maintain a balanced diet rich in calcium, iron, and vitamin D.
- Regular weight-bearing exercise can help strengthen bones.
- Moderate sun exposure can aid natural Vitamin D synthesis.
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