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Calcium D3 – a formula that has conquered the world. Almost everything preparations with calcium contain 3 , or cholecalciferol. No matter how different they are in names and additional components, calcium D3 - the basis of most remedies for bone fragility. Modern medicine cannot imagine treating bone demineralization without these substances.

Why calcium D 3 poses a health risk?

At first sight osteoporosis treatment by using calcium D3 logical. Since bones are rapidly losing this mineral, it is necessary to take more of it. And the problem of poor absorption of calcium without a sufficient amount of cholecalciferol is easily solved by adding this vitamin to the medicine, which forces the body to take in the calcium it takes. It seems like the solution is as simple as shelling pears!

However, such simplicity turns out to be worse than theft - and the patient steals his own. And today, voices are increasingly heard about the dangers of excess calcium in the body. That osteoporosis treatment regimen using formula calcium D 3 is a vicious and ineffective practice. Let us consider the arguments of opponents of the generally accepted therapeutic approach.

Calcium deficiency- not a very common phenomenon, contrary to the advertising statements of the manufacturers. After all, calcium is present in abundance in foods and drinks, including the most common water. This is macro, not trace element!

The amount of calcium in the body must be judged by its content in the bones (using ), as well as in urine and blood (using tests). Unfortunately, most people are in no hurry to get tested, but drink it “for prevention” calcium D3 - it's always easy! Moreover, many do not even suspect that blood calcium level may be normal and even go off scale, despite brittle hair, destruction of teeth and bones.

Worse, without getting into the bone, the additional calcium, invariably absorbed thanks to, saturates the blood more and more. And in the blood its content should not go beyond a very narrow physiological framework (2.10–2.55 mmol/l). Exceeding the permissible threshold leads to the development of life-threatening conditions - hypercalcemia and calcinosis.

Hypercalcemia And calcification

Hypercalcemia – this is an excess of the norm of total calcium in the blood. Its consequences are disorders of the central nervous system (deterioration of mental activity, depression, coma), neuromuscular pathologies, nausea and vomiting, stomach ulcers, pancreatitis, diseases of the heart, blood vessels, kidneys, eyes...

Calcinosis , or calcification, - calcium deposits in the wrong place - in soft tissues and organs due to improper mineral metabolism. Calcification myocardium, blood vessels, lymph nodes, kidneys and lungs, muscles, gastrointestinal mucosa and other organs disrupts their functions and poses a mortal danger.

Both of these conditions can occur in patients with fractures and osteoporosis. Moreover, calcium leaching from bones is the leading cause of an increase in its level in the blood (hypercalcemia). Calcium D3 in loading doses for such patients it is simply poison.

Vitamin D 3 : both its shortage and its excess are dangerous!

Just like calcium, D3 (by nature it is a D3 hormone) – a double-edged sword. And blindly following advertising that calls for constantly replenishing the deficiency of the “sunshine” vitamin can lead to D-vitamin intoxication.

Vitamin D3 poisoning is expressed in thirst, vomiting, dehydration, anorexia, muscle weakness, increased blood pressure, increased and interrupted heart rate, kidney damage, nervous pathologies, hypercalcemia and calcinosis.

If you spend a lot of time in the sun in the summer, you can provide a year's supply of this substance. A menu rich in butter, cheese, milk, eggs and fatty fish also protects against hypovitaminosis D3. So you should be extremely careful with cholecalciferol!

Calcium D 3 : What do the studies say?

A five-year observation by English researchers of 24,000 people aged 35–64 years confirmed the risk of premature death due to heart attack or stroke in connection with taking D3 calcium supplements. Taking 1000 mg or more of calcium per day increases the risk of cardiovascular pathologies by 20%.

Unlike natural calcium, which comes from food and is absorbed little by little, large doses calcium D3 cause sharp jumps in the level of calcium in the blood and its sedimentation inside the vessels and in the myocardium. The consequence of this is atherosclerosis.

U.S. experts The Preventative Services Task Force in 2013 concluded that daily supplementation in healthy adults up to age 65 years calcium D3 for strengthening bone tissue and preventing osteoporosis, it is not effective and may even be harmful. The likelihood of developing kidney stones doubles. An even more pronounced connection between the use of drugs calcium D3 with heart attacks indicate Swedish researchers.

Calcium D 3 at the epicenter of the paradoxes of modern medicine

A truly paradoxical situation has developed around drugs that include a complex calcium D3! Pharmacy windows are full of the following: “Calcium-D3 Nycomed”, “Complivit Calcium-D3”, “Natekal D3”, “Kalcemin”, “Vitrum Calcium”, etc. Doctors are well aware of all the dangers that come with taking them in large doses, but they invariably prescribe medications containing this insidious formula.

Because this is a classic and generally accepted approach to treatment of osteoporosis. Because the orthopedic traumatologist, prescribing lethal doses of calcium and cholecalciferol, is responsible only for the speedy fusion and does not worry about the patient’s blood vessels, heart, stomach or kidneys... Because in continuous medicine there is no individual approach to patients. Because doctors are following the aggressive lobbying of the interests of giant pharmaceutical companies promoting their drugs...

All these are topical problems of our medicine, but the worst thing is that under their pressure the very foundations of physiology are trampled. After all, in most cases the cause of demineralization of bone tissue is by no means lack of calcium, but the impossibility of its absorption by the bones! This means that the solution to the problem is not to poison the body with calcium, but to deliver it to the exact address - to the bone.

Why do bones stop absorbing calcium with age? Because as hormonal activity fades, fewer and fewer young bone cells - osteocytes - are born. And since they are the most important participants in the mineralization of bone tissue, calcium remains unclaimed by the bone. Think about it: will there be any use for extra calcium if the body doesn’t know what to do with what it already has? Have you guessed where the calcium not taken up by the bones will be stored?..

Is it possible to force calcium D 3 work to prevent and treat osteoporosis?

Still, don’t rush to write it off calcium D3 off the books! You just need to make it work for you, that is, help the macroelement get into the demineralized bone, direct it to emergency healing of the fracture. But how to achieve this?

Stimulating osteogenesis (the birth of new osteocytes) is the only correct approach to treatment of osteoporosis. Since the main anabolic hormone for all species is testosterone, osteogenesis can be enhanced by increasing testosterone level in organism.

This raises the question of a safe method. increase testosterone. Introducing it from outside, or , is fraught with the development of dangerous ones, including oncology, and the final suppression of the synthesis of one’s own hormone. This is not a solution - to treat one thing while crippling other systems and organs.

The search for safe ways to stimulate testosterone production led specialists from the Russian pharmaceutical company Parapharm to the idea of ​​using the unique properties of drone homogenate to improve bone formation.

– a source of insect hormones – testosterone, prolactin, progesterone and estradiol. But for a person it's just prohormones, which help him produce his own testosterone more intensively, which in turn stimulates osteogenesis. And young osteocyte cells will be able to attract calcium and begin to mineralize bone tissue.

Osteomed Forte: return of prodigal calcium

Incorporation of drone homogenate into an anti-osteoporotic drug containing (250 mg), vitamin D3 (1.5 mg) and vitamin B6 (0.5 mg), became a revolutionary solution. Drone homogenate this is not just an auxiliary substance, but an important anabolic component that helps calcium get to the right address and not settle in soft tissues. Thanks to him, calcium in the composition Forte gains not only effectiveness, but also safety.

To the benefits of the product Osteomed Forte it is necessary to include a relatively low dosage of calcium. placed emphasis not on its quantity, but on quality: calcium citrate– the most digestible and harmless form of this mineral. Better less, but better, as intended and straight to the target!

Addition vitamin B6 accelerates bone mineralization by improving the absorption and transport of magnesium into cells. And magnesium is a faithful companion and assistant to calcium in the mineralization of bones.

It not only increases mineral tissue in a safe way, but also promotes the closure of cavity formations in the bones, which is a new word in treatment of osteoporosis. Calcium D3 here it works one hundred percent. Osteomed Forte– this is the return of prodigal calcium home! This is smart calcium not into the blood, but into the bone!

USEFUL TO KNOW:

ABOUT CALCIUM

Let's say right away: sources of calcium are not scarce. But here’s the paradox: the body may experience a lack of it. And women feel it more often than men. This is when split ends are sent to the hairdresser to get a boy's haircut. Brittle nails cry out for extensions, not to mention teeth, the chronic restoration of which literally undermines the family budget. But the worst thing that comes from calcium deficiency...

2905 1

The drug Calcium D3 Nycomed has been taking its place in medical practice for quite some time now. It is especially often used for.

Calcium D3 Nycomed is a drug based on two main components - calcium and vitamin D3, which is also called cholecalciferol. In turn, calcium is a vital element for teeth, bones, bone tissue, and even neurotransmission in the central and peripheral nervous system of humans.

In addition, the drug balances the synthesis of parathyrin, a failure in the production of which can result in the appearance of periodic processes of destruction of bone tissue.

Vitamin D3 promotes the formation of active primary metabolites in the liver, which accelerate metabolism in the human body.

The medicine belongs to two groups:

• stabilizer of metabolic processes in bone and cartilage tissue;
• combined vitamins and vitamin-like preparations.

Simply put, it is a medicine that regulates the exchange of ortho and pyrophosphoric acid and Ca in living cells.

Types of the drug and its composition

The drug is manufactured and available in the form of chewable tablets with lemon, orange and mint flavors.

Orange-flavored tablets are produced without a shell, round in shape and white in color. Contains Calcium-D3 Nycomed with orange contains the main substances:

• calcium carbonate – 1250 milligrams;
• vitamin D3 – 5.0 mcg (200 IU);

and minor elements:

• isomaltitol – 62.0 mg;
• glucite – 390 mg;
• orange olive – 0.97 mg;
• di and monoglycerides of carboxylic fatty acids – 0.08 mcg.

The products are produced in boxes of 20, 50, 100 pieces per box.

The mint-flavored product, which is also available on store shelves, is completely similar in composition to orange tablets.

The only difference between them is that instead of orange oil, the drug contains mint flavor essence. Available in high-density polyethylene bottles of 30 and 100 pieces.

Chewable tablets with lemon flavor are somewhat different from other types in their composition, and, more precisely, in the amount of elements they contain. They are called Calcium D3 Nycomed Forte.

Primary substances:

• calcium carbonate – 1250 mg;
• equivalent to regular Ca – 500 mg;
• cholecalciferol – 10.0 mcg (400 IU);
• colecalciferol concentrate – 4.0 mg;

and additional elements:

• Zomaltit – 49.9 mg;
• povidone (enterosorbent) – 36.4 mg;
• magnesium stearate – 6.00 mg;
• L-Aspartyl-L-phenylalanine – 1.00 mg;
• glucite – 390 mg;
• lemon oil – 0.78 mg;
• di- and monoglycerides of carboxylic fatty acids – 0.0006 mg.

The product is released in polyethylene bottles of 30, 60, 120 pieces.

Pharmacological profile

As already indicated above, the main pharmacological effect of the drug is to compensate for the lack of calcium and cholecalciferol, but this is not its only effect on the body.

Therefore, from this we can conclude that it would be entirely appropriate to prescribe a remedy for diseases of the joints and (or) bones. It is due to the increased calcium content that weakened joints and bones will draw the necessary substance to strengthen them.

Since Calcium D3 Nycomed has two separately active ingredients, they can and should also be considered separately.

Impact and effect of calcium

Thanks to the optimal dosage of calcium, when using the drug, the human body receives stable bioavailability of calcium (about 30%), which is absorbed by the sorbent in the small intestine of the human digestive system.

A larger percentage of calcium in the drug is fixed on the bones, and only one percent is distributed into the extracellular space.

As a percentage it looks like 99/1%. Of the total percentage, half of the calcium in the blood is ionized.

About 10% is associated with negatively charged particles (phosphate, citrate, etc.). The rest is in reaction with soluble protein and other proteins.

Vitamin D3

Unlike calcium, vitamin D3 is absorbed better - about 80% of the total dose. The element is absorbed in the small intestine.

In conjunction with globulin, it circulates in the human circulatory system. The transformation of the element occurs in the liver during the process of hydroxylation of 25-OH vitamin D3.

After which, there it turns into a metabolite of vitamin D3, which promotes rapid absorption of the substance (1.25 dihydroxycholecalciferol). The component of the vitamin that is not metabolized is stored in muscle and adipose tissue.

The substance is eliminated through the intestines and kidneys.

Scope of application

Often this complex is prescribed in combination with other drugs for the treatment of:

• of various etiologies;
• joint diseases in various manifestations;
• bone injuries;
• diseases associated with a deficiency of the element Ca or vitamin D3.

By and large, these tablets are prescribed by doctors as auxiliary in the complex treatment of many diseases of the musculoskeletal system.

Restrictions on the use of the drug

Despite its usefulness, there are still a number of organic problems for which the use of the drug is not recommended, or it should be used with the utmost care:

Dosage regimen depending on goals

• adults- one unit of the drug (tablet) 2-3 times a day for treatment of the disease, and one unit 2 times a day for prevention;
• teenagers under twelve years old– one tablet for 24 hours.

For children, in order to restore calcium balance, Calcium-D3 Nycomed is prescribed in the following dosages:

• from three to five years– according to the recommendations of the attending physician;
• from five to twelve years old– one or two tablets per day;
• from twelve years old– one or two tablets, twice a day.

A type of drug with the designation “Forte”

• adults– two tablets / once a day, or one 2-3 times a day;
• teenagers under twelve years of age– one unit of medicine per day.

When restoring Ca balance in children:

• from three to twelve years– one tablet per day and only as prescribed by your local doctor;
• after twelve years– two tablets per day.

During pregnancy and breastfeeding

Most often, at this time, P-H-Cholecalciferol and Ca are needed to restore the reserves of the corresponding vitamins.

The daily intake of Calcium D3 Nycomed during pregnancy should not exceed 1500 mg of calcium and 12.0 mcg of vitamin D3 per day.

During gestation, an overdose of the drug and excess Ca in the blood should not be allowed, as this has an adverse effect on the pregnant child.

During the treatment of joint and bone diseases, before using this drug, it is strictly recommended to consult with a medical specialist who will determine the degree and form of the disease and prescribe the appropriate dosage of the drug.

What are the risks of an overdose?

Exceeding the safe dose begins with 2500 mg of calcium. Overdose is manifested by the following side effects:

• pain in the bones;
• feeling of thirst;
• abdominal pain;
• arrhythmia;
• rapid fatigue;
• headache;
• nausea and vomiting;
• nephrocalcinosis.

With prolonged abuse of these tablets, kidney function is impaired.

special instructions

In addition, special attention when using the product is required for those patients who have impaired liver and kidney function. With this problem, it is necessary to monitor the amount of phosphates and calcium in the blood plasma.

Due to the fact that excess calcium is harmful to the body, when taking the drug it is necessary to pay attention to the amount of the substance obtained from other foods and medications.

Drinking alcohol during the course of taking the drug is prohibited.

Interaction with other drugs

The following points should be taken into account when using Calcium D3 Nycomed and other drugs and elements together:

Doctors' point of view

The opinion of practicing specialists is especially valuable.

Very often, Calcium D3 Nycomed was purchased by people with brittle bones and joint pain. The product is especially often purchased by people with fractures.

And indeed, the drug works, the required amount of calcium and vitamin D3 perfectly mineralizes the bone cover and increases its density.

Kiselskaya A.N., pharmacist in a pharmacy

I have been prescribing this drug to patients with fractures and dislocations for about 10 years. A successful combination of components in tablets allows bones and bone tissue not only to quickly recover, but also to become stronger.

Medzhoev Artashes Artakyan, traumatologist

From patient experience

And here is what patients write in their reviews about Calcium D3 Nycomed.

I was on my left leg, the sensation was not pleasant. The doctor prescribed this drug, and the pain in the bones seemed to disappear, but itching and rash appeared, although the dosage was not exceeded. An unclear drug, I do not recommend it.

Plesnevaya Olga Olegovna

I've been taking these tablets like vitamins for about 5 years now. When I started drinking because of pain in my elbow and knee joints, the pain disappeared and the joints became more mobile. I decided not to stop taking the drug.

Old Nadezhda Andreevna

To the main thing - the pros and cons in brief

So, having studied the reviews of doctors and people who use Calcium D3 Nycomed, we can draw conclusions in which we can emphasize the pronounced disadvantages and advantages of the product.

• effective component composition;
• pleasant taste;
• relieves cramps;
• clear effect on osteoporosis.

• high price;
• chemistry in the composition;
• bad for the liver;
• destroys the kidneys;
• unpleasant side effects.

Purchase and storage

The price of Calcium D3 Nycomed for a package of 20 tablets ranges from 192 rubles, while the cost for 50 tablets is 288 rubles.

And the largest package of 100 tablets can be purchased for 420 rubles. As a rule, Calcium D3 Nycomed Forte is always about 30-40 rubles more expensive.

The drug should be stored in a dry place, out of reach of children, at a temperature of up to 25 degrees Celsius. Dispensed without a doctor's prescription.

If your pocket is empty

Due to the high price of the product, people often look for Russian analogues of Calcium D3 Nycomed, many of which are cheaper, and therefore more accessible to a wide range of buyers:

Calcemin VS Calcium D3 Nycomed

The choice can be made by looking at the composition of both drugs, and from this we can conclude that Calcemin is stronger than its rival.

Calcemin has more than two active elements, including natural minerals copper, zinc, boron and manganese. It is thanks to its composition that the drug is more effective, but its price is an order of magnitude higher, which makes you think.

A drug that regulates the metabolism of calcium and phosphorus

Active ingredients

Calcium carbonate
- colecalciferol (vit. D 3) (colecalciferol)

Release form, composition and packaging

◊ Chewable tablets (orange) white, round, biconvex, with an orange aroma; may have small patches of yellow and jagged edges.

Excipients: sorbitol - 390 mg, orange granulate flavor*** - 63 mg, - 36.4 mg, magnesium stearate - 6 mg, aspartame - 1 mg.

20 pcs. - bottles made of high-density polyethylene with first opening control (1) - cardboard packs.

50 pcs. - bottles made of high-density polyethylene with first opening control (1) - cardboard packs.

◊ Chewable tablets (mint) white, round, biconvex, with a mint aroma; may have small inclusions ranging from white to grayish in color and uneven edges.

Excipients: sorbitol - 390 mg, mint granulate flavor **** - 31.8 mg, povidone - 36.4 mg, magnesium stearate - 6 mg, aspartame - 1 mg.

30 pcs. - bottles made of high-density polyethylene with first opening control (1) - cardboard packs.
60 pcs. - bottles made of high-density polyethylene with first opening control (1) - cardboard packs.
100 pieces. - bottles made of high-density polyethylene with first opening control (1) - cardboard packs.
120 pcs. - bottles made of high-density polyethylene with first opening control (1) - cardboard packs.

◊ Chewable tablets (strawberry-watermelon) white, round, biconvex, with a strawberry-watermelon aroma; may have small inclusions ranging from yellow to grayish in color and uneven edges.

Excipients: sorbitol - 390 mg, strawberry-watermelon granulate flavor ***** - 10.2 mg, povidone - 36.4 mg, magnesium stearate - 6 mg, aspartame - 1 mg.

30 pcs. - bottles made of high-density polyethylene with first opening control (1) - cardboard packs.
60 pcs. - bottles made of high-density polyethylene with first opening control (1) - cardboard packs.
90 pcs. - bottles made of high-density polyethylene with first opening control (1) - cardboard packs.
120 pcs. - bottles made of high-density polyethylene with first opening control (1) - cardboard packs.

* the amount of colecalciferol (Vit. D 3), including 10% excess, is 5.5 mcg, in the form of colecalciferol concentrate.
** colecalciferol concentrate contains, including 10% excess: colecalciferol - 0.0055 mg, alpha-tocopherol - 0.022 mg, modified corn starch - 1.607 mg, sucrose - 0.385 mg, sodium ascorbate - 0.088 mg, medium chain triglycerides - 0.066 mg, silicon dioxide - 0.026 mg.
*** orange flavor granulate contains: isomalt - 62 mg, orange flavor - 0.95 mg, mono- and diglycerides of fatty acids - 0.0008 mg.
****mint flavor granules contain: isomalt - 31 mg, mint flavor - 0.8 mg, mono- and diglycerides of fatty acids - 0.0004 mg.
***** strawberry-watermelon flavor granulate contains: isomalt - 8.25 mg, strawberry-watermelon flavor - 0.276 mg, triacetin - 0.163 mg, esters of diacetyltartaric and fatty acids - 0.0918 mg, medium-chain triglycerides - 0.0918 mg, water - 1.33 mg .

pharmachologic effect

A combined drug that regulates the exchange of calcium and phosphorus in the body (in bones, teeth, nails, hair, muscles).

Reduces resorption (resorption) and increases bone density, replenishing the lack of calcium and D 3 in the body, necessary for the mineralization of teeth.

Calcium is involved in the regulation of nerve conduction, muscle contractions and is a component of the blood coagulation system. Adequate calcium intake is especially important during growth, pregnancy and lactation.

Vitamin D 3 increases calcium absorption in the intestines.

The use of calcium and vitamin D 3 prevents an increase in the production of parathyroid hormone, which is a stimulator of increased bone resorption (leaching of calcium from the bones).

Pharmacokinetics

Calcium

Suction

Typically, the amount of calcium that is absorbed from the gastrointestinal tract is approximately 30% of the dose taken.

Distribution and metabolism

99% of the calcium in the body is concentrated in the rigid structure of bones and teeth. The remaining 1% is found in intra- and extracellular fluids. About 50% of the total calcium content in the blood is in physiologically active ionized form, of which approximately 10% is complexed with citrate, phosphate or other anions, the remaining 40% is associated with proteins, primarily with.

Removal

Calcium is excreted through the intestines, kidneys and sweat glands. Renal excretion depends on glomerular filtration and tubular reabsorption of calcium.

Colecalciferol

Suction

Colecalciferol is easily absorbed from the small intestine (about 80% of the dose taken).

Distribution and metabolism

Colecalciferol and its metabolites circulate in the blood bound to a specific globulin. Colecalciferol is metabolized in the liver by hydroxylation to 25-hydroxycolecalciferol. It is then converted in the kidneys to the active form 1.25-hydroxycolecalciferol. 1.25-hydroxycolecalciferol is a metabolite responsible for increasing calcium absorption. Unchanged colecalciferol is deposited in adipose and muscle tissue.

Removal

Colecalciferol is excreted by the kidneys and intestines.

Indications

- prevention and treatment of calcium and/or vitamin D 3 deficiency;

- addition to specific therapy and prevention of osteoporosis and its complications (bone fractures).

Contraindications

- hypercalcemia;

- hypercalciuria;

- nephrolithiasis;

— hypervitaminosis D;

- severe renal failure;

- active form of tuberculosis;

- hypersensitivity to the components of the drug, soy or peanuts.

The drug in tablet form is not used in children under 3 years of age.

Chewable tablets (orange and mint) contain sorbitol, isomalt and sucrose. Chewable tablets (strawberry-watermelon) contain sorbitol and sucrose. The use of the drug is not recommended for patients with hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase deficiency.

Carefully: pregnancy, lactation, renal failure.

Calcium carbonate with colecalciferol should be administered with caution to patients with sarcoidosis due to the risk of increasing the metabolism of vitamin D 3 to its active form. In these patients, it is necessary to monitor the concentration of calcium in the blood serum and urine.

Dosage

The drug is taken orally. The tablets can be chewed or dissolved and taken with meals.

For prevention and treatment of calcium and/or vitamin D deficiency 3 adults and children over 12 years old 1 tablet is prescribed. 2 times/day, children from 5 to 12 years old- 1-2 tablets/day, children from 3 to 5 years old- dosage in accordance with the doctor’s recommendations. The average duration of treatment is at least 4-6 weeks. The number of repeat courses during the year is determined individually.

As additions to specific therapy and prevention of osteoporosis and its complications (bone fractures) adults- 1 tab. 2-3 times/day. The duration of treatment is determined by the doctor individually.

Patients with impaired liver function no dose adjustment is required.

The drug should not be used when severe renal failure.

Elderly patients the same dose is prescribed as for adults. A possible decrease in CC should be taken into account.

Side effects

The frequency of side effects of the drug is assessed as follows: very often (>1/10); often (>1/100,<1/10); нечасто (>1/1000, <1/100); редко (>1/10 000, <1/1000); очень редко (<1/10 000); частота неизвестна (не может быть подсчитана по имеющимся данным).

Metabolism and nutrition: uncommon - hypercalcemia, hypercalciuria; very rarely - milk-alkali syndrome (Burnett's syndrome), usually observed only in case of overdose.

From the digestive system: rarely - constipation, flatulence, nausea, abdominal pain, diarrhea, dyspepsia.

From the skin and subcutaneous tissue: very rarely - itching, rash, urticaria.

From the immune system: frequency unknown - hypersensitivity reactions such as angioedema or laryngeal edema.

Overdose

Overdose can lead to hypercalcemia and hypervitaminosis D.

Symptoms: manifestations of hypercalcemia - anorexia, thirst, polyuria, muscle weakness, nausea, vomiting, constipation, abdominal pain, increased fatigue, bone pain, mental disorders, polydipsia, nephrocalcinosis, urolithiasis and, in severe cases, arrhythmias. With long-term use of excessive doses (over 2500 mg of calcium) - kidney damage, soft tissue calcification. Milk-alkali syndrome (Burnett's syndrome) can occur in patients who ingest large amounts of calcium and well-absorbed alkaline solutions.

If symptoms of overdose are detected, the patient should stop taking calcium and vitamin D 3, as well as thiazide diuretics and cardiac glycosides, and consult a doctor.

Treatment: gastric lavage, replenishment of fluid loss, use of “loop” diuretics (for example), corticosteroids, calcitonin, bisphosphonates. It is necessary to monitor the content of electrolytes in the blood plasma, renal function and diuresis. In severe cases, measurement of central venous pressure and ECG monitoring are necessary.

Drug interactions

Hypercalcemia can potentiate the toxic effects of cardiac glycosides when used simultaneously with calcium and vitamin D preparations. Monitoring of ECG and serum calcium levels is necessary.

Calcium supplements may reduce absorption from the gastrointestinal tract. Therefore, tetracycline drugs should be taken at least 2 hours before or 4-6 hours after taking Calcium-D 3 Nycomed.

To prevent decreased absorption of bisphosphonate drugs, it is recommended to take them at least 1 hour before taking Calcium-D 3 Nycomed.

GCS reduce the absorption of calcium, so treatment of GCS may require an increase in the dose of Calcium-D 3 Nycomed.

With simultaneous use of thiazide diuretics, the risk of hypercalcemia increases, because they increase tubular reabsorption of calcium. When thiazide diuretics are used concomitantly, serum calcium levels should be regularly monitored.

Calcium reduces the effectiveness of levothyroxine by reducing its absorption. The period of time between doses of levothyroxine and Calcium-D 3 Nycomed should be at least 4 hours.

The absorption of quinolone antibiotics is reduced when used simultaneously with calcium supplements. Therefore, quinolone antibiotics should be taken 2 hours before or 6 hours after taking Calcium-D 3 Nycomed.

Calcium salts may reduce the absorption of iron, zinc and strontium ranelate. Therefore, iron, zinc or strontium ranelate preparations should be taken at least 2 hours before or 2 hours after taking Calcium-D 3 Nycomed.

Treatment with orlistat may potentially interfere with the absorption of fat-soluble vitamins (eg vitamin D3).

special instructions

During long-term therapy, serum calcium and creatinine levels should be monitored. Monitoring is especially important in elderly patients during concomitant treatment with cardiac glycosides and diuretics and in patients with an increased tendency to form kidney stones. In cases of hypercalcemia or signs of renal impairment, reduce the dose or discontinue treatment.

Vitamin D 3 should be taken with caution in patients with renal failure. In this case, it is necessary to monitor the calcium and phosphate levels in the blood serum. The risk of soft tissue calcification must also be considered.

To avoid overdose, additional intake of vitamin D and calcium from other sources must be taken into account.

Calcium and vitamin D 3 should be used with caution in immobilized patients with osteoporosis due to the risk of developing hypercalcemia.

Concomitant use with tetracycline or quinolone antibiotics is usually not recommended or should be used with caution.

Impact on the ability to drive vehicles and machinery

There is no data on the effect of the drug Calcium D 3 Nycomed on the ability to drive vehicles and machinery.

Pregnancy and lactation

Calcium-D 3 Nycomed is used during pregnancy to compensate for the deficiency of calcium and vitamin D 3 in the body. The total daily intake during pregnancy should not exceed 2500 mg of calcium and 4000 IU of vitamin D. Hypercalcemia due to overdose during pregnancy can have an adverse effect on the developing fetus.

The drug is used during lactation. Calcium and vitamin D 3 can pass into breast milk, so it is necessary to consider the intake of calcium and vitamin D from other sources in the mother and baby.

Use in childhood

The dosage form of the tablet is not used in children under 3 years of age.

For impaired renal function

The drug is contraindicated in severe renal failure.

Conditions for dispensing from pharmacies

The drug is available without a prescription.

Storage conditions and periods

The drug should be stored in a tightly closed bottle, in a dry place, out of reach of children, at a temperature not exceeding 25°C. Shelf life - 2.5 years. Do not use after expiration date.

Prescribe 1 tablet of the drug 2 times a day, children 5-12 years old - also 1 tablet of “Calcium-D3 Nycomed” 1-2 times a day. The dosage for 3-5 years is determined by the pediatrician. The duration of treatment for vitamin deficiency is 4-6 weeks. Repeated courses are recommended after consulting a doctor.

When treating osteoporosis, 1 tablet of the drug is prescribed three times a day. To prevent osteoporosis - 1 tablet 2 times a day. The duration of treatment is determined individually, depending on the severity of the condition. Pregnant women are advised to strictly adhere to the dosage prescribed by the doctor, since excess calcium can adversely affect the development of the fetus.

The drug can be taken with meals or on its own. The tablets can be dissolved, chewed or swallowed with water.

Contraindications and precautions

The drug should not be taken if you are hypersensitive to any of its components, including sucrose and fructose. This drug is contraindicated in case of hypervitaminosis of vitamin D, hypercalcemia, urolithiasis accompanied by the presence of calcium stones. The drug is also contraindicated in cases of severe renal failure, sarcoidosis, phenylketonuria, and active tuberculosis. The drug is not prescribed to children under 3 years of age.

When using Calcium-D3 Nycomed simultaneously with cardiac drugs and diuretics, regular monitoring of calcium levels in the blood serum is necessary. Antibiotics must be taken separately from the calcium supplement with an interval of at least 3 hours. Concomitant use with laxatives reduces the absorption of vitamin D.

Foods such as sorrel, spinach, rhubarb and cereals reduce calcium absorption. After using them, it is recommended to take the drug no earlier than 2 hours later.

Side effects

When treating with Calcium-D3 Nycomed, adverse reactions may occur in the form of hypercalcemia, hypercalciuria, flatulence, constipation or diarrhea, stomach pain, as well as skin allergies (urticaria, itching, rash).

In some cases, an overdose of the drug may occur. Its signs are thirst, nausea, anorexia, muscle weakness, bone pain, increased fatigue, urolithiasis, cardiac arrhythmia. If symptoms of overdose appear, you need to stop taking the drug itself, as well as cardiac and diuretic drugs (if they were present), do a gastric lavage, replenish the loss of fluid in the body and consult a doctor.

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Qualitative and quantitative composition

Composition per tablet

Active ingredients: calcium 500 mg in the form of calcium carbonate 1250 mg; cholecalciferol 5.0 mcg (200 IU) as cholecalciferol concentrate (powder) 2.0 mg.

For a complete list of excipients, see the “List of excipients” section.

Description

Round, biconvex, white, uncoated tablets. May have small inclusions and uneven edges. There may be a small amount of powder at the bottom of the bottle.

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Indications for use

Prevention and treatment of vitamin D and calcium deficiency.

Meeting vitamin D and calcium requirements as an adjunct to specific osteoporosis therapy in patients at risk of vitamin D and calcium deficiency.

Directions for use and doses

Dosage regimen

Adults, including elderly patients

Complementary therapy for osteoporosis

1 chewable tablet 2-3 times a day.

Calcium and vitamin deficiencyD

1 chewable tablet 1-3 times a day.

Children from 3 years old

Calcium and vitamin deficiencyD (only)

1 chewable tablet 1-2 times a day.

Special patient groups

Kidney failure

Calcium-D3 Nycomed tablets should not be used in patients with severe renal failure (see section "Contraindications").

Liver failure

No dose adjustment is required.

Mode of application

Orally. The tablet can be chewed or dissolved. The drug is taken regardless of meals.

You should not take an additional dose of the drug if you miss a pill.

Duration of treatment

The duration of taking the drug is determined individually

Contraindications

Hypersensitivity to the active substances or to any of the excipients listed in the “List of excipients” section. - Severe renal failure (glomerular filtration rate< 30 мл/мин/1,73 м 2). - Заболевания и/или состояния, приводящие к гиперкальциемии и/или гиперкальциурии. - Почечнокаменная болезнь (нефролитиаз). - Гипервитаминоз D.

Special instructions and precautions

During long-term treatment, it is necessary to monitor serum calcium levels and monitor renal function by determining serum creatinine. Monitoring is especially important for elderly patients receiving concomitant treatment with cardiac glycosides or diuretics (see section "Interactions with other drugs"), and for patients with a strong tendency to form kidney stones. In case of hypercalcemia or signs of renal impairment, the dose should be reduced or treatment discontinued.

Calcium carbonate tablets with cholecalciferol should be used with caution in patients with hypercalcemia or signs of renal impairment; Calcium and phosphate levels should be monitored. The risk of soft tissue calcification must be taken into account.

When used concomitantly with other sources of vitamin D and/or drugs or nutrients (such as milk) containing calcium, there is a risk of developing hypercalcemia and milk-alkali syndrome with subsequent impairment of renal function. Serum calcium levels and renal function should be monitored in these patients.

Calcium-D3 Nycomed should be used with caution in patients suffering from sarcoidosis due to the risk of increased metabolism of vitamin D3 to its active form. In these patients, serum and urine calcium levels should be regularly monitored.

Calcium-D3 Nycomed should be used with caution in immobilized patients with osteoporosis due to the increased risk of hypercalcemia.

Calcium-D3 Nycomed contains isomalt (E953) and sucrose. Patients suffering from rare hereditary disorders such as fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase deficiency should not take this drug. With long-term use, sucrose can have a negative effect on tooth enamel.

Interaction with other medicinal products and other types of interactions

Thiazide diuretics reduce urinary calcium excretion. Due to the increased risk of hypercalcemia during use of thiazide diuretics, serum calcium levels should be regularly monitored.

Calcium carbonate may interfere with the absorption of concomitantly prescribed tetracycline drugs. For this reason, tetracycline medications should be administered at least two hours before or 4 to 6 hours after oral calcium intake.

The development of hypercalcemia during treatment with calcium and vitamin D may increase the toxicity of cardiac glycosides. In such patients, electrocardiogram (ECG) and serum calcium levels should be monitored.

When concomitantly using a bisphosphonate, the latter should be taken at least an hour before taking Calcium-D3 Nycomed to avoid decreased absorption in the gastrointestinal tract.

The effectiveness of levothyroxine may be reduced with concomitant use of calcium due to decreased absorption of levothyroxine. An interval of at least four hours should be maintained between taking calcium and levothyroxine.

The absorption of quinolone antibiotics may be impaired by concomitant administration of calcium. Quinolone antibiotics should be taken two hours before or six hours after taking calcium.

Calcium salts may reduce the absorption of iron, zinc and strontium ranelate. Therefore, it is recommended to take iron, zinc or strontium ranelate supplements two hours before or two hours after taking Calcium-D3 Nycomed.

Treatment with orlistat may potentially interfere with the absorption of fat-soluble vitamins (eg vitamin D3).

Pregnancy and lactation

Pregnancy

The drug Calcium-D3 Nycomed can be used during pregnancy in case of vitamin D and calcium deficiency. During pregnancy, the daily dose should not exceed 2500 mg of calcium and 4000 IU of vitamin D. Animal studies have shown reproductive toxicity of high doses of vitamin D. Overdose of calcium and vitamin D should be avoided in pregnant women, as persistent hypercalcemia has been associated with adverse effects in developing fetus. There is no data on the teratogenic effect of vitamin D in therapeutic doses in humans.

Lactation

The drug Calcium-D3 Nycomed can be used during breastfeeding. Calcium and vitamin D3 pass into breast milk. This should be taken into account when supplementing vitamin D to a child.

Impact on the ability to drive vehicles and machinery

The effect of the drug Calcium-D3 Nycomed on the ability to drive vehicles and machines has not been identified.

Side effect

Adverse reactions are listed below according to classification by system-organ class and frequency of development. Frequency defined as: uncommon (≥ 1/1000,< 1/100), редко (≥ 1/10000, < 1/1000), очень редко (< 1/10000); частота неизвестна (невозможно оценить на основании имеющихся данных).

Immune system disorders

Frequency unknown: hypersensitivity reactions such as angioedema or laryngeal edema.

Metabolic and nutritional disorders

Infrequently: hypercalcemia and hypercalciuria.

Very rarely: Milk-alkali syndrome (frequent urge to urinate; persistent headache; prolonged loss of appetite; nausea or vomiting; unusual fatigue or weakness; hypercalcemia, alkalosis, and renal failure). As a rule, it is observed only in case of overdose (see section “Overdose”).

Gastrointestinal disorders

Rarely: constipation, dyspepsia, flatulence, nausea, abdominal pain and diarrhea.

Skin and subcutaneous tissue disorders

Very rarely: itching, rash and hives.

Special patient groups

Patients with renal failure: potential risk of developing hyperphosphatemia, nephrolithiasis and nephrocalcinosis (see section "Special instructions and precautions").

Reporting suspected adverse reactions

It is important to report suspected adverse reactions after registration of a medicinal product to ensure continuous monitoring of the benefit-risk relationship of the medicinal product.

If an undesirable reaction occurs, either listed or not mentioned in these instructions for medical use, patients are advised to consult their doctor.

Medical professionals and patients are recommended to report any suspected adverse reactions of the drug to the Republican Unitary Enterprise “Center for Expertise and Testing in Healthcare” (see section “Send information about adverse reactions to the address”).

Overdose

Symptoms

Overdose can lead to hypercalcemia and hypervitaminosis of vitamin D. Symptoms of hypercalcemia may include anorexia, thirst, nausea, vomiting, constipation, abdominal pain, muscle weakness, fatigue, mental disorders, polydipsia, polyuria, bone pain, nephrocalcinosis, kidney stones and , in severe cases, cardiac arrhythmias. Extreme hypercalcemia can lead to coma and death. Persistently high calcium levels can lead to irreversible kidney damage and soft tissue calcification.

Milk-alkali syndrome can occur in patients who ingest large amounts of calcium and absorbable alkaline foods.

Treatment hypercalcemia

Treatment is mainly symptomatic and supportive. Treatment with calcium and vitamin D should be discontinued. It is also necessary to stop treatment with thiazide diuretics and cardiac glycosides (see section “Interaction with other drugs and other types of interactions”). For patients with impaired consciousness, removal of gastric contents is indicated. Rehydration and, depending on the severity, isolated or combined treatment with loop diuretics, bisphosphonates, calcitonin and corticosteroids. Monitoring of serum electrolytes, renal function and diuresis is mandatory. In severe cases, ECG and central venous pressure should be monitored.

Pharmacotherapeutic group

Mineral supplements. Combinations of calcium with vitamin D and/or other agents.

ATX code: A12AX

Pharmacological properties

Pharmacodynamics

Vitamin D3 increases calcium absorption in the intestines.

The administration of calcium and vitamin D3 counteracts the increase in parathyroid hormone (PTH) levels caused by calcium deficiency and leading to increased bone resorption. A clinical study in patients suffering from vitamin D deficiency showed that taking two daily calcium 500 mg/vitamin D 400 IU tablets for 6 months normalized the 25-hydroxylated metabolite of vitamin D3 and reduced the severity of secondary hyperparathyroidism and alkaline phosphatase levels.

Pharmacokinetics

Calcium

Absorption: The amount of calcium that is absorbed through the gastrointestinal tract is approximately 30% of the consumed dose.

Distribution and Metabolism: 99% of calcium in the body is concentrated in the hard structures of bones and teeth. The remaining amount (1%) is present in intra- and extracellular fluid. About 50% of the total calcium contained in the blood is present in the physiologically active ionized form, with approximately 10% forming complexes with citrate, phosphate and other anions; the remaining 40% is associated with proteins, mainly albumin.

Excretion: Calcium is excreted in feces, urine and sweat. Renal excretion depends on glomerular filtration and tubular reabsorption.

Cholecalciferol

Absorption: Vitamin D3 is easily absorbed in the small intestine.

Distribution and metabolism: Cholecalciferol and its metabolites circulate in the blood in association with a specific globulin. Cholecalciferol is converted in the liver by hydroxylation to the active form 25-hydroxycholecalciferol. The latter is then converted in the kidneys to 1,25-dihydroxycholecalciferol, a metabolite responsible for increasing calcium absorption. Unmetabolized vitamin D3 is stored in adipose and muscle tissues.

Excretion: Vitamin D3 is excreted from the body in feces and urine.

List of excipients

Xylitol

Isomalt

Orange flavor

Mono- and diglycerides of fatty acids

Chewable tablets 500 mg/200M.E. with tasteorange.

20, 50 or 100 tablets in a bottle made of high-density polyethylene, sealed with a screw cap, under which there is a ring for tearing off the sealing gasket, ensuring first opening control.

One bottle along with instructions for use is placed in a cardboard box.

Special precautions when disposing of the drug

No special requirements.

Conditions for dispensing from pharmacies

Without a doctor's prescription.