What is calcium carbonate prescribed for?

From the Guidelines

Calcium carbonate is prescribed primarily as a calcium supplement to prevent or treat calcium deficiency and as an antacid to relieve heartburn, acid indigestion, and upset stomach. As a supplement, it helps maintain bone health and prevent conditions like osteoporosis, especially in people with inadequate dietary calcium intake, including postmenopausal women, older adults, and those with malabsorption disorders. Typical supplemental doses range from 500-1200 mg of elemental calcium daily, often divided into smaller doses for better absorption, as recommended by the New England Journal of Medicine 1. When used as an antacid, calcium carbonate neutralizes stomach acid to provide relief from acid reflux and indigestion, with typical doses of 500-1000 mg as needed.

Key Considerations

• Calcium carbonate should be taken with food for optimal absorption, as gastric acidity is required for sufficient absorption 1.
• Users should be aware that it may cause constipation, gas, or bloating in some individuals, and alternative preparations like calcium citrate may be considered for those with bothersome gastrointestinal symptoms 1.
• The decision to use calcium supplements depends on the adequacy of dietary calcium intake and the balance between the potential benefits and harms of supplements, as discussed in the New England Journal of Medicine 1.
• Calcium-rich foods and beverages, particularly dairy products, are the preferred sources of calcium due to their wide availability and few adverse effects, as noted in the New England Journal of Medicine 1.

Special Populations

• For patients with chronic kidney disease (CKD), the use of calcium-containing phosphate binders should be limited by the maximally acceptable total oral and enteral calcium intake, as recommended by the American Journal of Kidney Diseases 1.
• In children with CKD, calcium intake should be individualized based on their specific needs and the risk of calcium overload, as discussed in the American Journal of Kidney Diseases 1.

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From the Research

Calcium Carbonate Prescriptions

• Calcium carbonate is prescribed for various conditions, including:
  • Bone health in children, young adults, and menopausal women 2
  • Osteoporosis 3
  • Non-ulcer dyspepsia and minor episodes of heartburn (gastro-oesophageal reflux disease) 3
  • Calcium deficiency 4
• It is also used as an antacid to neutralize gastric hydrochloric acid and inhibit the proteolytic enzyme, pepsin 3
• Calcium carbonate can be used as a dietary phosphate binder in patients with chronic renal failure 3

Administration and Absorption

• Calcium carbonate should be taken with a meal to ensure optimal absorption 2, 5
• The maximum dose of elemental calcium that should be taken at a time is 500 mg 2
• Inhibition of gastric acid secretion does not affect calcium absorption after calcium carbonate compound granules, but moderately decreases it after traditional calcium carbonate preparations 4

Potential Adverse Effects

• Potential adverse effects of calcium supplementation include gastrointestinal complaints 2
• Renal calculi in most studies have not been associated with calcium supplementation, but high doses of calcium carbonate can cause hypercalcaemia and renal impairment 2, 6
• Calcium-alkali syndrome is a potential risk of long-term ingestion of calcium carbonate antacids, particularly if taken in high doses or with other medications that exacerbate hypercalcaemia 6