Consists of Elemental calcium, magnesium, vitamin D3, zinc
Elemental calcium indications
nutritional supplement for pregnant and breast-feeding women
Uses of Elemental calcium in details
Acute hypocalcaemia, hyperphosphataemia, hypocalcaemia, in hypocalcaemic tetany, osteoporosis prophylaxis, osteoporosis, cardiopulmonary resuscitation, severe hyperkalaemia.
Elemental calcium side effects
Nausea, Abdominal pain, Cardiac arrest, Constipation, Dry mouth, Fainting, Headache, Decreased phosphate level in blood, Decreased blood pressure, Loss of appetite, Sinus bradycardia, Vomiting
What is Magnesium?
Magnesium is used as a dietary supplement for individuals who are deficient in magnesium. Although a balanced diet usually supplies all the magnesium a person needs, magnesium supplements may be needed by patients who have lost magnesium because of illness or treatment with certain medicines.
Lack of magnesium may lead to irritability, muscle weakness, and irregular heartbeat.
Injectable magnesium is given only by or under the supervision of a health care professional. Some oral magnesium preparations are available only with a prescription. Others are available without a prescription.
Magnesium indications
Magnesium Sulfate Injection, USP is suitable for replacement therapy in Magnesium deficiency, especially in acute hypomagnesemia accompanied by signs of tetany similar to those observed in hypocalcemia. In such cases, the serum Magnesium (Mg++) level is usually below the lower limit of normal (1.5 to 2.5 mEq/liter) and the serum calcium (Ca++) level is normal (4.3 to 5.3 mEq/liter) or elevated.
In total parenteral nutrition (TPN), Magnesium sulfate may be added to the nutrient admixture to correct or prevent hypomagnesemia which can arise during the course of therapy.
Magnesium Sulfate Injection, USP is also indicated for the prevention and control of seizures (convulsions) in pre-eclampsia and eclampsia, respectively.
How should I use Magnesium?
Use magnesium as directed by your doctor. Check the label on the medicine for exact dosing instructions.
- Take magnesium by mouth with food.
- If you miss a dose of magnesium and are using it regularly, take it as soon as possible. If it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use magnesium.
Uses of Magnesium in details
This medication is a mineral supplement used to prevent and treat low amounts of magnesium in the blood. Magnesium is very important for the normal functioning of cells, nerves, muscles, bones, and the heart. Usually, a well-balanced diet provides normal blood levels of magnesium. However, certain situations cause your body to lose magnesium faster than you can replace it from your diet. These situations include treatment with "water pills" (diuretics such as furosemide, hydrochlorothiazide), a poor diet, alcoholism, or other medical conditions (e.g., severe diarrhea/vomiting, stomach/intestinal absorption problems, poorly controlled diabetes).
How to use Magnesium
Take this product by mouth as directed. Follow all directions on the product package. If you are uncertain about any of the information, consult your doctor or pharmacist.
It is best to take magnesium supplements with a meal to reduce stomach upset and diarrhea unless otherwise directed by the product instructions or your doctor.
Take each dose with a full glass (8 ounces or 240 milliliters) of water unless your doctor directs you otherwise. Swallow extended-release capsules and delayed-release/enteric coated tablets or capsules whole. Do not crush or chew extended-release or delayed-release/enteric coated capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split extended-release tablets unless they have a score line and your doctor or pharmacist tells you to do so. Swallow the whole or split tablet without crushing or chewing.
If you are using a liquid product, use a medication measuring device to carefully measure the dose. Do not use a household spoon because you may not get the correct dose. If you are using a suspension, shake the bottle well before each dose.
Take this medication regularly in order to get the most benefit from it. Remember to take it at the same time(s) each day. Dosage is based on your medical condition and response to treatment. Do not increase your dose or take it more often than directed on the product package or by your doctor. Too much magnesium in the blood can cause serious side effects.
Tell your doctor if symptoms of low magnesium blood levels (e.g., muscle cramps, tiredness, irritability, depression) persist or worsen. If you think you may have a serious medical problem, seek immediate medical attention.
Magnesium dosage
Usual Adult Dose for Hypomagnesemia
500 to 1000 mg magnesium gluconate (27 to 54 mg elemental magnesium) orally 3 times a day.
Usual Adult Dose for Dietary Supplement
500 to 1000 mg magnesium gluconate (27 to 54 mg elemental magnesium) orally once a day.
Usual Pediatric Dose for Hypomagnesemia
10 to 20 mg/kg of elemental magnesium per dose orally 4 times a day. Use magnesium gluconate oral liquid preparations for more accurate measurement of dose.
Renal Dose Adjustments
Do not use without physician supervision in patients with renal impairment due to increased risk of hypermagnesemia. The use of magnesium salts are generally contraindicated in patients with severe renal dysfunction.
Liver Dose Adjustments
Data not available
Dose Adjustments
May increase by 500 to 1,000 mg/day (27 to 54 mg elemental magnesium) in order to achieve a normal serum magnesium level. Daily doses > 1,000 mg (54 mg elemental magnesium) should be given in 2 to 3 divided doses.
Precautions
Because magnesium is primarily eliminated by the kidney, there is significant risk of hypermagnesemia in patients with renal dysfunction.
Dialysis
Data not available; however, use of magnesium salts is generally contraindicated in renal failure.
Other Comments
Magnesium supplements are often used with "low normal" serum magnesium levels in patients predisposed to hypomagnesemia (e.g., patients on diuretics).
Magnesium interactions
See also:
What other drugs will affect Magnesium?
Alfacalcidol: May increase the serum concentration of Magnesium Salts. Consider therapy modification
Alpha-Lipoic Acid: Magnesium Salts may decrease the absorption of Alpha-Lipoic Acid. Alpha-Lipoic Acid may decrease the absorption of Magnesium Salts. Consider therapy modification
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Avoid combination
Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Consider therapy modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Consider therapy modification
Calcitriol (Systemic): May increase the serum concentration of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving calcitriol. If magnesium-containing products must be used with calcitriol, serum magnesium concentrations should be monitored closely. Consider therapy modification
Calcium Channel Blockers: May enhance the adverse/toxic effect of Magnesium Salts. Magnesium Salts may enhance the hypotensive effect of Calcium Channel Blockers. Monitor therapy
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Consider therapy modification
Dolutegravir: Magnesium Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral magnesium salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral magnesium salts. Consider therapy modification
Doxercalciferol: May enhance the hypermagnesemic effect of Magnesium Salts. Management: Consider using a non-magnesium-containing antacid or phosphate-binding product in patients also receiving doxercalciferol. If magnesium-containing products must be used with doxercalciferol, serum magnesium concentrations should be monitored closely. Consider therapy modification
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Consider therapy modification
Elvitegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Elvitegravir. Management: Administer elvitegravir 2 hours before or 6 hours after the administration of polyvalent cation containing products. Consider therapy modification
Gabapentin: Magnesium Salts may enhance the CNS depressant effect of Gabapentin. Specifically, high dose intravenous/epidural magnesium sulfate may enhance the CNS depressant effects of gabapentin. Magnesium Salts may decrease the serum concentration of Gabapentin. Management: Administer gabapentin at least 2 hours after use of a magnesium-containing antacid. Monitor patients closely for evidence of reduced response to gabapentin therapy. Monitor for CNS depression if high dose IV/epidural magnesium sulfate is used. Consider therapy modification
Levothyroxine: Magnesium Salts may decrease the serum concentration of Levothyroxine. Management: Separate administration of oral levothyroxine and oral magnesium salts by at least 4 hours. Consider therapy modification
Multivitamins/Fluoride (with ADE): Magnesium Salts may decrease the serum concentration of Multivitamins/Fluoride (with ADE). Specifically, magnesium salts may decrease fluoride absorption. Management: To avoid this potential interaction separate the administration of magnesium salts from administration of a fluoride-containing product by at least 1 hour. Consider therapy modification
Mycophenolate: Magnesium Salts may decrease the serum concentration of Mycophenolate. Management: Separate doses of mycophenolate and oral magnesium salts. Monitor for reduced effects of mycophenolate if taken concomitant with oral magnesium salts. Consider therapy modification
Neuromuscular-Blocking Agents: Magnesium Salts may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Monitor therapy
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Consider therapy modification
Phosphate Supplements: Magnesium Salts may decrease the serum concentration of Phosphate Supplements. Management: Administer oral phosphate supplements as far apart from the administration of an oral magnesium salt as possible to minimize the significance of this interaction. Exceptions: Sodium Glycerophosphate Pentahydrate. Consider therapy modification
Quinolones: Magnesium Salts may decrease the serum concentration of Quinolones. Management: Administer oral quinolones several hours before (4 h for moxi/pe/spar-, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome/pe-, 3 h for gemi-, and 2 h for levo-, nor-, or ofloxacin or nalidixic acid) oral magnesium salts. Exceptions: LevoFLOXacin (Oral Inhalation). Consider therapy modification
Raltegravir: Magnesium Salts may decrease the serum concentration of Raltegravir. Management: Avoid the use of oral / enteral magnesium salts with raltegravir. No dose separation schedule has been established that adequately reduces the magnitude of interaction. Avoid combination
Tetracyclines: Magnesium Salts may decrease the absorption of Tetracyclines. Only applicable to oral preparations of each agent. Management: Avoid coadministration of oral magnesium salts and oral tetracyclines. If coadministration cannot be avoided, administer oral magnesium at least 2 hours before, or 4 hours after, oral tetracyclines. Monitor for decreased tetracycline therapeutic effects. Exceptions: Eravacycline. Consider therapy modification
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Consider therapy modification
Magnesium side effects
See also:
What are the possible side effects of Magnesium?
The adverse effects of parenterally administered Magnesium usually are the result of Magnesium intoxication. These include flushing, sweating, hypotension, depressed reflexes, flaccid paralysis, hypothermia, circulatory collapse, cardiac and central nervous system depression proceeding to respiratory paralysis. Hypocalcemia with signs of tetany secondary to Magnesium sulfate therapy for eclampsia has been reported.
Magnesium contraindications
See also:
What is the most important information I should know about Magnesium?
Do NOT use Calcium Carbonate/Magnesium Carbonate if:
you are allergic to any ingredient in Calcium Carbonate/Magnesium Carbonate
you have an increased calcium level in your blood
Contact your doctor or health care provider right away if any of these apply to you.
What is Vitamin D3?
Cholecalciferol is a vitamin D3. Vitamin D is important for the absorption of calcium from the stomach and for the functioning of calcium in the body.
Cholecalciferol is used to treat or prevent many conditions caused by a lack of vitamin D, especially conditions of the skin or bones.
Cholecalciferol may also be used for purposes not listed in this medication guide.
Vitamin D3 indications
Vitamin D3 has an important role in energize the intestinal absorption for calcium and phosphor, to regulate their metabolism and balance in blood. It helps bone calcification. Deficiency of vitamin D3 in the body causes deficiency of the calcium in the bone, weakness of its resistance and deformity.
Uses of Vitamin D3 in details
Vitamin D3 is used for the prevention and treatment of vitamin D deficiency. Vitamin D3 is important for absorption of calcium in the body. It is also used to prevent bone disorders such as osteomalacia and rickets.
Vitamin D3 description
Vitamin D3 (Vitamin D2) is a derivative of ergosterol formed by ultraviolet rays breaking of the C9-C10 bond. It differs from cholecalciferol in having a double bond between C22 and C23 and a methyl group at C24.
Vitamin D3 dosage
1 tab daily.
Vitamin D3 interactions
Interactions for vitamin D analogues (Vitamin D2, Vitamin D3, Calcitriol, and Calcidiol)
Cholestyramine
Cholestyramine has been reported to reduce intestinal absorption of fat soluble vitamins; as such it may impair intestinal absorption of any of vitamin D
Phenytoin/Phenobarbital
The coadministration of phenytoin or phenobarbital will not affect plasma concentrations of vitamin D, but may reduce endogenous plasma levels of calcitriol/ergocalcitriol by accelerating metabolism. Since blood level of calcitriol/ergocalcitriol will be reduced, higher doses of Rocaltrol may be necessary if these drugs are administered simultaneously
Thiazides
Thiazides are known to induce hypercalcemia by the reduction of calcium excretion in urine. Some reports have shown that the concomitant administration of thiazides with vitamin D causes hypercalcemia. Therefore, precaution should be taken when coadministration is necessary
Digitalis
Vitamin D dosage must be determined with care in patients undergoing treatment with digitalis, as hypercalcemia in such patients may precipitate cardiac arrhythmias
Ketoconazole
Ketoconazole may inhibit both synthetic and catabolic enzymes of vitamin D. Reductions in serum endogenous vitamin D concentrations have been observed following the administration of 300 mg/day to 1200 mg/day ketoconazole for a week to healthy men. However, in vivo drug interaction studies of ketoconazole with vitamin D have not been investigated
Corticosteroids
A relationship of functional antagonism exists between vitamin D analogues, which promote calcium absorption, and corticosteroids, which inhibit calcium absorption
Phosphate-Binding Agents
Since vitamin D also has an effect on phosphate transport in the intestine, kidneys and bones, the dosage of phosphate-binding agents must be adjusted in accordance with the serum phosphate concentration
Vitamin D
The coadministration of any of the vitamin D analogues should be avoided as this could create possible additive effects and hypercalcemia
Calcium Supplements
Uncontrolled intake of additional calcium-containing preparations should be avoided
Vitamin D3
Vitamin D3-containing preparations (eg, antacids) may cause hypermagnesemia and should therefore not be taken during therapy with vitamin D by patients on chronic renal dialysis.
Vitamin D3 side effects
Applies to cholecalciferol: oral capsule, oral capsule liquid filled, oral solution, oral tablet, oral tablet chewable, oral wafer
As well as its needed effects, cholecalciferol (the active ingredient contained in Vitamin D3) may cause unwanted side effects that require medical attention.
Major Side Effects
If any of the following side effects occur while taking cholecalciferol, check with your doctor immediately:
Incidence not known:
- Cough
- difficulty swallowing
- dizziness
- fast heartbeat
- hives or itching
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- skin rash
- tightness in the chest
- unusual tiredness or weakness
Vitamin D3 contraindications
Contraindications for vitamin D analogues (Vitamin D2, Vitamin D3, Calcitriol, and Calcidiol)
Vitamin D should not be given to patients with hypercalcemia or evidence of vitamin D toxicity. Use of vitamin D in patients with known hypersensitivity to vitamin D (or drugs of the same class) or any of the inactive ingredients is contraindicated.
What is Zinc?
Zinc is a naturally occurring mineral. Zinc is important for growth and for the development and health of body tissues.
Zinc sulfate is used to treat and to prevent zinc deficiency.
Zinc sulfate may also be used for purposes not listed in this medication guide.
Zinc indications
Patients with deficiency of B-complex vitamins, vitamin C and zinc or where supplementation of these vitamins and zinc can be beneficial. Such patients and conditions include: Patients who are on prolonged antibiotic therapy; those who are suffering from infection, injuries, burns, fever, illness; patients with diarrhoea and GI disorders; patients who have undergone surgical operations; patients on diet restrictions eg, in diabetes, anorexia and alcoholism and in elderly persons; pregnant and lactating women due to increased nutritional needs.
Zinc description
Zinc Capsule: Each capsule contains zinc sulphate monohydrate 54.93 mg, thiamine nitrate 10 mg, riboflavin 10 mg, pyridoxine hydrochloride 3 mg, vitamin B12 (coated) equivalent to cyanocobalamin 15 mcg, ascorbic acid 150 mg, folic acid 1 mg, nicotinamide 50 mg and calcium pantothenate 12.5 mg.
Zinc Syrup: Each 5 mL contains zinc gluconate 34.9 mg, thiamine mononitrate 2.5 mg, riboflavin 2.5 mg, pyridoxine hydrochloride 1 mg, cyanocobalamin 3 mcg, ascorbic acid 50 mg, d-panthenol 12.5 mg and niacinamide 25 mg in a flavoured liquid glucose sorbitol syrup base.
Zinc dosage
Zinc 1 mg/mL (Zinc Chloride Injection, USP) contains 1 mg zinc/mL and is administered intravenously only after dilution. The additive should be diluted prior to administration in a volume of fluid not less than 100 mL. For the metabolically stable adult receiving TPN, the suggested intravenous dosage is 2.5 to 4 mg zinc/day (2.5 to 4 mL/day). An additional 2 mg zinc/day (2 mL/day) is suggested for acute catabolic states. For the stable adult with fluid loss from the small bowel, an additional 12.2 mg zinc/liter of small bowel fluid lost (12.2 mL/liter of small bowel fluid lost), or an additional 17.1 mg zinc/kg of stool or ileostomy output (17.1 mL/kg of stool or ileostomy output) is recommended. Frequent monitoring of zinc blood levels is suggested for patients receiving more than the usual maintenance dosage level of zinc.
For full term infants and children up to 5 years of age, 100 mcg zinc/kg/day
(0.1 mL/kg/day) is recommended. For premature infants (birth weight less than 1500 g) up to 3 kg in body weight, 300 mcg zinc/kg/day (0.3 mL/kg/day) is suggested.
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. See PRECAUTIONS.
How supplied
Zinc 1 mg/mL (Zinc Chloride Injection, USP) is supplied in 10 mL Plastic Vials (List No. 4090).
Store at 20 to 25°C (68 to 77°F).
HOSPIRA, INC., LAKE FOREST, IL 60045 USA. Revised: October, 2004
Zinc interactions
Pyridoxine reduces the effects of levodopa (but this does not occur if a dopa decarboxylase is also given); decreases serum concentrations of phenobarbitone. Concurrent administration of drugs eg, isoniazid, penicillamine and oral contraceptives increase the requirement for pyridoxine.
Absorption of cyanocobalamin from the GIT may be reduced by neomycin, aminosalicylic acid, histamine H2-receptor antagonists and colchicine. Serum concentrations may be decreased by concurrent administration of oral contraceptives. Many of these interactions are unlikely to be of clinical significance but should be taken into account when performing assays for blood concentrations.
Parenteral chloramphenicol may attenuate the effect of vitamin B12 in anaemia.
Folate deficiency states may be produced by a number of drugs including antiepileptics, oral contraceptives, antituberculous drugs, alcohol and folic acid antagonists eg, aminopterin, methotrexate, pyrimethamine, trimethoprim and sulphonamides; folic acid may decrease serum-phenytoin concentrations.
There may be an increased risk of myopathy or rhabdomyolysis when nicotinic acid is used concurrently with statins. Nicotinamide may increase the requirements for insulin or oral hypoglycaemics.
Ascorbic acid may increase the absorption of iron-deficiency states.
Ascorbic acid is often given in addition to desferrioxamine to patients with iron overload (thalassemia) to achieve better iron excretion. However, early on in treatment when there is excess tissue iron, there is some evidence that ascorbic acid may worsen the iron toxicity, particularly to the heart. Thus, ascorbic acid should not be given for the first month after starting desferrioxamine treatment.
The absorption of zinc may be reduced by iron supplements, penicillamine, phosphorus-containing preparations and tetracyclines. Zinc supplements reduce the absorption of copper, ciprofloxacin, iron, norfloxacin, penicillamine and tetracyclines.
Zinc side effects
Applies to zinc sulfate: capsules, tablets
Check with your doctor if any of these most COMMON side effects persist or become bothersome:
Nausea; vomiting.
Seek medical attention right away if any of these SEVERE side effects occur while taking zinc sulfate (the active ingredient contained in Zinc)
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); severe vomiting; unusual restlessness; very dry mouth, eyes, or skin.
Zinc contraindications
Hypersensitivity to any of the ingredients of Zinc.
Active ingredient matches for Elemental calcium/magnesium/vitamin D3/zinc:
Elemental calcium/magnesium/vitamin D3/zinc
References
- DailyMed. "CHOLECALCIFEROL: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
- PubChem. "Vitamin D3". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
- PubChem. "Zinc". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
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Information checked by Dr. Sachin Kumar, MD Pharmacology
