When a dose is taken in higher dose than the recommended doses, it is called Overdose. Overdose always needs a clinical supervision. Any medicine or drug when consumed in Overdose produces untoward side effects on one or various organs in the body. A medicine is excreted in the kidney or metabolized in the liver most of the times. This process goes without any hurdles when taken in normal dose, but when taken in an overdose, the body is not able to metabolize it or send it out properly which causes the effects of anoverdose.
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An overdose can lead to hypervitaminosis and hypercalcaemia. The symptoms of hypercalcaemia can include: Anorexia, thirst, nausea, vomiting, constipation, dehydration, abdominal pain, muscle weakness, fatigue, mental disturbances, polydipsia, polyuria, skeletal pain, renal calcinosis, kidney stones and in severe cases cardiac arrhythmia. Extreme hypercalcaemia may lead to coma and death. Continuous high calcium levels may lead to irreversible damage to the kidneys and soft tissue calcification.
Treatment: All calcium and vitamin D3 treatments must be stopped. Treatment with thiazide diuretics, lithium, vitamin A and cardiac glycosides must also be stopped. Gastric lavage should be performed on patients with problems affecting consciousness. Rehydrate and depending on severity, isolated or combined treatment with loop diuretics, bisphosphonates, calcitonin and corticosteroids should be considered. Serum electrolytes, kidney function and diuresis must be monitored. In severe cases ECG and calcaemia should be monitored.
The threshold for vitamin D intoxication is between 40,000 and 100,000 IU/day for 1-2 months in persons with normal parathyroid function, for calcium in excess of 2000 mg/day.
Sandoz Ca D warnings
Warnings are a mix of Precautions. Contraindications and interactions and serious harmful effects associated with the medicine intake. A diabetic or Hypertensive patient need to be warned about few drug interactions. A known hypersensitivity patient needs to be careful about the reactions or anaphylactic shock. A pregnant woman or a breastfeeding woman should be warned of certain medications. A Hepatitis [liver disease] patient or a cardiac patient should avoid few drugs.
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Tell your doctor if you are
allergic to any other medicines,
foods, dyes or preservatives.
Tell your doctor if you are
pregnant or plan to become
pregnant:
Your doctor will discuss the risks
and benefits of taking this medicine
during pregnancy.
Tell your doctor if you are
breastfeeding or wish to
breastfeed:
this medicine may pass into the breast
milk and cause drowsiness and
feeding difficulties in the baby.
Your doctor will discuss the risks
and benefits of taking this medicine
when breastfeeding.
Tell your doctor if you have any
medical conditions, especially
the following:
• depression, psychosis or
schizophrenia
• glaucoma (high pressure in the
eye)
• epilepsy (fits or convulsions)
• liver, kidney or lung disease
• high or low blood pressure
• previous problems with addiction
to medicine.
Tell your doctor if you drink
alcohol regularly:
Alcohol may increase the effects of
this medicine.
Sandoz Ca D precautions
Certain people who are very sick or very old or who are sensitive show an exacerbation of side effect of the drug which can turn dangerous at times. So, it is very important to remember the precautions while taking the medicine. Pregnancy and Breastfeeding are also special categories wherein extra care or precaution is needed when taking a drug. Few patients may have a hypersensitivity reaction to few medications, and that can be life-threatening rarely. Penicillin hypersensitivity is one example. Diarrhea, rashes are few other symptoms which need a watch. A patient with other co-existing diseases like liver disease, heart disease, kidney disease should take special precautions.
In the event of prolonged treatment, checking calcaemia and renal function by assaying serum creatinine is justified. This monitoring is particularly important in the elderly, in cases of combined treatment with cardiac glycosides and diuretics and in patients who are frequently subject to the formation of kidney stones. In the presence of hypercalcaemia or signs of problems with renal function, the dose must be reduced or treatment interrupted. Therapy should be reduced or preliminary interrupted if urinary calcium level exceeds 7.5 mmol/24 hrs (300 mg/24 hrs).
Sandoz Ca D must be prescribed with caution to patients who are immobilized and suffering from osteoporosis, because of the increase in the risk of hypercalcaemia.
Take into account the intake of vitamin D, calcium and alkali eg, carbonate from all other sources (eg, dietary supplements or food) before prescribing Sandoz Ca D. As this product already contain vitamin D and Calcium Carbonate (Sandoz Ca D), the additional administration of vitamin D or Calcium Carbonate (Sandoz Ca D) may lead to a Burnett Syndrome (hypercalcaemia, metabolic alkalosis, renal failure and soft tissue calcification), and must therefore be carried out under strict medical supervision with regular monitoring of calcaemia and calciuria.
Sandoz Ca D must be used with caution in patients suffering from sarcoidosis because of a possible increase in vitamin D3 metabolism to its active form. In these patients, calcaemia and calciuria must be monitored.
It must be used with caution and phosphate-calcium levels monitored in patients presenting with a decrease in renal function. The risk of soft tissue calcification must be taken into account. In patients with severe renal insufficiency, vitamin D3 in the form of cholecalciferol is not metabolized in the normal way and other forms of vitamin D3 must be used.
Sandoz Ca D contains sucrose; therefore, patients with rare hereditary problems of fructose intolerance, glucosegalactose malabsorption or sucrose-isomaltase insufficiency should not take this medicine.
Note for Diabetics: The proportion of digestible carbohydrate in Sandoz Ca D is 0.47 g per tablet. The daily dose of 2 tablets corresponds to 0.08 carbohydrate units (CU).
Use in pregnancy: Sandoz Ca D may be given during pregnancy in cases of calcium and vitamin D3 deficiency. During pregnancy, the daily dose should not exceed 1500 mg of calcium and 600 IU of vitamin D. Therefore, the daily dose must not exceed 1 tablet. Animal studies have shown toxic effects on reproduction at high doses of vitamin D. In pregnant women, all calcium or vitamin D overdoses must be avoided, as prolonged hypercalcaemia in pregnancy may lead to retardation of physical and mental development, supravalvular aortic stenosis and retinopathy in the child. There are no indications that vitamin D3 at therapeutic doses is teratogenic in man.
Use in lactation: Sandoz Ca D can be used during breastfeeding. Calcium and vitamin D3 pass into maternal milk. This must be taken into consideration when vitamin D3 is given concomitantly to the child.
In pregnant and lactating women, the calcium preparation should be taken at a distance of 2 hrs from a meal due to a possible decrease of iron absorption.
Use in children: Sandoz Ca D is not intended for use in children or adolescents.
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References
DailyMed. "CALCIUM CARBONATE; FAMOTIDINE; MAGNESIUM HYDROXIDE: 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).
DailyMed. "CALCIUM: 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).
