Tonacal D3 Uses
this antacid is useful for the temporary relief of occasional indigestion and heartburn. Frequent, daily or nightly symptoms usually mean a more serious problem. Antacids by themselves do not correct these problems. The medications that are now available to treat acid problems are generally superior to antacids.
The second and more important use of Calcium Carbonate (Tonacal D3) is as a source of calcium, necessary for bones and teeth and to prevent osteoporosis. A quart of milk contains about 1500 mg of calcium which is about what you need. Otherwise this or a similar calcium preparation can be taken.
This combination medication is used to prevent or treat low blood calcium levels in people who do not get enough calcium from their diets. It may be used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased activity of the parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). It may also be used in certain patients to make sure they are getting enough calcium (e.g., women who are pregnant, nursing, or postmenopausal, people taking certain medications such as phenytoin, phenobarbital, or prednisone).
Calcium plays a very important role in the body. It is necessary for normal functioning of nerves, cells, muscle, and bone. If there is not enough calcium in the blood, then the body will take calcium from bones, thereby weakening bones. Vitamin D helps your body absorb calcium and phosphorus. Having the right amounts of vitamin D, calcium, and phosphorus is important for building and keeping strong bones.
Take this medication by mouth with food. If your product contains calcium citrate, then it may be taken with or without food. Follow all directions on the product package, or take as directed by your doctor. For best absorption, if your total daily dose is more than 600 milligrams, then divide your dose and space it throughout the day. If you are uncertain about any of the information, consult your doctor or pharmacist.
If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.
If you are taking the chewable form of this medication, chew thoroughly before swallowing. If you are taking capsules, swallow each capsule whole.
Do not crush or chew extended-release tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Also, do not split the 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.
Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.
If your doctor has recommended that you follow a special diet, it is very important to follow the diet to get the most benefit from this medication and to prevent serious side effects. Do not take other supplements/vitamins unless ordered by your doctor.
Calcium supplements come in different forms that contain different amounts of calcium/vitamin D. Ask your doctor or pharmacist to help select the best product for you.
If you think you may have a serious medical problem, seek immediate medical attention.
Each chewable tablet contains Calcium Carbonate (Tonacal D3) 1500 mg (equivalent to elemental calcium 600 mg) and cholecalciferol concentrate 4 mg (equivalent to vitamin D3 400 IU).
Adult and the Elderly:
Elderly:1 tab twice daily [eg, 1 tab in the morning and in the evening (equivalent to calcium 1200 mg & vitamin D3 800 IU)]. Reduction of intake should be considered necessary following the monitoring of calcium levels.
Pregnant Women: 1 tab daily. No dose adjustment is required in cases of hepatic insufficiency.
The tablets are chewed and then swallowed with some liquid. In exceptional cases (eg, disabled patients), the tablets can, after consulting a doctor, be sucked.
Tonacal D3 should be taken by adults only.
Thiazide diuretics reduce calcium excretion in the urine. Because of the increased risk of hypercalcaemia, calcium monitoring is recommended in cases when thiazide diuretics are given simultaneously.
Systemic corticosteroids reduce calcium absorption. In the case of concomitant administration of corticosteroids, it might be necessary to increase the dose of Tonacal D3.
Orlistat, combined ion-exchange resin treatment eg, cholestyramine or laxatives eg, paraffin oil can reduce the gastrointestinal absorption of vitamin D3. An interval of at least 2 hrs should be observed between ingestion of ion-exchange resins (eg, cholestyramine) or laxatives and Tonacal D3 as otherwise the absorption of vitamin D3 is reduced.
Calcium Carbonate (Tonacal D3) can alter tetracycline absorption when given simultaneously. It is recommended that taking tetracycline be staggered by at least 2 hrs before or 4-6 hrs after taking calcium by mouth.
Hypercalcaemia can increase the toxicity of cardiac glycosides in the case of simultaneous administration with calcium and vitamin D. Consequently patients must be monitored regularly (ECG check and calcaemia).
Rifampicin, phenytoin or barbiturates may reduce the activity of vitamin D3, since they increase the rate of its metabolism.
Calcium salts may decrease the absorption of iron, zinc or strontium. Consequently, the iron, zinc or strontium preparation should be taken at a distance of 2 hrs from the calcium preparation.
Calcium salts may reduce the absorption of the estramustin or thyroid hormones. It is recommended that taking Tonacal D3 be spaced at least 2 hrs from these medicines.
In the case of concomitant bisphosphonate, sodium fluoride or fluoroquinolone administration, it is recommended that taking Tonacal D3 be spaced by at least 3 hrs, as their absorption during digestion may be reduced.
Oxalic acid (found in spinach and rhubarb) and phytic acid (found in wholegrain cereals) can inhibit calcium absorption by forming insoluble compound with calcium ions. Patients must not take calcium containing-products in the 2 hrs after the consumption of foods rich in oxalic acid and phytic acid.
Constipation or stomach upset may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
If your doctor has directed you to use this medication, remember that he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.
Tell your doctor right away if any of these unlikely but serious side effects occur: nausea/vomiting, loss of appetite, unusual weight loss, mental/mood changes, signs of kidney problems (such as change in the amount of urine), bone/muscle pain, headache, increased thirst, increased urination, weakness, tiredness, fast/pounding heartbeat.
A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Hypersensitivity to the Calcium Carbonate (Tonacal D3) or cholecalciferol, or to any of the excipients of Tonacal D3. Renal failure; hypercalciuria and hypercalcaemia and diseases and/or conditions, which lead to hypercalcaemia and/or hypercalciuria (eg, myeloma, bone metastases, primary hyperparathyroidism); kidney stones (nephrolitiasis, nephrocalcinosis); hypervitaminosis D.
Calcium Carbonate/Colecalciferol in Italy.
List of Tonacal D3 substitutes (brand and generic names)
|Sort by popularity|
|Unit description / dosage (Manufacturer)||Price, USD|
|Shelcal (Georgia, India)|
|30's (Elder Pharmaceuticals Pvt Ltd)||$ 0.76|
|15's (Elder Pharmaceuticals Pvt Ltd)||$ 0.76|
|Shelcal 1 Bottle 150 mL (Elder Pharmaceuticals Pvt Ltd)|
|Shelcal 625 mg+125 iu Tablet (Elder Pharmaceuticals Pvt Ltd)||$ 0.03|
|Shelcal 200 ml Syrup (Elder Pharmaceuticals Pvt Ltd)||$ 0.02|
|Shelcal 250 mg+125 iu Tablet (Elder Pharmaceuticals Pvt Ltd)||$ 0.03|
|Shelcal 150 ml Suspension (Elder Pharmaceuticals Pvt Ltd)||$ 0.02|
|Shelcal 1250 mg+250 iu Tablet (Elder Pharmaceuticals Pvt Ltd)||$ 0.06|
|Shelcal 500 mg+250 iu Tablet (Elder Pharmaceuticals Pvt Ltd)||$ 0.06|
|Steovit D3 500mg/200UI (Luxembourg)|
|Steovit D3 500mg/400UI (Luxembourg)|
|Steovit Forte (Belgium)|
|Steovit Forte 1000mg/800UI (Luxembourg)|
|Steovit Forte 1000mg/880UI (Luxembourg)|
|Structocal Vitamine D3 (France)|
|Super Calcio+Vit. D (Peru)|
|Tacal D3 (Netherlands)|
|theiCal-D3 (United Kingdom)|
|Thompson's Liquid Calcium (New Zealand)|
|Tablet; Oral; Calcium / Calcium Carbonate; Calcium Gluconate; Calcium Phosphate Tribasic; Vitamin D3 (Svizera (ACE))|
|Trical-D Ca Carbonate 500mg, Vit D3250iu TAB / 15 (Svizera (ACE))||$ 0.72|
|Trical-D Ca Carbonate 250mg, Vit D3125iu TAB / 30 (Svizera (ACE))||$ 0.72|
|TRICAL-D tab 30's (Svizera (ACE))||$ 0.72|
|TRICAL-D tab 15's (Svizera (ACE))||$ 0.72|
|Varcal Forte (India)|
|VARCAL FORTE tab 10's (Zota)||$ 0.40|
|Veriscal D (Spain)|
|Vicalvit D (Poland)|
|Vit-Dcal Calcium carbonate 1250 mg, cholecalciferol 200 IU. TAB / 15 (Fenestra)||$ 1.64|
|VIT-DCAL tab 15's (Fenestra)||$ 1.81|
|Vita Calcea (Belgium)|
|Vitrum Calcium + Vitamin D3 (Georgia)|
|Tablet, Film-Coated; Oral; Calcium Carbonate / Oyster Shells 1.25 g; Vitamin D3 / Cholecalciferol 200 IU|
|Vitrum Calcium + Vitamin D3 - 60 Tablets||$ 19.80|
|Zivical D (Colombia)|
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Information checked by Dr. Sachin Kumar, MD Pharmacology