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 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.
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 as otherwise the absorption of vitamin D3 is reduced.
Calcium Carbonate (Tonacal) 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 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 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.
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Information checked by Dr. Sachin Kumar, MD Pharmacology