Novartis Consumer Health
Indications And Clinical Uses: Osteoporosis; conditions requiring supplemental calcium.
Contra-Indications: Hypercalcemia and hypercalciuria (e.g., in hyperparathyroidism, vitamin D overdosage, decalcifying tumors such as plasmocytoma, bone metastases); severe renal disease; and in calcium loss due to immobilization. Gramcal is suitable for patients with sodium or potassium restricted diets. Hypersensitivity to any of the components.
Precautions: In mild hypercalciuria (exceeding 300 mg/ 24 hours) as well as in chronic renal failure, or where there is evidence of stone formation in the urinary tract, adequate checks must be made on urinary calcium excretion. If necessary, the dosage should be reduced or calcium therapy discontinued. In patients prone to formation of calculi in the urinary tract, an increased fluid intake is recommended.
Drug Interactions: Administration of corticosteroids may interfere with calcium absorption.
Calcium compounds should not be taken within 3 hours of oral tetracycline or fluoride administration (possible interference of absorption).
High vitamin D intake should be avoided during calcium therapy, unless especially indicated.
Thiazide diuretics cause calcium retention and this may exacerbate hypercalcemia from CaCO3 (calcium carbonate).
Administration of calcium may reduce the response to verapamil and possibly other calcium channel blockers.
Given in large doses to digitalized patients, calcium may increase the risk of cardiac arrhythmias.
Drug/Food Interactions : Certain dietary substances interfere with the absorption of calcium. These include oxalic acid (found in large quantities in rhubarb and spinach), phytic acid (bran and whole cereals) and phosphorus (milk and other dairy products).
Adverse Reactions: Occasional diarrhea has been reported with high doses of calcium. In other patients, high calcium intake is an occasional cause of constipation.
Symptoms And Treatment Of Overdose: Symptoms and Treatment: Acute overdosage has not been reported. It would be expected to cause gastrointestinal disturbances but not to result in hypercalcemia, except in patients treated with an excessive dose of vitamin D.
Dosage: Usual dose in osteoporosis, 1 or 2 effervescent tablets (dissolved in water) daily, or as prescribed.
Availability And Storage: Each whitish, effervescent tablet contains: calcium lactate gluconate 2 327 mg, calcium carbonate 1 750 mg and provides 1 000 mg (25 mmol) of elemental calcium. Nonmedicinal ingredients: aspartame, citric acid, flavor and polyethylene glycol. Energy: 59.3 kJ (14.17 kcal). Potassium: 0.01 mmol (0.382 mg). Sodium: 0.07 mmol (1.69 mg). Tubes of 20, cartons of 10. Protect from heat and humidity. (Shown in Product Recognition Section)
GRAMCAL® Novartis Consumer Health Calcium Preparation Calcium Therapy