Pharmacopoeias. In China, Europe, International, Japan, US.
European Pharmacopoeia, 6th ed. (Calcium Carbonate). A white or almost white powder. Practically insoluble in water.
The United States Pharmacopeia 31, 2008 (Calcium Carbonate). A fine, white, odourless, microcrystalline powder. Practically insoluble in water its solubility in water is increased by the presence of carbon dioxide or ammonium salts although the presence of any alkali hydroxide reduces its solubility insoluble in alcohol dissolves with effervescence in acetic acid, in hydrochloric acid, and in nitric acid.
Adverse Effects, Treatment, and Precautions
Calcium carbonate may occasionally cause constipation. Flatulence from released carbon dioxide may occur in some patients. High doses or prolonged use may lead to gastric hypersecretion and acid rebound. Like other calcium salts, calcium carbonate can cause hypercalcaemia, particularly in patients with renal impairment or after high doses. Alkalosis may also occur as a result of the carbonate anion. There have been rare reports of the milk-alkali syndrome, see below, and tissue calcification.
For precautions to be observed with the use of calcium carbonate, see Calcium.
Milk-alkali syndrome. The milk-alkali syndrome of hypercalcaemia, alkalosis and renal impairment was first identified in the 1920s and may still occur in patients who ingest large amounts of calcium and absorbable alkali, and in patients being treated for osteoporosis with calcium carbonate plus other drugs that may increase the absorption of calcium. It is not uncommon as a cause of hypercalcaemia requiring hospitalisation. The syndrome has also been reported in a patient taking recommended doses of antacids containing calcium carbonate for chronic epigastric discomfort, and in a pregnant woman taking high, but not grossly excessive, doses of calcium (about 3 g of elemental calcium daily) Metastatic calcification can develop. For reference to thiazide diuretics increasing the risk of the milk-alkali syndrome in patients taking moderately large doses of calcium carbonate.
As for other calcium salts. As outlined, antacids, including calcium salts, interact with many other drugs both by alterations in gastric pH and emptying, and by formation of complexes that are not absorbed. Interactions can be minimised by giving calcium carbonate and any other medication 2 to 3 hours apart.
Omeprazole. In a study of 18 women over the age of 65, the use of omeprazole for a week significantly reduced the absorption of calcium from a calcium carbonate supplement given on an empty stomach. Fractional calcium absorption was reduced from 9.1% with placebo to 3.5% with omeprazole.
Calcium carbonate is converted to calcium chloride by gastric acid. Some of the calcium is absorbed from the intestines and the unabsorbed portion is excreted in the faeces, as described for other calcium salts.
Uses and Administration
Calcium carbonate is used as an antacid, usually in oral doses of up to about 1.5 g. It is often given with other antacids, especially magnesium-containing antacids.
Calcium carbonate is also used as a calcium supplement in deficiency states and as an adjunct in the management of osteoporosis, as described under Calcium.
Calcium carbonate binds phosphate in the gastrointestinal tract to form insoluble complexes and reduces phosphate absorption. It is used to treat hyperphosphataemia in patients with chronic renal failure (see Renal Osteodystrophy) or associated secondary hyperparathyroidism. For this purpose, initial doses of 2.5 g daily by mouth in divided doses have been given, increased to up to 17 g daily in divided doses as required. The BNFC suggests the following doses in infants and children, given 3 or 4 times daily with or before meals, and adjusted as necessary:
• 1 month to 1 year of age, 120 mg
• 1 to 6 years, 300 mg
• 6 to 12 years, 600 mg
• 12tol8years, 1.25 g
Calcium carbonate is also used as a food additive.
Homoeopathy. Native forms of calcium carbonate have been used in homoeopathic medicines under the following names: Calcarea Carbonica; Calc. Carb.; Calcium carbonicum Hahnemanni; Conchae; Calcium Carbonate of Hahnemann; Cal. carb.
British Pharmacopoeia 2008: Alginate Raft-forming Oral Suspension; Calcium and Colecalciferol Tablets; Chewable Calcium Carbonate Tablets
The United States Pharmacopeia 31, 2008: Alumina, Magnesia, and Calcium Carbonate Oral Suspension; Alumina, Magnesia, and Calcium Carbonate Tablets; Alumina, Magnesia, Calcium Carbonate, and Simethicone Tablets; Aluminum Subacetate Topical Solution; Calcium and Magnesium Carbonates Oral Suspension; Calcium and Magnesium Carbonates Tablets; Calcium Carbonate and Magnesia Tablets; Calcium Carbonate Lozenges; Calcium Carbonate Oral Suspension; Calcium Carbonate Tablets; Calcium Carbonate, Magnesia, and Simethicone Tablet.
Argentina: Bica Calcio Acido Calcional Calcium-Sandoz Cavirox Dexacid Mylanta Pocket Pluscal Renacalcio Ultracalcium Uvasal Turns
Australia:: Andrews Turns Antacid Cal-Sup Caltrate Sandocal Titralac
Austria: Calcium-Sandoz Dreisacarb
Belgium: Cacit Calci-Chew Sandoz Calcium Steocar
Brazil: Calcium-Sandoz Calciumvit Calsan Maxicalc Natecal- Nutricalcio Os-Cal Osporin Osseopor
Canada: Apo-Cal Cal-500 Calcite Calcium Oyster Shell Calcium-Sandoz Calsan Caltrate Hi Potency Cal Maalox Extra Strength Maalox Quick Dissolve Maalox Regular Strength Neo Cal Nu Cal Os-Cal Turns
Chile: Aplical Calcefor CalceforCap Calcio Calcium Factor Calcium-Sandoz Calcivorin Caprimida Elcal Kaplus Levucal Natecal Sanidecal
Czech Republic: Maxi-Kalz Vitacalcin
Finland: Calcichew Calcium-Sandoz Kalcidon Kalcipos
France: Cacit Calcidia Calcidose Calciprat Calcium-Sandoz Calperos Calprimum Caltrate Densical Densical vitamine D Eucalcic Fixical Osteocal Perical
Germany: Basti-Cal Biolectra Calciumf Calci-Gry Calcigamma Calcimagon Calcimed Calcitridin Calcium AL Calcium beta Calcium Dago Calcium Heumann Calcium Hexal Calcium Stada Calcium Verla Calcium von CT Calciumdura Calcium-Sandoz CC-Nefro Dreisacarb Loscalcon Ospur Ca Vivural
Greece: Alcamex Body-Calcin Calcional Turns
Hong Kong: Apo-Cal Calcichew Calcium-Sandoz Caltrate Os-Cal Scott’s Hi-Calcium Titralac
Hungary: Beres Calcium Calcicarb Calcichew Calcium-Sandoz
India: Calcium-Sandoz Sandocal
Indonesia: Calcium-Sandoz Junior Strength Calnat Cabs Calsan Osteocal Stomacain
Ireland: Cacit Calcichew Rennie Chewable Tablets Rowarolan Sandocal Tums
Israel: Calci-Rav Calcimore Calcium-Sandoz Caltrate Fast Turns Tzarevet X
Italy: Adiecal Biocalcium Cacit Cal-Car Calbisan Calciodie Calciopiu Calcium-Sandoz Calma Carbo Carbosint Carbotop Citracal Fervical Idracal Lubical Metocal Recal Salicalcium Savecal Top Calcium Unical
Malaysia: Apo-Calf Cal-Sup Caltrate
Mexico: Bexacal Calcifar Calcium-Sandoz Calsan Caltrate Ciocar Grisical Mubonet Osteomin Solibone Turns
The Netherlands: Cacit Calci-Chew Calcium-Sandoz
Norway: Calcium-Sandoz Titralac
New Zealand: Calcium-Sandoz Caltrate Osteo Titralac
Philippines: Calci-Aid Calcium-Sandoz Calmate Calsan Turns
Poland: Additiva Calcium Calcium-Sandoz Forte Calperos FrutiCal Ostical Vicalvit
Portugal: Calcior Calcioral Calcitab Calcium-Sandoz Natecal Sandocal Turns
Russia: Calcium-Sandoz Forte
South Africa: Calcichew Calcium-Sandoz Calsuba Caltrate Titralac Turns
Singapore: Cal-Sup Calcium-Sandoz Caltrate
Spain: Calcio 20 Calcium-Sandoz Forte Caosina Carbocal Cimescal Densical Fortical Mastical Natecal
Sweden: Calcitugg Calcium-Sandoz Kalcidon Kalcipos Kalcitena
Switzerland: Calcium-Sandoz Calperos Fixateur phosphocalcique Maxi-calc
Thailand: Bo-Ne-Ca Cal-Os Calcanate Calcar Calcarbonate Calcium Central Poly Calcium-Sandoz Calsum Caltab Caltrate Carbocal Carbocalc Kal-Forte Prima-Cal Sorcal Weifa-Calcium
Turkey: Anti-Fosfat Cc Calcium-Sandoz
UK: Adcal Cacit Calcichew Rapeze Remegel Rennie Soft Chews Sandocal Sea-Cal Setlers Titralac Turns
USA: Alka-Mints Alkets Amitone Antacid Calci-Chew Calci-Mix Calcium-600 Caltrate Chooz Equilet Maalox Antacid/Calcium Maalox Childrens Maalox Quick Dissolve Mallamint Mylanta Nephro-Calci Os-Cal Oysco Oyst-Cal Rolaids Extra Strength Softchews Surpass Titralac Extra Strength Trial Antacid Turns
Venezuela: Calcion Calcium-Sandoz Caltrate Foscalvit Frutacid Oscal Sandocal Titralac Turns.
Used as an adjunct in
Argentina: Aspirina Bufferin
Canada: Aspirin with Stomach Guard Bufferin Tri-Buffered ASA
Poland: Calcipiryna Polopiryna S
USA: Adprin-B Ascriptin Asprimox Bufferin Extra Strength Bayer Plus Magnaprin-F.