The combination of Calcium Citrate USP 1200 mg + Calcitriol USP 0.25 mcg is recently introduced in Bangladesh pharma market. I want to know about its safety studies in pregnancy and lactation as it is a major concern for using it in gynecology and obstetric phenomenon.
Calcium citrate is not asociated with urinary obstruction as other calcium salt (carbonate by the way).
A WHO guideline "Calcium supplementation in pregnant women" published in 2013 suggests 1.5-2 g elemental calcium/day from 20 wk to to reduce the risk of gestational hypertension.
Yes but is still not employed widely, perhaps sometime is needed to stabish this recommendation
yes calcium supplementation 1000mg to 1500mg during pregnancy for the calcium requirement of pregnancy and reducing the risk of pregnancy induced hypertension.
Hi Sarker,
The WHO recommend 1.5 - 2.0gm of elemental calcium per day, given as three divided doses in a day starting from 20th week of gestation. See WHO. Guideline: Calcium supplementation in pregnant women. Geneva, World Health Organization, 2013 But the formulation in your country is 1.2gm - i.e. slightly lower than the WHO recommendation.
The WHO recommendation is based on two Cochran reviews That you may wish to study:
1. Buppasiri P, Lumbiganon P, Thinkhamrop J, Ngamjarus C, Laopaiboon M.
Calcium supplementation (other than for preventing or treating hypertension) for improving pregnancy and infant outcomes. Cochrane Database of Systematic Reviews 2011, Issue 10. Art. No.: CD007079. DOI: 10.1002/14651858.CD007079.pub2. and
2. Hofmeyr GJ, Lawrie TA, Atallah AN, Duley L.
Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews 2014, Issue 8. Art. No.: CD001059. DOI: 10.1002/14651858.CD001059.pub4.
But Food and Nutrition Board (FNB) of the Institute of Medicine of the National Academies (formerly National Academy of Sciences) recommended 1300mg for adolescents between the age of 14 and 18, while adult from 19 yeaars and above 1000mg/day. also lower than that of WHO. ( see : - http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/)
yes, we know that patients on calcium supplements might experience gastrointestinal side effects including gas, bloating, constipation, or a combination of these symptoms. Calcium carbonate appears to cause more of these side effects than calcium citrate – which is used in your country.
Also, Pregnant women consuming moderate (800 to 1,000 mg/day to high (1,950 mg/day levels of calcium are often hypercalciuric due to increased intestinal calcium absorption (i.e., absorptive hypercalciuria), and as such pregnancy itself can be a risk factor for kidney stones.
However, the above two studies may allay your anxiety.
Dear Abdulkarim G. Mairiga
yes thanks for your valuable information but still is it widely implemented ?
Would you please kindly read the following manuscript: Expert Opin Investig Drugs :2013 Nov;22(11):1425-36. doi: 10.1517/13543784.2013.825248. Epub 2013 Aug 10.New insights into the role of aminopeptidases in the treatment for both preeclampsia and preterm labor.Calcium is very acvtive stimulator of aminopeptidase A,which is essential enzyme for the etiology and treatment of preeclampsia.
Dear Arjyabrata,
In assessing the potential role of calcium supplements it must be emphasized that calcium is a nutrient and not a drug (medicine). For maximizing absorption, intake needs to be limited to 500 mg of elemental calcium at one time. The recommended dose of, let us say, 1.5 g of calcium per day needs to be divided into 3 doses, as indicated above (WHO recommendation)..
The element, calcium, is taken by the body from food as a divalent cation with multiple anions, such as phosphate, citrate or bicarbonate. In the diet, calcium is associated with protein complexes. Food with its myriad nutrients (in food matrices) can have profound effects on calcium’s impact on metabolism and physiologic (and pathologic) functions. Food and food components are integral to calcium when considering the potential salubrious effects of supplemental calcium. Calcium is associated with dairy (protein) foods. And the beneficial effects of calcium are accentuated in diets with high protein.
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