Calcium + Alfacalcidol + Vitamin C Pharmacology

Calcium + Alfacalcidol + Vitamin C

About Calcium + Alfacalcidol + Vitamin C
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Mechanism of Action of Calcium + Alfacalcidol + Vitamin C
N/A
Pharmacokinets of Calcium + Alfacalcidol + Vitamin C
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Onset of Action for Calcium + Alfacalcidol + Vitamin C
N/A
Duration of Action for Calcium + Alfacalcidol + Vitamin C
N/A
Half Life of Calcium + Alfacalcidol + Vitamin C
N/A
Side Effects of Calcium + Alfacalcidol + Vitamin C
N/A
Contra-indications of Calcium + Alfacalcidol + Vitamin C
N/A
Special Precautions while taking Calcium + Alfacalcidol + Vitamin C
N/A
Pregnancy Related Information
Use with caution
Old Age Related Information
N/A
Breast Feeding Related Information
Use with caution
Children Related Information
N/A
Indications for Calcium + Alfacalcidol + Vitamin C
1.Osteoporosis
2.Osteomalacia
3.Hypoparathyroidism
4.Rickets
Interactions for Calcium + Alfacalcidol + Vitamin C
N/A
Typical Dosage for Calcium + Alfacalcidol + Vitamin C
2 capsule / day
Schedule of Calcium + Alfacalcidol + Vitamin C
N/A
Storage Requirements for Calcium + Alfacalcidol + Vitamin C
N/A
Effects of Missed Dosage of Calcium + Alfacalcidol + Vitamin C
N/A
Effects of Overdose of Calcium + Alfacalcidol + Vitamin C
N/A

Calcium

About Calcium
Calcium is necessary for cardiac function, muscle contraction, nervous activity, coagulation of blood and for maintaining structural integrity of cell membranes.
Plasma concentration of calcium is kept in normal range by three endocrine factors which control metabolism of calcium. These are (a) Parathyroid hormone, (b) Calcitonin, (c) Vitamin D. Calcium in plasma is bound to albumin, is complexed with anions (e.g. phosphate) and as diffusible ionic calcium. The physiological effects are exerted by ionic calcium. The predominant source of calcium is dairy products and the daily intake varies from 200 - 2500 mg. Adequate calcium intake is particularly important during periods of bone growth in childhood and adolescence and during pregnancy and lactation.
Patients with advanced renal insufficiency exhibit phosphate retention and some degree of hyperphosphataemia. The retention of phosphate plays a pivotal role in causing secondary hyperparathyroidism associated with osteodystrophy and soft tissue calcification. Calcium acetate, when taken with meals, combines with dietary phosphate to form insoluble calcium phosphate which is excreted in the faeces.
Deficiency signs and symptoms: Osteoporosis, pathological fractures, brittle nails and hair.
Mechanism of Action of Calcium
Calcium is essential for maintaining the functional integrity of nervous, muscular, and skeletal system. It controls excitability of nerves and muscles and regulates permeability of cell membrane. It also regulates cell adhesion and maintains integrity of cell membrane. Calcium acts as intracellular messenger for hormones, autacoids, and transmitters. It is required for excitation-contraction coupling in all types of muscle and excitation-secretion coupling in exocrine and endocrine glands. It is essential for release of transmitters from nerve endings and other release reactions. It is also essential for impulse generation in heart and determines level of automaticity and
A-V conduction. Calcium is also required for blood-coagulation.
Pharmacokinets of Calcium
Absorption: Actively absorbed from gastrointestinal tract in an ionized form; and vitamin D in it`s active form is required for calcium absorption, Distribution: Distributed mainly in to skeletal tissue (99%) and 1% is distributed equally between the intracellular and extra cellular fluid. CSF levels are about half of the serum calcium levels, Metabolism: Not significantly metabolized in the body, Excretion: Excreted mainly through faeces and a small amount is excreted through urine.
Onset of Action for Calcium
N/A
Duration of Action for Calcium
N/A
Half Life of Calcium
N/A
Side Effects of Calcium
1.Constipation
2.Bloating
3.Excess gas
4.Anorexia
5.Nausea
6.Vomiting
7.Abdominal pain
8.Thirst
9.Hypercalcaemia
10.Polyuria
11.Dry mouth
12.Delirium
13.Confusion
Contra-indications of Calcium
1.Renal calculi
2.Hypophosphataemia
3.Hypercalcaemia
4.Ventricular fibrillation.
Special Precautions while taking Calcium
1.Renal impairment
2.Cardiac diseases
3.Sarcoidosis
4.Cor pulmonale
5.Respiratory acidosis
6.Respiratory failure
7.End stage renal failure
8.Hypoparathyroid patients
9.Digitalized patients
10.Prolonged use of therapeutic amounts.
Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
May be used
Children Related Information
Use with caution
Indications for Calcium
1.Hypocalcaemia
2.Calcium and vitamin D deficiency
3.Calcium deficiency during pregnancy and lactation
4.Rickets
5.Prevention of osteoporosis in postmenopausal women
6.Chronic renal failure.
Interactions for Calcium
N/A
Typical Dosage for Calcium
Oral: 500mg to 2g daily in two to four divided doses.
Hypocalcaemia:
Adults: 1g daily. Increases to 2g daily if required.
Prevention of osteoporosis: 1 to 1.5g daily.
Children: 45 to 65mg/kg daily.
Neonates: 50 to 150mg/kg and should not exceed 1g.

Schedule of Calcium
N/A
Storage Requirements for Calcium
Store in a well closed container in a cool and dry place. Protect from light.


Effects of Missed Dosage of Calcium
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Calcium
Remove calcium from stomach by induced emesis and gastric lavage. Provide symptomatic treatment and supportive measures.

Alfacalcidol

About Alfacalcidol
Nutritional supplement,Vitamin D derivative, Antihypoparathyroid, Antihypocalcemic.
Mechanism of Action of Alfacalcidol
Alfacalcidol is a prodrug of Vitamin D and is rapidly hydroxylated in the liver in to calcitriol. Vitamin D exerts it`s action by influencing calcium homoeostasis. It increases the intestinal absorption of calcium and phosphate. It binds to the cytoplasmic Vitamin D receptor and translocates to the nucleus and thus increases the synthesis of specific m RNA and regulates protein synthesis. It increases the synthesis of a carrier protein for calcium called "calbindin" or calcium binding protein. Activation of Vitamin D receptor enhances endocytotic capture of calcium and it`s transport across duodenal mucosal cells in a vesicular form. Vitamin D promotes resorption of calcium and phosphate from bone by enhancing recruitment and differentiation of osteoclast precursors in the bone remodeling units. It helps in bone mineralization.
Pharmacokinets of Alfacalcidol
Absorption: Well absorbed orally, Distribution: Widely distributed in a protein bound form. It is stored in adipose tissue and liver. Metabolism: It is hydroxylated in to calcitriol in liver. Excretion: Excreted mainly through bile.

Onset of Action for Alfacalcidol
N/A
Duration of Action for Alfacalcidol
N/A
Half Life of Alfacalcidol
N/A
Side Effects of Alfacalcidol
1.Hypercalcaemia
2.Fatigue
3.Weakness
4.Diarrhoea
5.Vomiting
6.Sluggishness
7.Albuminuria
8.Polyuria
9.Calcification of soft tissues (blood vessels, parenchymal organs including heart)
10.Renal stones
11.Growh retardation in children
12.Hypertension
13.Anorexia
14.Nausea
15.Constipation
16.Hyperphosphataemia.
Contra-indications of Alfacalcidol
1.Hypercalcaemia
2.Hypervitaminosis D
3.Hyperphosphataemia (except when occurring with hypoparathyroidism
4.Hypermagnesaemia.
Special Precautions while taking Alfacalcidol
1 Renal impairment
2.Hypercalciurea
3.Renal stones
4.Coronary diseases.
Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
Use with caution
Indications for Alfacalcidol
1.Rickets and Osteomalacia
2.Hypoparathyroidism with bone disease
3.Renal osteodystrophy
4.Osteoporosis
Interactions for Alfacalcidol
Digitallis preparations: Cardiac arrhythmias precipitated.
Thiazide Diuretics: Hypercalcaemic response enhanced.
Barbiturates & other enzyme inducing anticonvulsants: Reduce efficacy.
Minteral Oil: Prolonged use reduces efficacy.
Cholestyramine, Cholestipol, Sucralfate, Aluminium based Antacids: Reduced efficacy by decreasing absorption of alfacalcidol.
Magnesium based Antacids or Laxatives: Hypermagnesaemia in those on chronic renal dialysis.
Typical Dosage for Alfacalcidol
Oral:
Starts with 1mcg daily. Adjusted based on patients response to 2mcg daily if required.
Children over 20kg: Starts with 1mcg daily. Adjusted based on patient`s response.
Children under 20kg: 0.5mcg daily or 0.05mcg/kg/day
Schedule of Alfacalcidol
C1
Storage Requirements for Alfacalcidol
Store in a well closed container in a cool place. Protect from light and excess heat. Keep out of reach of children.
Effects of Missed Dosage of Alfacalcidol
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Alfacalcidol
Provide supportive and symptomatic treatment. Stops the treatment and starting a low calcium diet. Increases the fluid intake and administer Loop diuretics like furosemide may be given with saline I.V. infusion to increase calcium excretion. Calcitonin may decrease hypercalcaemia.

Vitamin C

About Vitamin C
Water soluble vitamin, antioxidant.
Mechanism of Action of Vitamin C
Vitamin C exerts it`s action by influencing the biologic oxidations and reductions used in cellular respirations. It directly stimulates collagen synthesis and maintains intracellular connective tissue. It involves in various metabolic reactions such as 1).Hydroxylation of praline and lysine residues of protocollagen which is essential for formation and stabilization of collagen triple helix, 2).hydroxylation of carnitine, 3).Conversion of folic acid to folinic acid, 4).biosynthesis of adrenal steroids, catecholamines, oxytocin, and ADH, 5).Metabolism of cyclic nucleotides and prostaglandins. Vitamin C is important in resistance to infections.
Pharmacokinets of Vitamin C
Absorption: Well absorbed orally.
Distribution: Widely distributed both extracellularly and intracellularly, It crosses the placenta and also distributed in to the breast milk.
Metabolism: Metabolized in the liver; partly oxidized in to active dehydroascorbic acid and inactive metabolites.
Excretion: Inactive metabolites and extra drug is excreted through urine.
Onset of Action for Vitamin C
N/A
Duration of Action for Vitamin C
N/A
Half Life of Vitamin C
N/A
Side Effects of Vitamin C
1. Discomfort at injection site
2. Acid urine
3. Renal calculi
4. Oxaluria
Contra-indications of Vitamin C
No known contraindications
Special Precautions while taking Vitamin C
1. Renal impairment
2. Ingestion of large doses during pregnancy has resulted in scurvy in neonates
Pregnancy Related Information
Use with caution
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
May be used
Indications for Vitamin C
1. Scurvy
2. Prophylaxis and treatment of vitamin C deficiency
3. As an antioxidant to maintain natural colour and flavour of food items
4. For acidification of urine
5. Capillary fragility
6. Dental caries

Interactions for Vitamin C
Oral contraceptives and estrogens: Vitamin C increases serum levels of oestrogen resulting in adverse reactions .
Warfarin: The anticoagulant effects of warfarin is reduced.
Lab Tests: Large doses (>500 mg) of vitamin C may cause false negative urine glucose determinations. May result in false negative amine dependent stool occult blood tests.
Typical Dosage for Vitamin C
Oral:
Adults: 50 to 1000mg/day depending up on the requirement.
Pregnancy and lactation: 100 to 150mg/day
Children: 30 to 100mg/day.
Scurvy:
Oral:
Adults: 1000mg twice daily to thrice daily.
Children: 300mg to 1000mg daily.
Sub clinical scurvy:
Oral, S.C., I.M., or I.V.: 100 to 250mg once daily or twice daily depending up on the severity of the condition. Then give a maintenance dosage of 50mg/day.
Children: 100 to 300mg depending up on the severity. Then give a maintenance dose of 35mg/day.

Schedule of Vitamin C
C1 (Oral)
C (Parenteral)
Storage Requirements for Vitamin C
Store in a cool dry area in a well closed container. Protects from moisture, light and direct heat.
Effects of Missed Dosage of Vitamin C
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Vitamin C
Discontinue the therapy and provide symptomatic and supportive measures.

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