Calcium Citrate + Calcitriol interactions

Food & lifestyle

• bran

  Moderate

  Absorption

  Administration with food may increase the absorption of calcium. However, foods high in oxalic acid (spinach or rhubarb), or phytic acid (bran and whole grains) may decrease calcium absorption.

  What to do: Calcium may be administered with food to increase absorption. Consider withholding calcium administration for at least 2 hours before or after consuming foods high in oxalic acid or phytic acid.

  6 sources

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. Agencia Espa?ola de Medicamentos y Productos Sanitarios Healthcare "Centro de informaci��n online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  5. Mangels AR "Bone nutrients for vegetarians." Am J Clin Nutr 100 (2014): epub
  6. Davies NT "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc 38 (1979): 121-8

• grain

  Moderate

  Absorption

  Administration with food may increase the absorption of calcium. However, foods high in oxalic acid (spinach or rhubarb), or phytic acid (bran and whole grains) may decrease calcium absorption.

  What to do: Calcium may be administered with food to increase absorption. Consider withholding calcium administration for at least 2 hours before or after consuming foods high in oxalic acid or phytic acid.

  6 sources

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. Agencia Espa?ola de Medicamentos y Productos Sanitarios Healthcare "Centro de informaci��n online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  5. Mangels AR "Bone nutrients for vegetarians." Am J Clin Nutr 100 (2014): epub
  6. Davies NT "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc 38 (1979): 121-8

• rhubarb

  Moderate

  Absorption

  Administration with food may increase the absorption of calcium. However, foods high in oxalic acid (spinach or rhubarb), or phytic acid (bran and whole grains) may decrease calcium absorption.

  What to do: Calcium may be administered with food to increase absorption. Consider withholding calcium administration for at least 2 hours before or after consuming foods high in oxalic acid or phytic acid.

  6 sources

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. Agencia Espa?ola de Medicamentos y Productos Sanitarios Healthcare "Centro de informaci��n online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  5. Mangels AR "Bone nutrients for vegetarians." Am J Clin Nutr 100 (2014): epub
  6. Davies NT "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc 38 (1979): 121-8

• spinach

  Moderate

  Absorption

  Administration with food may increase the absorption of calcium. However, foods high in oxalic acid (spinach or rhubarb), or phytic acid (bran and whole grains) may decrease calcium absorption.

  What to do: Calcium may be administered with food to increase absorption. Consider withholding calcium administration for at least 2 hours before or after consuming foods high in oxalic acid or phytic acid.

  6 sources

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  2. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. Agencia Espa?ola de Medicamentos y Productos Sanitarios Healthcare "Centro de informaci��n online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
  5. Mangels AR "Bone nutrients for vegetarians." Am J Clin Nutr 100 (2014): epub
  6. Davies NT "Anti-nutrient factors affecting mineral utilization." Proc Nutr Soc 38 (1979): 121-8

Conditions

Conditions in which Calcium Citrate + Calcitriol needs care, as documented in this source.

• Arrhythmias, Cardiac

  Major

  Vitamin D analogs function to increase serum calcium concentrations and can exacerbate arrhythmias, particularly in patients receiving cardiac glycosides. Therapy with vitamin D analogs should be administered cautiously in patients with or predisposed to cardiac arrhythmias. Clinical monitoring of serum electrolyte concentrations and cardiac function is recommended.

  3 sources

  1. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma (2001):
  2. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):
  3. "Product Information. Calderol (calcifediol)." Organon (2001):

• Cardiac Conduction System Disease

  Major

  Calcium is involved in cardiac muscle contraction and electrical impulse conduction. Therapy with calcium salt formulations (particularly IV) should be administered cautiously to patients with cardiac disease. Patients receiving cardiac glycosides and concomitant IV calcium may experience arrhythmias. Therapy with IV calcium should be administered slowly and at reduced dosages in patients with cardiac disease.

  2 sources

  1. "Product Information. Posture (calcium phosphate, tribasic)." Whitehall-Robbins
  2. "Product Information. Neo-Calglucon (calcium glubionate)." Sandoz Pharmaceuticals Corporation (2001):

• Hypercalcemia

  Major

  Vitamin D analogs such as calciferol and ergocalciferol should not be given to patients with hypercalcemia, malabsorption syndrome, or evidence of vitamin D toxicity.

  4 sources

  1. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):
  2. "Product Information. Zemplar (paricalcitol)." Abbott Pharmaceutical (2001):
  3. "Product Information. Delta D3 (cholecalciferol)." Freeda Vitamins Inc (2002):
  4. "Product Information. Drisdol (ergocalciferol)." sanofi-aventis (2016):

• Hyperphosphatemia

  Major

  Elevated serum concentrations of calcium and phosphate can exceed the solubility level and result in calcium- phosphate precipitates that deposit in vascular and renal systems as well as other soft tissues of the body. Therapy with calcium should be administered with extreme caution in patients with hyperphosphatemia (hypoparathyroidism or severe renal impairment). Administration of oral calcium acetate or calcium carbonate, in addition to providing calcium, complexes phosphates within the GI tract. These complexes are eliminated in the feces. Clinical monitoring of serum calcium and phosphate concentrations is necessary.

  2 sources

  1. "Product Information. Posture (calcium phosphate, tribasic)." Whitehall-Robbins
  2. "Product Information. Neo-Calglucon (calcium glubionate)." Sandoz Pharmaceuticals Corporation (2001):

• Kidney Diseases

  Major

  Ergocalciferol, cholecalciferol, and calcifediol undergo renal biotransformation during metabolic activation. Renal impairment can alter metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as dihydrotachysterol (hepatic activation) and calcitriol (active form) may be considered in patients with compromised renal function.

  3 sources

  1. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma (2001):
  2. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):
  3. "Product Information. Calderol (calcifediol)." Organon (2001):

• Kidney Diseases

  Major

  Absorption of oral calcium formulations may be altered and elimination of calcium by the kidney decreased with renal impairment. Hyperphosphatemia occurs during renal failure. Calcium acetate or calcium carbonate, in addition to providing calcium, complexes phosphates within the GI tract. Calcium carbonate can partially correct metabolic acidosis associated with chronic renal failure. Clinical monitoring of renal function and serum calcium and phosphate concentrations is necessary.

  2 sources

  1. "Product Information. Posture (calcium phosphate, tribasic)." Whitehall-Robbins
  2. "Product Information. Neo-Calglucon (calcium glubionate)." Sandoz Pharmaceuticals Corporation (2001):

• Malabsorption Syndromes

  Major

  Calcium is absorbed from the intestinal tract by active transport and passive diffusion. Malabsorption syndromes (celiac disease, GI resection), deficiency of vitamin D, parathyroid hormone, or calcitonin, or an alkaline gastric pH (achlorhydria, carbonate or phosphate salts) can decrease the absorption of oral formulations of calcium. Calcium is available in oral and parenteral formulations.

  2 sources

  1. "Product Information. Posture (calcium phosphate, tribasic)." Whitehall-Robbins
  2. "Product Information. Neo-Calglucon (calcium glubionate)." Sandoz Pharmaceuticals Corporation (2001):

• Sarcoidosis

  Major

  Hypercalciuria, with or without hypercalcemia, may occasionally occur in patients with sarcoidosis. Elevated calcium levels may result from increased intestinal absorption of calcium, which is related to the extrarenal production of vitamin D by mononuclear phagocytes present within the sarcoid granuloma. Therapy with calcium salts should be administered cautiously and only if necessary in patients with sarcoidosis.

  3 sources

  1. "Product Information. Posture (calcium phosphate, tribasic)." Whitehall-Robbins
  2. "Product Information. Neo-Calglucon (calcium glubionate)." Sandoz Pharmaceuticals Corporation (2001):
  3. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):

• Water-Electrolyte Imbalance

  Major

  Vitamin D analogs administered in the presence of hyperphosphatemia can result in precipitation of calcium-phosphate deposits within the vascular or renal systems or other soft tissue calcifications. A solubility product (Serum Calcium X Phosphate) should not exceed 70. Serum electrolyte concentrations should be corrected prior to vitamin D analog therapy and monitored during therapy.

  4 sources

  1. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma (2001):
  2. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):
  3. "Product Information. Calderol (calcifediol)." Organon (2001):
  4. "Product Information. Zemplar (paricalcitol)." Abbott Pharmaceutical (2001):

• Diseases requiring dialysis

  Moderate

  Calcitriol increases inorganic phosphate levels in serum and caution should be used in patients with renal impairment to maintain adequate phosphorus levels and avoid ectopic calcification. A non-aluminum phosphate-binding compound and a low phosphate diet should be used to control serum phosphorus levels in patients undergoing dialysis.

  1 source

  1. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):

• Liver Diseases

  Moderate

  Vitamin D analogs are fat soluble and oral formulations require bile for adequate intestinal absorption. Hepatic and/or biliary dysfunction decrease the absorption of vitamin D analogs. Metabolites of vitamin D analogs are primarily excreted in bile and feces. Ergocalciferol, cholecalciferol, and dihydrotachysterol undergo hepatic hydroxylation during metabolic activation. Hepatic impairment can alter the metabolic and therapeutic activity of certain vitamin D analogs. Alternative vitamin D analogs such as calcifediol (requires renal activation) and calcitriol (active form) may be considered in patients with compromised hepatic function.

  3 sources

  1. "Product Information. Calciferol (ergocalciferol)." Schwarz Pharma (2001):
  2. "Product Information. Rocaltrol (calcitriol)." Roche Laboratories (2001):
  3. "Product Information. Calderol (calcifediol)." Organon (2001):

Therapeutic duplication

Drug classes that overlap with Calcium Citrate + Calcitriol, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• vitamin d analogs

  The recommended maximum number of medicines in the 'vitamin d analogs' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'vitamin d analogs' category.

  Example product in the source data (US market): Os-cal extra d3

• vitamin d analogs

  The recommended maximum number of medicines in the 'vitamin d analogs' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'vitamin d analogs' category.

  Example product in the source data (US market): Ortho df

• vitamin d analogs

  The recommended maximum number of medicines in the 'vitamin d analogs' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'vitamin d analogs' category.

  Example product in the source data (US market): Alendronate/cholecalciferol