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Calcium carbonate is an inorganic salt primarily used to manage and treat low calcium conditions, GERD, CKD, and other indicated conditions. Calcium carbonate is classified as a calcium supplement, antacid, and phosphate binder. This activity outlines the significant indications, actions, and contraindications for calcium carbonate as a valuable agent in treating osteoporosis, hypothyroidism, rheumatoid arthritis, and many other conditions or disorders that lower serum calcium levels. As an antacid, calcium carbonate also increases gastrointestinal motility and initiates peristalsis. Calcium carbonate works in the small intestines as a phosphate binder and drug chelator. In individuals with hyperphosphatemia or overdose, calcium will bind to form an insoluble compound blocking dietary phosphate or excess drug absorption and excreting it in feces. Calcium carbonate, used as a calcium supplement, also acts in the small intestine by chelating with oxalate to prevent absorption and renal calculi formation. Lastly, calcium carbonate also works in the blood to treat or prevent negative calcium balance seen in low serum calcium conditions. This activity will highlight the mechanism of action, adverse event profile, and other key factors (eg, off-label uses, dosing, pharmacodynamics, pharmacokinetics, monitoring, relevant interactions) pertinent for members of the healthcare team in the care of patients with low serum calcium, GERD, CKD, and related conditions. Objectives: Identify appropriate indications for calcium carbonate use in patients with low calcium levels, GERD, CKD, and related conditions. Screen patients for contraindications and potential drug interactions before initiating calcium carbonate therapy. Assess patients regularly for response to calcium carbonate therapy, monitor calcium levels, and evaluate for adverse effects. Communicate effectively with patients about the benefits, risks, and proper use of calcium carbonate. Access free multiple choice questions on this topic.

The FDA recognizes calcium carbonate as a generally safe drug and food additive.[1] A maximum dose of 8 to 10 g per day of calcium carbonate can be administered for short-term use.[2][45] However, long-term use of over 2 grams can lead to adverse effects such as hypercalcemia, renal calculi, hypophosphatemia, and nephrotoxicity, especially in individuals with chronic kidney disease.[1][11] Fetotoxicity has also been observed in pregnant women taking over 1500 mg/kg of body weight per day of calcium carbonate.[1]

As a non-prescription drug, calcium carbonate is easily accessible "over the counter" and often used. Proper patient education by clinicians and pharmacists is needed to avoid improper use. Symptomatic relief provided by calcium carbonate often masks underlying gastrointestinal disorders that will not improve by using the drug. Patient awareness is necessary to hasten the correct diagnosis and treatment. Furthermore, patients on polypharmacy need to understand calcium carbonate's drug interactions. Clinicians should advise their patients to take their medications at separate times of the day and limit additional calcium intake that could lead to overdose and milk-alkali syndrome. Working with a pharmacist to assist with medication reconciliation would be a prudent choice to prevent adverse drug-drug interactions. Nurses can also work with the patient to answer questions, review appropriate dosing, and ensure patient compliance. These are examples of how interprofessional teamwork and communication can improve patient results with calcium carbonate therapy, respective of the reason the patient takes it. Proper clinician education on considerations when prescribing, monitoring, and stopping treatment is also necessary. Vigilance is essential, and routine monitoring should occur when prescribing calcium carbonate to patients with hyperphosphatemia due to the possibility of calcification of vascular tissues. Care is also necessary when prescribing calcium carbonate to infants and older patients because of renal function changes. Additionally, calcium carbonate should not be coadministered with ceftriaxone because of an increased risk of end-organ failure.

Proper clinician education on considerations when prescribing, monitoring, and stopping treatment is also necessary. Vigilance is essential, and routine monitoring should occur when prescribing calcium carbonate to patients with hyperphosphatemia due to the possibility of calcification of vascular tissues. Care is also necessary when prescribing calcium carbonate to infants and older patients because of renal function changes. Additionally, calcium carbonate should not be coadministered with ceftriaxone because of an increased risk of end-organ failure. All interprofessional healthcare team members can improve outcomes by ensuring patient compliance. Patient compliance is problematic with calcium carbonate because of its interactions, adverse effects, and frequency of administration. Calcium carbonate can be inconvenient because it must be taken alone, except for vitamin D and other drugs that do not require a low stomach pH. Calcium carbonate has many gastrointestinal side effects, especially for older adults. Calcium carbonate prescriptions can also translate to a high pill burden, like patients with hyperphosphatemia who may require more than 17 doses daily. Encouraging patient compliance and proper scheduling would greatly help improve patients on polypharmacy, those with comorbidities, and those who need to limit dietary electrolytes.