Calcemin Advance tablets p / o No. 60 No. 1

DescriptionOval pink tablets with a notch on one side. Release form Tablets Pharmacological properties Combined preparation containing vitamins, macro-/microelements. The action is due to the properties of the ingredients included in the composition. Pharmacokinetics Calcium is absorbed predominantly in the proximal small intestine via an active vitamin D-dependent transport mechanism. The calcium received after absorption is distributed among organs and systems and, first of all, enters the bone tissue. In the stomach, calcium ions are released in a pH dependent manner. Absorption of calcium in the form of calcium carbonate is about 20-30% and occurs mainly in the duodenum through vitamin D-dependent, saturable, active transport. Excreted in urine, feces and sweat. Urinary calcium excretion is a function of glomerular filtration and tubular reabsorption of calcium. Vitamin D is absorbed in the small intestine. Bioavailability is 50-70%. It binds to specific alpha globulins and is transported to the liver, where it is metabolized to 25-hydroxycholecalciferol. Subsequent hydroxylation to 1,25-dehydroxycholecalciferol occurs in the kidneys. This metabolite is responsible for the vitamin’s ability to increase calcium absorption. Unmetabolized vitamin D is stored in adipose and muscle tissue. Vitamin D is excreted in feces and urine. Minerals are absorbed mainly in the upper small intestine and excreted by the kidneys. In addition, they can be partially excreted in the feces. Indications for use Replenishment of calcium, vitamin D and micronutrient deficiencies when the need for them cannot be met by an appropriate diet, especially in case of long-term deficiency, irregular and unbalanced nutrition and increased needs, in particular at certain periods of life: adolescence postmenopause pregnancy and feeding breastfeeding (according to clinical indications and / or doctor’s recommendation) the elderly, as well as: for the prevention and as an adjunct to the specific treatment of osteoporosis. Dosage and administration Adults and adolescents over 12 years of age: 1 tablet twice a day with meals. Elderly patients: no special instructions. Patients with impaired renal function: Contraindicated in patients with severe renal insufficiency. With impaired renal function of mild and moderate severity – with caution, under the control of the concentration of calcium and phosphorus in the blood and urine. Patients with impaired liver function: no special instructions. Duration of treatment: When used to compensate for calcium and vitamin D deficiency, the average duration of treatment is at least 4-6 weeks. When used for the prevention of osteoporosis, the average duration of the course is 2 months; in the treatment of osteoporosis – 3 months. The number of repeated courses during the year is determined by the doctor. Use during pregnancy and lactation Calcemin Advance can be used during pregnancy and lactation at the recommended doses, if clinically indicated. The daily dose for pregnant women should not exceed 1500 mg of calcium and 600 IU of vitamin D3, since chronic overdose of calcium and vitamin D can be harmful to the fetus and newborn. Hypercalcemia during pregnancy can lead to the development of side effects in the fetus: parathyroid hormone suppression, hypocalcemia, tetany, epileptic seizures and aortic stenosis syndrome, the symptoms of which may be retinopathy, mental retardation or growth failure, and also lead to the development of hypercalcemia in newborns. In lactating women, it should be borne in mind that cholecalciferol and calcium penetrate into breast milk. This should be taken into account when additionally prescribing calcium and vitamin D3 to a child. Precautions Do not exceed the recommended dose. Calcemin Advance should be taken under close medical supervision when other sources of high doses of vitamin D and/or medicinal products or nutrients (such as milk) containing calcium are co-administered. In this case, regular monitoring of the calcium content in the blood serum and urine is required. During long-term treatment with combined calcium and vitamin D preparations, it is necessary to monitor serum and urinary calcium levels, as well as kidney function by measuring serum creatinine, especially in elderly patients, and with concomitant therapy with cardiac glycosides, calcium channel blockers and / or thiazide diuretics. This also applies to patients with a high tendency to form stones. In case of hypercalcemia or signs of impaired renal function, reduce the dose or stop treatment. Vitamin D is recommended to be used with caution in patients with mild to moderate renal impairment and under the control of calcium and phosphate in the blood serum. Be aware of the risk of soft tissue calcification. In patients with severe renal insufficiency, vitamin D in the form of cholecalciferol is not metabolized. Therefore, other forms of vitamin D are recommended in these patients. Due to the risk of increased metabolism of vitamin D to its active form, the drug should be used with caution in patients with sarcoidosis. In these patients, it is recommended to monitor the calcium content in the blood serum and urine. The drug is not intended for use in children under 12 years of age. Combination vitamin preparations should be used with caution in immobilized (immobilized) patients with osteoporosis due to an increased risk of hypercalcemia. It is obligatory to consult a doctor regarding the use of the drug in diseases of the kidneys, urolithiasis, diseases of the parathyroid glands, metastases of tumors in the bones. Interaction with other drugs Phenytoin, barbiturates, carbamazepine, rifampicin: may reduce the effect of vitamin D3 by increasing its metabolism to inactive metabolites. Bisphosphonates, fluorides: May reduce the absorption of bisphosphonates and sodium fluoride in the gastrointestinal tract. It is recommended to take at least 1-2 hours before or after taking Calcemin Advance. Preferably, bisphosphonates and calcium preparations are used at different times of the day. Tetracycline: may reduce the absorption of tetracycline in the gastrointestinal tract. It is recommended to take at least 2-3 hours before or 4-6 hours after taking Calcemin Advance. Cardiac glycosides, calcium channel blockers: possible increase in the toxicity of cardiac glycosides (danger of lethal arrhythmias). It is recommended to monitor the ECG and the concentration of calcium in the blood. The effectiveness of calcium channel blockers, such as verapamil, is reduced in atrial fibrillation. Co-administration is not recommended. Levothyroxine: possible violation of the absorption of levothyroxine. Recommended to be taken at least 2-4 hours before or 4-6 hours after taking this drug. Quinolones, antiviral agents: Absorption of quinolone antibacterial agents (eg, ciprofloxacin, levofloxacin, norfloxacin, ofloxacin, nalidixic acid) and antiviral agents (protease inhibitors) may be impaired. Recommended to be taken at least 2-4 hours before or 4-6 hours after taking this drug. Thiazide diuretics: Thiazide diuretics decrease urinary calcium excretion. Due to the increased risk of hypercalcemia with the simultaneous use of thiazide diuretics and calcium preparations, it is recommended to regularly check the level of calcium in the blood serum in case of long-term treatment. Glucocorticoids, hormonal contraceptives: reduce calcium absorption, possibly reducing the effect of vitamin D3. Dose adjustment of Calcemin Advance may be required. Ion exchange resins such as cholestyramine, laxatives, orlistat: concomitant use with this drug will reduce the absorption of vitamin D3 in the gastrointestinal tract. It is recommended to take 2 hours before or 4-6 hours after taking vitamin D. Iron, zinc, magnesium, strontium ranelate: Calcium may reduce the absorption of iron, magnesium, zinc and strontium ranelate. If necessary, joint use is recommended to observe an interval of at least 2 hours before or 4-6 hours after taking calcium supplements. Foods: Possible interactions with certain foods (for example, those containing oxalic acid, phosphates, phytic acids, or foods high in fiber). Due to the risk of reduced calcium absorption, it is recommended that an interval of at least 2 hours be observed between taking calcium supplements and these foods. ContraindicationsIncreased individual sensitivity to any of the components of the drug. Hypercalcemia, severe hypercalciuria, nephrolithiasis, hypervitaminosis D, severe renal failure. Active ingredients: calcium (calcium citrate and calcium carbonate) 500 mg vitamin D3 200 ME magnesium (magnesium oxide) 40 mg zinc (zinc oxide) 7.5 mg copper (copper oxide) 1 mg manganese (manganese sulfate) 1.8 mg boron (sodium borate) 250 mcg. Excipients: microcrystalline cellulose (E460), stearic acid (E570), croscarmellose sodium, maltodextrin, soy polysaccharide, sodium lauryl sulfate. Shell: hypromellose, magnesium silicate (E553a), titanium dioxide (E171), triacetin (E1518), mineral oil (E905), FD&C Red No. 40 Lacquer (E129), FD&C Blue No. 1 Lacquer (E133), FD&C Yellow No. 6 Lacquer (E110). Overdose There is no evidence that the drug can lead to overdose when used in accordance with the recommendations for use. Most, if not all, reports of overdose have been associated with the concomitant use of large doses of mono- and/or multivitamin preparations. Intake of calcium and vitamin D in doses exceeding 2500 mg calcium and 4000 IU/day of vitamin D may lead to toxic effects. In patients with hypercalcemia or conditions associated with hypercalcemia, renal insufficiency and / or a tendency to nephrolithiasis, toxic effects of calcium and vitamin D may occur at lower doses. Patients with impaired renal function are at increased risk of hyperphosphatemia, nephrolithiasis, and nephrocalcinosis. Acute or prolonged overdose of calcium and vitamin D, especially in predisposed patients, can cause hypervitaminosis D, hypercalcemia, hypercalciuria, and hyperphosphatemia. Consequences include renal failure, “milk-alkali syndrome”, vascular and soft tissue calcification, including calcification leading to nephrolithiasis. Signs of acute overdose may include sudden headache, confusion, and gastrointestinal disturbances such as constipation, diarrhea, nausea, and vomiting. If these symptoms appear, treatment should be discontinued and a doctor should be consulted. Laboratory and clinical manifestations of toxicity and hypercalcemia are varied and depend on the susceptibility of the patient and the accompanying circumstances. Symptoms may include anorexia, weight loss, thirst, polyuria, and malabsorption of other minerals. Changes in laboratory parameters are possible: an increase in the concentration of aspartate aminotransferase and alanine aminotransferase in blood plasma. Chronic overdose can lead to calcification of vessels and organs caused by hypercalcemia. Extremely high hypercalcemia can cause coma and death. Treatment: rehydration, the use of loop diuretics (eg, furosemide), glucocorticosteroids, calcitonin, bisphosphonates, in severe cases, hemodialysis. Side effects From the gastrointestinal tract: in rare cases, constipation, bloating, abdominal pain, diarrhea, nausea, vomiting. From the immune system: allergic and anaphylactic reactions, very rarely anaphylactic shock, hypersensitivity reactions, including asthmatic syndrome, mild and moderate skin reactions (rash, urticaria, swelling, itching) and / or respiratory system, gastrointestinal tract and / or cardiovascular system (symptoms may include respiratory distress syndrome). After prolonged use of the drug, the level of calcium in the urine and the concentration of calcium in the blood serum may increase, which should be monitored by a doctor. If you experience any of the listed adverse reactions, as well as a reaction not listed in the package insert, you should consult a doctor. Storage conditions At a temperature not exceeding 25 ° C, out of reach of children. Buy Calcemin Advance tablets p/o No. 60 No. 1 Price for Calcemin Advance tablets p / o No. 60 No. 1 one