Vitamin D + calcium supplement Pregnancy: §4.6: may be given during pregnancy in cases of calcium and vitamin D3 deficiency; during pregnancy the daily dose should not exceed 1500 mg of calcium and 600 IU of vitamin D. All calcium or vitamin D overdoses must be avoided in pregnancy, as prolonged hypercalcaemia may lead to retardation of physical and mental development, supravalvular aortic stenosis and retinopathy in the child. There are no indications that vitamin D3 at therapeutic doses is teratogenic in humans. Can be used during breast-feeding; calcium and vitamin D pass into breast milk, which should be considered when giving additional vitamin D to the child.

Colecalciferol with calcium carbonate

Brand names: Adcal-D3, Calcichew-D3, Accrete D3

Used in: Osteoporosis Falls & Frailty

A combined oral supplement of colecalciferol (vitamin D3) with calcium carbonate, used to treat or prevent vitamin D and calcium deficiency, including as adjunct to osteoporosis therapy.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One tablet twice a day

Route: Oral - swallow whole without chewing, with a glass of water or juice, within one and a half hours of a meal (the tablet can be broken in half if needed)

Frequency: Twice daily (e.g. one tablet in the morning and one tablet in the evening)

eMC §4.2 (Accrete D3 film-coated tablets, UK SPC). Stated dose applies to adults and the elderly. Dose reduction should be considered as necessary following monitoring of calcium levels (§4.4, §4.5). HEPATIC IMPAIRMENT: no dose adjustment is required. RENAL IMPAIRMENT: should not be used in patients with severe renal impairment. PAEDIATRIC: 'Accrete D3 film coated tablets are not intended for use in children and adolescents' - no paediatric dose is given; verify any under-18 use against a children's formulary. §4.4: during long-term treatment monitor serum calcium and renal function (serum creatinine), especially in elderly patients on concomitant cardiac glycosides or diuretics and in patients prone to calculus formation; reduce or discontinue if hypercalcaemia or impaired renal function develops; it is advisable to reduce or interrupt treatment temporarily if urinary calcium exceeds 7.5 mmol/24 h (300 mg/24 h). §4.4 states the vitamin D content is 400 IU per tablet and that this should be considered when prescribing other vitamin D-containing products; the calcium carbonate strength per tablet was not captured in the fetched sections - clinician to confirm from the full SPC. Milk-alkali syndrome (Burnett's syndrome) can develop when large amounts of calcium are ingested with absorbable alkali. Tablets contain sucrose (unsuitable in rare hereditary fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency). Allowances should be made for calcium and vitamin D supplements from other sources.

Dose adjustments

Renal

§4.2: should not be used in patients with severe renal impairment; §4.3 lists severe renal impairment and renal failure as contraindications. §4.4: vitamin D should be used with caution in renal impairment with monitoring of calcium and phosphate levels and consideration of the risk of soft tissue calcification; in severe renal insufficiency colecalciferol is not metabolised normally and other forms of vitamin D should be used.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Diseases and/or conditions resulting in hypercalcaemia and/or hypercalciuria (e.g. myeloma, bone metastases or other malignant bone disease, sarcoidosis, primary hyperparathyroidism) (§4.3)
Nephrolithiasis / nephrocalcinosis (§4.3)
Severe renal impairment and renal failure (§4.3)
Hypervitaminosis D (§4.3)
Hypersensitivity to the active substances or to any of the excipients, including soya or peanut (§4.3)
Relative contraindications: osteoporosis due to prolonged immobilisation, renal stones, severe hypercalciuria (§4.3)

Side effects

Hypercalcaemia and hypercalciuria (uncommon)
Constipation, flatulence, nausea, abdominal pain and diarrhoea (rare); dyspepsia (very rare)
Pruritus, rash and urticaria (rare)
Hypersensitivity reactions including pruritus, wheezing, urticaria and oropharyngeal swelling (frequency not known, post-marketing)
Milk-alkali syndrome (very rare - seen usually only in overdose). In patients with renal impairment there is a potential risk of hyperphosphataemia, nephrolithiasis and nephrocalcinosis

Interactions

Thiazide diuretics reduce the urinary excretion of calcium - monitor serum calcium regularly during concomitant use because of the increased risk of hypercalcaemia (§4.5); §4.4 adds that patients already taking thiazide diuretics and/or cardiac glycosides should be referred to their doctor prior to concomitant use
Systemic corticosteroids reduce calcium absorption - it may be necessary to increase the dose during concomitant use (§4.5)
Ion exchange resins - §4.5 was truncated at source fetch mid-sentence ('Simultaneous treatment with ion exchange...'); the remainder of the interaction section was not captured, so the clinician should review §4.5 in the full SPC

Clinical monograph

How it works

Colecalciferol is converted in the liver and kidney to active calcitriol, which enhances intestinal calcium absorption, while calcium carbonate provides elemental calcium as substrate for bone mineralisation.

Prescribing in practice

The most important safety point is the risk of hypercalcaemia and hypercalciuria, so it should be avoided in conditions predisposing to high calcium and used cautiously with other vitamin D or calcium products.
Calcium carbonate reduces absorption of several drugs, notably oral bisphosphonates, levothyroxine, and certain antibiotics, which should be separated in time.
Use with caution in renal impairment and in patients with a history of renal stones or sarcoidosis.

Monitoring

Monitor serum calcium (and renal function where relevant), particularly in those on high doses or with impaired renal function.

Counselling the patient

Take any bisphosphonate, levothyroxine, or relevant antibiotic at a separate time from this supplement.
Report symptoms such as nausea, thirst, constipation, or confusion that could indicate too much calcium.

Evidence & guidelines

Combined calcium and vitamin D supplementation is supported by NICE and NOGG guidance as adjunctive therapy alongside bone-protective treatment in osteoporosis.

Reference: NICE NG56; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways