Calcium carbonate with calcium lactate gluconate

How it works

Both salts dissociate to deliver elemental calcium, replenishing extracellular calcium and supporting bone mineralisation, neuromuscular function and the negative feedback that suppresses parathyroid hormone.

Prescribing in practice

• Avoid in conditions associated with hypercalcaemia or hypercalciuria (such as certain malignancies, sarcoidosis or severe renal impairment) where further calcium loading can be harmful.
• Separate dosing from oral tetracyclines, quinolones, levothyroxine, iron and bisphosphonates, as calcium chelates and reduces their absorption.
• The effervescent preparation carries a notable sodium load, which is relevant in hypertension, heart failure or renal impairment.

Monitoring

Monitor serum calcium (and renal function) periodically, particularly with high-dose or long-term use or where there is a risk of hypercalcaemia.

Counselling the patient

• Dissolve the effervescent tablet fully in water before drinking.
• Take other medicines such as antibiotics or thyroid tablets a couple of hours apart from your calcium.
• Report persistent nausea, constipation, excessive thirst or confusion, which can signal high calcium levels.

Evidence & guidelines

Calcium with vitamin D supplementation is recommended by NICE as an adjunct to osteoporosis treatment in those with inadequate dietary intake.