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Combined calcium + vitamin D Pregnancy: UK SPC section 4.6: 'Pregnancy: The tablets should not be used in the second and third trimester of pregnancy. Breast-feeding: Should not be used while breast-feeding as it may cause hypercalcaemia in the infant, since calcium is excreted in the breast milk. In the neonate problems in nursing babies have not been documented.'

Ergocalciferol with calcium lactate and calcium phosphate

Brand names: Calcium with Vitamin D

This is a combination preparation of ergocalciferol (vitamin D2) with calcium lactate and calcium phosphate, used to treat or prevent combined calcium and vitamin D deficiency.

Adult dose

Dose: Treatment of calcium and vitamin D deficiency, adults - normal deficiency: one tablet daily (each tablet contains calcium lactate pentahydrate 300 mg, calcium phosphate 150 mg and ergocalciferol 400 i.u.). Severe deficiency: higher doses may be necessary, as directed by the physician (the SPC gives no figure for these).
Route: Oral
Frequency: Once daily
Section 4.1 is 'For the treatment of calcium and vitamin D deficiency'; the SPC does not name osteoporosis. This card is for this product only; other calcium/vitamin D products differ in strength and are not covered. VERBATIM section 4.2: 'Adults: Normal deficiency: One tablet daily. Severe deficiency: Higher doses may be necessary, as directed by the physician. The elderly: Do not use in the elderly without medical advice. Children: Over 12 years of age: As directed by the physician. Under 12 years of age: Not recommended. Method of administration: Oral.' NO MAXIMUM DOSE is printed, so none is given. PAEDIATRIC: no figure is printed (over 12 years 'as directed by the physician', under 12 years 'not recommended'), so no paediatric dose is given. Text came from a PDF and has odd spacing and a few garbled lines in section 4.5.

Dose adjustments

Renal

UK SPC section 4.3: renal function impairment and renal calculi are contraindications. Section 4.4: plasma-calcium concentrations should be monitored in renal impairment; the role of the liver and kidney in the different forms of vitamin D should be borne in mind. No dose adjustment figure is given.

Hepatic

The UK SPC gives no dose adjustment for hepatic impairment; section 4.4 asks that the role of the liver and kidney in the different forms of vitamin D be borne in mind.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via MHRA Products — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

  • Hypersensitivity to the active substances or to any of the excipients (section 4.3)
  • Hypercalcaemia; hypercalciuria; renal calculi; renal function impairment (section 4.3)
  • Sarcoidosis; hypoparathyroidism; metastatic calcification (section 4.3)
  • Rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption (section 4.4; the tablet contains lactose)
  • Not to be used in the second and third trimesters of pregnancy, or while breast-feeding (section 4.6)
  • Not to be used in the elderly without medical advice (section 4.2)

Side effects

  • Hypercalcaemia may occur (frequency unknown); constipation, drowsiness, headache, loss of appetite, unusually dry mouth, tiredness or weakness are early signs of hypercalcaemia (section 4.8)
  • Abdominal pain, constipation, diarrhoea, nausea, vomiting, weight loss, hypercalciuria, arrhythmia, asthenia, myalgia (section 4.8)
  • Undesirable effects are more likely if larger than recommended doses are taken, if taken for a longer period of time or if taken by patients with renal function impairment (section 4.8)

Interactions

  • Thiazides (e.g. hydrochlorothiazide, chlorothiazide, bendroflumethiazide) and also chlortalidone, indapamide, metolazone: increased risk that hypercalcaemia may develop (section 4.5)
  • Digoxin and other cardiac glycosides: their effects may be enhanced by calcium, especially in combination with ergocalciferol, and may precipitate digitalis intoxication (section 4.5)
  • Other calcium and magnesium-containing medications: may increase serum calcium or magnesium concentrations, leading to hypercalcaemia or hypermagnesaemia (section 4.5)
  • Large doses of vitamin D, especially calcifediol and calcitriol: may increase intestinal absorption of calcium, increasing the risk of chronic hypercalcaemia (section 4.5)
  • Calcium lactate decreases the absorption of iron, tetracyclines, zinc, dolutegravir, eltrombopag, estramustine (section 4.5)
  • Phenytoin: decreases the bioavailability of both phenytoin and calcium (section 4.5)
  • Barbiturates or anticonvulsants may reduce vitamin D activity; phenobarbitone and primidone decrease the effect of ergocalciferol (section 4.5)
  • Sodium fluoride: may complex and inhibit absorption of both fluoride and calcium (section 4.5)
  • Potassium phosphates or potassium and sodium phosphates: may increase the potential for deposition of calcium in soft tissues if serum ionised calcium is high (section 4.5)
  • More than 5,000 iu vitamin A per day may stimulate bone loss and counteract the effects of calcium supplementation (section 4.5)
  • Excessive alcohol, caffeine or tobacco decrease calcium absorption; fibre, oxalates and phytates may reduce calcium absorption; oestrogens or oestrogen-containing oral contraceptives may increase calcium absorption (section 4.5)
  • Three lines of section 4.5 (calcitonin, cellulose sodium phosphate, etidronate) are garbled at source and are not reproduced

Monitoring

  • Plasma-calcium concentrations at intervals, and whenever nausea or vomiting occurs, or in renal impairment and in patients receiving high doses (section 4.4)
  • Risk-benefit should be considered in dehydration, electrolyte imbalance, diarrhoea or chronic gastro-intestinal malabsorption (section 4.4)
  • The hypercalcaemic effect should be borne in mind when prescribing (section 4.4)

Clinical monograph

How it works

Ergocalciferol is converted to active vitamin D metabolites that enhance intestinal absorption of calcium and phosphate, while the calcium salts directly supply elemental calcium for bone mineralisation.

Prescribing in practice

  • Avoid in hypercalcaemia, hypercalciuria and conditions with vitamin D oversensitivity, as the combined calcium and vitamin D load can precipitate or worsen hypercalcaemia.
  • Calcium salts reduce absorption of oral tetracyclines, levothyroxine, bisphosphonates and some quinolones, so separate administration times.
  • Use with caution in renal impairment, sarcoidosis and a history of calcium-containing renal stones.

Monitoring

Monitor serum and urinary calcium periodically, especially in renal impairment or where high doses are used long term.

Counselling the patient

  • Take other medicines such as thyroid tablets or certain antibiotics at a different time from this supplement.
  • Report nausea, constipation, excessive thirst or passing large amounts of urine, which can indicate high calcium.
  • Do not take additional calcium or vitamin D products without advice.

Evidence & guidelines

Combined calcium and vitamin D supplementation is supported by NICE guidance for correcting deficiency and as an adjunct in osteoporosis management.

Reference: NICE NG121; Royal Osteoporosis Society; 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).

Related

Curated clinical cross-links plus same-class fallbacks.

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