Calcium carbonate
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]
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Overview
Calcium carbonate is an antacid that is FDA approved for the treatment of heartburn, sour stomach, acid indigestion, upset stomach associated with these symptoms. Common adverse reactions include Constipation, flatulence, swollen abdomen.
Adult Indications and Dosage
FDA-Labeled Indications and Dosage (Adult)
Indications
- Heartburn
- Sour stomach
- Acid indigestion
- Upset stomach associated with these symptoms
Dosage
- Chew 2 - 4 tablets as symptoms occur, or as directed by a doctor.
Off-Label Use and Dosage (Adult)
Guideline-Supported Use
Indications and Dosage
- Recommended dietary allowance (RDA) applies to elemental calcium from all sources (ie, dietary plus supplements).
- Calcium carbonate is 40% elemental calcium [3]; each mg calcium carbonate contains 0.4 mg of elemental calcium.
- Calcium deficiency; Prophylaxis: recommended dietary allowance (RDA) is the average daily intake from all sources (ie, diet and supplements) necessary to meet the nutrient requirements of nearly all (97% to 98%) healthy individuals; MAX is the upper intake level that is unlikely to cause adverse health effects.
- Calcium deficiency; Prophylaxis: 19 to 50 years, RDA is 1000 mg elemental calcium per day in divided doses of 500 mg or less each; MAX 2500 mg per day (guideline dosing).
- Calcium deficiency; Prophylaxis: 51 to 70 years (men), RDA is 1000 mg elemental calcium per day in divided doses of 500 mg or less each; MAX 2000 mg per day (guideline dosing).
- Calcium deficiency; Prophylaxis: 51 to 70 years (women), RDA is 1200 mg elemental calcium per day in divided doses of 500 mg or less each; MAX 2000 mg per day (guideline dosing).
- Calcium deficiency; Prophylaxis: greater than 70 years, RDA is 1200 mg elemental calcium per day in divided doses of 500 mg or less each; MAX 2000 mg per day (guideline dosing).
- Fracture of bone; Prophylaxis: United States Preventive Services Task Force recommendations for community-dwelling asymptomatic postmenopausal women without a history of fractures: Supplemental daily doses of 400 international units or less of vitamin D and 1000 mg or less of calcium are not recommended due to lack of evidence of a net benefit; evidence is lacking for a benefit of daily supplementation with greater than 400 international units of vitamin D and greater than 1000 mg of calcium as risk versus benefit could not be determined.
- Fracture of bone; Prophylaxis: men (50 to 70 years) 1000 mg elemental calcium per day total intake (diet plus supplements) in combination with 800 to 1000 international units vitamin D (National Osteoporosis Foundation guideline dosing).
- Fracture of bone; Prophylaxis: men (71 years or older) 1200 mg elemental calcium per day. total intake (diet plus supplements) in combination with 800 to 1000 international units vitamin D (National Osteoporosis Foundation guideline dosing).
- Fracture of bone; Prophylaxis: women (51 years or older) 1200 mg elemental calcium per day total intake (diet plus supplements) in combination with 800 to 1000 international units vitamin D (National Osteoporosis Foundation guideline dosing).
- Heartburn: 2 to 4 chewable tablets (calcium carbonate 750 mg [elemental calcium 300 mg] per tablet) ORALLY as symptoms occur; MAX: 10 tablets (7500 mg calcium carbonate; 3000 mg elemental calcium) in 24 hours; do not use maximum dosage for longer than 2 weeks.
- Hypocalcemia, Chronic: 1 to 3 g elemental calcium ORALLY daily in divided doses.
- Postmenopausal osteoporosis: women 51 years or older, 1200 mg elemental calcium per day total intake (diet plus supplements) in combination with 800 to 1000 international units vitamin D (National Osteoporosis Foundation guideline dosing).
- Renal failure-associated hyperphosphatemia: stage 3 to 5 chronic kidney disease, total dose of elemental calcium from all sources (ie, dietary and calcium-based phosphate binder) not to exceed 2000 mg/day (guideline dosing).
- Renal failure-associated hyperphosphatemia: stage 5 chronic kidney disease, total dose of elemental calcium from calcium-based phosphate binder not to exceed 1500 mg/day (guideline dosing).
Non–Guideline-Supported Use
There is limited information regarding Off-Label Non–Guideline-Supported Use of Calcium carbonate in adult patients.
Pediatric Indications and Dosage
FDA-Labeled Indications and Dosage (Pediatric)
There is limited information regarding Calcium carbonate FDA-Labeled Indications and Dosage (Pediatric) in the drug label.
Off-Label Use and Dosage (Pediatric)
Guideline-Supported Use
Indications and Dosing
Recommended dietary allowance (RDA) applies to elemental calcium from all sources (ie, dietary plus supplements).
- Calcium carbonate is 40% elemental calcium [3]; each mg calcium carbonate contains 0.4 mg of elemental calcium.
- Calcium deficiency; Prophylaxis: recommended dietary allowance (RDA) is the average daily intake from all sources (ie, diet and supplements) necessary to meet the nutrient requirements of nearly all (97% to 98%) healthy individuals; MAX is the upper intake level that is unlikely to cause adverse health effects.
- Calcium deficiency; Prophylaxis: 0 to 6 months, RDA is 200 mg elemental calcium per day; MAX 1000 mg per day (guideline dosing).
- Calcium deficiency; Prophylaxis: 6 to 12 months, RDA is 260 mg elemental calcium per day; MAX 1500 mg per day (guideline dosing).
- Calcium deficiency; Prophylaxis: 1 to 3 years, RDA is 700 mg elemental calcium per day; MAX 2500 mg per day (guideline dosing).
- Calcium deficiency; Prophylaxis: 4 to 8 years, RDA is 1000 mg elemental calcium per day; MAX 2500 mg per day (guideline dosing).
- Calcium deficiency; Prophylaxis: 9 to 13 years, RDA is 1300 mg elemental calcium per day; MAX 3000 mg per day (guideline dosing).
- Calcium deficiency; Prophylaxis: 14 to 18 years, RDA is 1300 mg elemental calcium per day; MAX 3000 mg per day (guideline dosing).
- Renal failure-associated hyperphosphatemia: stage 2 to 4 chronic kidney disease, serum levels of corrected total calcium should be maintained within the normal range for the laboratory used.
- Renal failure-associated hyperphosphatemia: stage 5 chronic kidney disease, total dose of elemental calcium from calcium-based phosphate binder not to exceed up to 2 times the dietary reference intake for calcium based on age and total intake of elemental calcium from all sources (dietary and phosphate binder) not to exceed 2500 mg/day (guideline dosing).
Non–Guideline-Supported Use
There is limited information regarding Off-Label Non–Guideline-Supported Use of Calcium carbonate in pediatric patients.
Contraindications
There is limited information regarding Calcium carbonate Contraindications in the drug label.
Warnings
Ask a doctor before use if you have
- Kidney stones
- A calcium-restricted diet
Ask a doctor or pharmacist before use if you are
- Now taking a prescription drug. Antacids may interact with certain prescription drugs.
When using this product
- Do not take more than 10 tablets in 24 hours
- Do not use the maximum dosage for more than 2 weeks
Keep out of reach of children.
Adverse Reactions
Clinical Trials Experience
Common
Gastrointestinal:
- Constipation
- Flatulence
- Swollen abdomen
Serious
Cardiovascular
- Myocardial infarction
Renal
- Urolithiasis
Reproductive
- Prostate cancer
Other
- Milk alkali syndrome
Postmarketing Experience
There is limited information regarding Calcium carbonate Postmarketing Experience in the drug label.
Drug Interactions
There is limited information regarding Calcium carbonate Drug Interactions in the drug label.
Use in Specific Populations
Pregnancy
Pregnancy Category (FDA):
There is no FDA guidance on usage of Calcium carbonate in women who are pregnant.
Pregnancy Category (AUS):
There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Calcium carbonate in women who are pregnant.
Labor and Delivery
There is no FDA guidance on use of Calcium carbonate during labor and delivery.
Nursing Mothers
There is no FDA guidance on the use of Calcium carbonate in women who are nursing.
Pediatric Use
There is no FDA guidance on the use of Calcium carbonate in pediatric settings.
Geriatic Use
There is no FDA guidance on the use of Calcium carbonate in geriatric settings.
Gender
There is no FDA guidance on the use of Calcium carbonate with respect to specific gender populations.
Race
There is no FDA guidance on the use of Calcium carbonate with respect to specific racial populations.
Renal Impairment
There is no FDA guidance on the use of Calcium carbonate in patients with renal impairment.
Hepatic Impairment
There is no FDA guidance on the use of Calcium carbonate in patients with hepatic impairment.
Females of Reproductive Potential and Males
There is no FDA guidance on the use of Calcium carbonate in women of reproductive potentials and males.
Immunocompromised Patients
There is no FDA guidance one the use of Calcium carbonate in patients who are immunocompromised.
Administration and Monitoring
Administration
Oral
Monitoring
There is limited information regarding Calcium carbonate Monitoring in the drug label.
IV Compatibility
There is limited information regarding the compatibility of Calcium carbonate and IV administrations.
Overdosage
There is limited information regarding Calcium carbonate overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.
Pharmacology
There is limited information regarding Calcium carbonate Pharmacology in the drug label.
Mechanism of Action
There is limited information regarding Calcium carbonate Mechanism of Action in the drug label.
Structure
There is limited information regarding Calcium carbonate Structure in the drug label.
Pharmacodynamics
There is limited information regarding Calcium carbonate Pharmacodynamics in the drug label.
Pharmacokinetics
There is limited information regarding Calcium carbonate Pharmacokinetics in the drug label.
Nonclinical Toxicology
There is limited information regarding Calcium carbonate Nonclinical Toxicology in the drug label.
Clinical Studies
There is limited information regarding Calcium carbonate Clinical Studies in the drug label.
How Supplied
There is limited information regarding Calcium carbonate How Supplied in the drug label.
Storage
- Store at 20 - 25°C (68 - 77°F)
Images
Drug Images
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Package and Label Display Panel
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Patient Counseling Information
There is limited information regarding Calcium carbonate Patient Counseling Information in the drug label.
Precautions with Alcohol
Alcohol-Calcium carbonate interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
Brand Names
Calcium carbonate
Look-Alike Drug Names
There is limited information regarding Calcium carbonate Look-Alike Drug Names in the drug label.
Drug Shortage Status
Price
References
The contents of this FDA label are provided by the National Library of Medicine.
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]
Overview
Calcium carbonate is a chemical compound, with the chemical formula CaCO3. It is a common substance found as rock in all parts of the world, and is the main component of shells of marine organisms, snails, and eggshells. Calcium carbonate is the active ingredient in agricultural lime, and is usually the principal cause of hard water. It is commonly used medicinally as a calcium supplement or as an antacid.
Occurrence
Calcium carbonate is found naturally as the following minerals and rocks: Aragonite, Calcite, Vaterite or (μ-CaCO3), Chalk, Limestone, Marble and Travertine
To test whether a mineral or rock contains calcium carbonate, strong acids, such as hydrochloric acid, can be added to it. If the sample does contain calcium carbonate, it will fizz and produce carbon dioxide and water. Weak acids such as acetic acid will react, albeit less vigorously. All of the rocks/minerals mentioned above will react with acid.
Chemical properties
- See also: Carbonate
Calcium carbonate shares the typical properties of other carbonates. Notably:
- it reacts with strong acids, releasing carbon dioxide:
CaCO3 + 2HCl → CaCl2 + CO2 + H2O
Calcium carbonate will react with water that is saturated with carbon dioxide to form the soluble calcium bicarbonate.
- CaCO3 + CO2 + H2O → Ca(HCO3)2
Preparation
The vast majority of calcium carbonate used in industry is extracted by mining or quarrying. Pure calcium carbonate (e.g. for food or pharmaceutical use), can be produced from a pure quarried source (usually marble).
Alternatively, calcium oxide is prepared by calcining crude calcium carbonate. Water is added to give calcium hydroxide, and carbon dioxide is passed through this solution to precipitate the desired calcium carbonate, referred to in the industry as precipitated calcium carbonate (PCC):[1]
- CaCO3 → CaO + CO2
- CaO + H2O → Ca(OH)2
- Ca(OH)2 + CO2 → CaCO3 + H2O
Uses
Health and dietary applications
Calcium carbonate is widely used medicinally as an inexpensive dietary calcium supplement or antacid.[2] It may be used as a phosphate binder for the treatment of hyperphosphatemia (primarily in patients with chronic renal failure) when lanthanum carbonate is not prescribed. It is also used in the pharmaceutical industry as an inert filler for tablets and other pharmaceuticals.[3]
As a food additive, it is used in some soy milk products as a source of dietary calcium; one study concludes that calcium carbonate is as bioavailable as ordinary cow's milk.[4]
Solubility
With varying pH
We now consider the problem of the maximum solubility of calcium carbonate in normal atmospheric conditions (<math>\scriptstyle P_{\mathrm{CO}_2}</math> = 3.5 × 10−4 atm) when the pH of the solution is adjusted. This is for example the case in a swimming pool where the pH is maintained between 7 and 8 (by addition of NaHSO4 to decrease the pH or of NaHCO3 to increase it). From the above equations for the solubility product, the hydratation reaction and the two acid reactions, the following expression for the maximum [Ca2+] can be easily deduced:
- <math>[\mathrm{Ca}^{2+}]_\mathrm{max} = \frac{K_\mathrm{sp}k_\mathrm{H}} {K_\mathrm{h}K_\mathrm{a1}K_\mathrm{a2}} \frac{[\mathrm{H}^+]^2}{P_{\mathrm{CO}_2}}</math>
showing a quadratic dependence in [H+]. The numerical application with the above values of the constants gives
| Template:Chembox header width="170" align="center" |pH | 7.0 | 7.2 | 7.4 | 7.6 | 7.8 | 8.0 | 8.2 | 8.27 | 8.4 |
| Template:Chembox header width="170" align="center" |[Ca2+]max (10-4mol/L or °F) | 1590 | 635 | 253 | 101 | 40.0 | 15.9 | 6.35 | 4.70 | 2.53 |
| Template:Chembox header width="170" align="center"|[Ca2+]max (mg/L) | 6390 | 2540 | 1010 | 403 | 160 | 63.9 | 25.4 | 18.9 | 10.1 |
Comments:
- decreasing the pH from 8 to 7 increases the maximum Ca2+ concentration by a factor 100
- note that the Ca2+ concentration of the previous table is recovered for pH = 8.27
- keeping the pH to 7.4 in a swimming pool (which gives optimum HClO/OCl− ratio in the case of "chlorine" maintenance) results in a maximum Ca2+ concentration of 1010 mg/L. This means that successive cycles of water evaporation and partial renewing may result in a very hard water before CaCO3 precipitates. Addition of a calcium sequestrant or complete renewing of the water will solve the problem.
Solubility in a strong or weak acid solution
Solutions of strong (HCl) or weak (acetic, phosphoric) acids are commercially available. They are commonly used to remove limescale deposits. The maximum amount of CaCO3 that can be "dissolved" by one liter of an acid solution can be calculated using the above equilibrium equations.
- In the case of a strong monoacid with decreasing concentration [A] = [A−], we obtain (with CaCO3 molar mass = 100 g):
| width="160" Template:Chembox header |[A] (mol/L) | 1 | 10−1 | 10−2 | 10−3 | 10−4 | 10−5 | 10−6 | 10−7 | 10−10 |
| width="160" Template:Chembox header |Initial pH | 0.00 | 1.00 | 2.00 | 3.00 | 4.00 | 5.00 | 6.00 | 6.79 | 7.00 |
| width="160" Template:Chembox header |Final pH | 6.75 | 7.25 | 7.75 | 8.14 | 8.25 | 8.26 | 8.26 | 8.26 | 8.27 |
| width="160" Template:Chembox header |Dissolved CaCO3 (g per liter of acid) | 50.0 | 5.00 | 0.514 | 0.0849 | 0.0504 | 0.0474 | 0.0471 | 0.0470 | 0.0470 |
where the initial state is the acid solution with no Ca2+ (not taking into account possible CO2 dissolution) and the final state is the solution with saturated Ca2+. For strong acid concentrations, all species have a negligible concentration in the final state with respect to Ca2+ and A− so that the neutrality equation reduces approximately to 2[Ca2+] = [A−] yielding <math>\scriptstyle[\mathrm{Ca}^{2+}] \simeq \frac{[\mathrm{A}^-]}{2}</math>. When the concentration decreases, [HCO3−] becomes non negligible so that the preceding expression is no longer valid. For vanishing acid concentrations, we recover the final pH and the solubility of CaCO3 in pure water.
- In the case of a weak monoacid (here we take acetic acid with pKA = 4.76) with decreasing concentration [A] = [A−]+[AH], we obtain:
| width="160" Template:Chembox header |[A] (mol/L) | 1 | 10−1 | 10−2 | 10−3 | 10−4 | 10−5 | 10−6 | 10−7 | 10−10 |
| width="160" Template:Chembox header |Initial pH | 2.38 | 2.88 | 3.39 | 3.91 | 4.47 | 5.15 | 6.02 | 6.79 | 7.00 |
| width="160" Template:Chembox header |Final pH | 6.75 | 7.25 | 7.75 | 8.14 | 8.25 | 8.26 | 8.26 | 8.26 | 8.27 |
| width="160" Template:Chembox header |Dissolved CaCO3 (g per liter of acid) | 49.5 | 4.99 | 0.513 | 0.0848 | 0.0504 | 0.0474 | 0.0471 | 0.0470 | 0.0470 |
We see that for the same total acid concentration, the initial pH of the weak acid is less acid than the one of the strong acid; however, the maximum amount of CaCO3 which can be dissolved is approximately the same. This is because in the final state, the pH is larger that the pKA, so that the weak acid is almost completely dissociated, yielding in the end as many H+ ions as the strong acid to "dissolve" the calcium carbonate.
- The calculation in the case of phosphoric acid (which is the most widely used for domestic applications) is more complicated since the concentrations of the four dissociation states corresponding to this acid must be calculated together with [HCO3−], [CO32−], [Ca2+], [H+] and [OH−]. The system may be reduced to a seventh degree equation for [H+] the numerical solution of which gives
| width="160" Template:Chembox header |[A] (mol/L) | 1 | 10−1 | 10−2 | 10−3 | 10−4 | 10−5 | 10−6 | 10−7 | 10−10 |
| width="160" Template:Chembox header |Initial pH | 1.08 | 1.62 | 2.25 | 3.05 | 4.01 | 5.00 | 5.97 | 6.74 | 7.00 |
| width="160" Template:Chembox header |Final pH | 6.71 | 7.17 | 7.63 | 8.06 | 8.24 | 8.26 | 8.26 | 8.26 | 8.27 |
| width="160" Template:Chembox header |Dissolved CaCO3 (g per liter of acid) | 62.0 | 7.39 | 0.874 | 0.123 | 0.0536 | 0.0477 | 0.0471 | 0.0471 | 0.0470 |
where [A] = [H3PO4] + [H2PO4−] + [HPO42−] + [PO43−]. We see that phosphoric acid is more efficient than a monoacid since at the final almost neutral pH, the second dissociated state concentration [HPO42−] is not negligible (see phosphoric acid ).
References
- ↑ "Solvay Precipitated Calcium Carbonate: Production". Solvay S. A. 2007-03-09. Retrieved 2007-12-30.
- ↑ "Calcium Carbonate". Medline Plus. National Institutes of Health. 2005-10-01. Retrieved 2007-12-30.
- ↑ Herbert A. Lieberman, Leon Lachman, Joseph B. Schwartz (1990). Pharmaceutical Dosage Forms: Tablets. p. 153. ISBN 0824780442.
- ↑ Y. Zhao, B. R. Martin and C. M. Weaver (2005). "Calcium Bioavailability of Calcium Carbonate Fortified Soymilk Is Equivalent to Cow's Milk in Young Women". J. Nutr. 135 (10): 2379–2382.
External links
ar:كربونات كالسيوم cs:Uhličitan vápenatý da:Calciumcarbonat de:Calciumcarbonat et:Kaltsiumkarbonaat it:Carbonato di calcio he:סידן פחמתי lv:Kalcija karbonāts hu:Kalcium-karbonát nl:Calciumcarbonaat no:Kalsiumkarbonat nn:Kalsiumkarbonat simple:Calcium carbonate sk:Uhličitan vápenatý sl:Kalcijev karbonat sr:Калцијум карбонат fi:Kalsiumkarbonaatti sv:Kalciumkarbonat th:แคลเซียมคาร์บอเนต uk:Карбонат кальцію