Calcium + Vitamin D3: dosage, use and indications

It is obvious that products containing colecalciferol can be considered the drugs of choice for the treatment and prevention of vitamin D insufficiency and deficiency: they are included in domestic and foreign clinical recommendations. But in what cases is it appropriate to recommend combined preparations of vitamin D and calcium to visitors and what should their attention be paid to?

From effect to indications

As you know, the main function of vitamin D is to regulate calcium-phosphorus metabolism. In the form of active metabolites, it takes part in the process of calcium absorption in the intestine and its excretion by the kidneys. In the presence of sufficient vitamin D, calcium absorption in the intestine is optimal. If the need for the “sunshine vitamin” is not compensated, calcium absorption decreases. Due to the low level of ionized calcium in the blood, the synthesis of parathyroid hormone is stimulated, which works to increase serum calcium, in particular, it stimulates the leaching of calcium and phosphorus from the bones. This chain of changes leads to a natural result of vitamin D deficiency - a decrease in calcium levels, changes in bone mineralization and, as a consequence, the development of rickets and osteoporosis.

Of course, there is no need to educate clients about these difficulties. Suffice it to say that hypovitaminosis D is associated with a negative calcium balance and decreased bone mineralization. These complications can be prevented by complex preparations of vitamin D and calcium, which potentiate the effect of each component. Their main task and leading indication is the prevention and treatment (as part of complex therapy) of osteoporosis, which usually develops in old age.

• It is appropriate to give preference to colecalciferol and calcium preparations when asking for drugs for the prevention and treatment of osteoporosis in women during or after menopause, as well as for strengthening bones in old age.

Dosage and course of treatment

According to the recommendations of the Russian Association of Endocrinologists, the preventive dose of vitamin D for 18-50 years old is 600-800 IU per day, and for those over 50 years old - 800-1000 IU per day. The dosage of calcium aimed at preventing bone density can be up to 2000 mg per day. In addition, existing recommendations indicate that for better absorption, a single dose of calcium should not exceed 600 mg.

Medicines - sources of vitamin D and calcium have balanced formulas and contain 200 or 400 IU of colecalciferol and 500 mg of calcium. All of them are taken 1 tablet 1-2 times a day, and the average dosage of the components supplied with them does not exceed the recommended daily doses.

• When dispensing drugs of this group to clients, it is appropriate to note that the dosage of the drugs is selected in such a way as to compensate for the body’s needs and to prevent excess vitamin and calcium. Therefore, you cannot independently increase the dose indicated in the instructions - this can lead to an increase in the level of calcium in the blood, which can impair the functioning of the kidneys and blood vessels.

Along with the dosage, it is important to follow the course of treatment recommended in the instructions. On average, it ranges from 4 to 6 weeks, but it may vary slightly for different drugs.

• When consulting a client, it should be emphasized that colecalciferol and vitamin D 3 for a long time without consulting a doctor .

Use during pregnancy, lactation, and childhood

Almost all drugs containing colecalciferol and vitamin D3 can be used during pregnancy and breastfeeding. However, we must not forget that hypercalcemia during pregnancy can adversely affect the development of the fetus. Therefore, the drugs themselves, and their dosage and course of treatment, should be selected by the attending physician.

Children's age is also not a contraindication to the use of the combination of colecalciferol + calcium. But, again, the doctor must decide on prescribing these drugs to children and select the dose and duration of therapy.

What else should you warn the client about?

When dispensing combined preparations of vitamin D and calcium, it is important to take into account that calcium salts reduce the pH of gastric juice, slow down gastric motility and, moreover, easily form complexes with a number of substances, which can interfere with the absorption of drugs. Therefore, it is better to take medications containing calcium separately from other medications - on average 2 hours before or 4-6 hours after, unless otherwise indicated.

In addition, you should remember the most common drug interactions with drugs from the following pharmacological groups:

• Antibiotics of the tetracycline group - when taken simultaneously with calcium supplements, the absorption of antibiotics may decrease. Therefore, tetracycline antibiotics should be taken at least 2 hours before or 4–6 hours after taking calcium supplements.
• Bisphosphonates – when taken simultaneously with colecalciferol and calcium, the absorption of bisphosphonates is reduced. Therefore, the time interval between the use of bisphosphonates and calcium supplements should be at least half an hour, and it is better to take them at different times of the day.

NB! Bisphosphonates are first-line drugs for the treatment of osteoporosis and can be part of a comprehensive treatment regimen along with vitamin D and calcium supplements.

• Cardiac glycosides and calcium channel blockers - when taken together with calcium supplements and/or vitamin D, it is recommended to monitor the level of calcium in the blood to avoid the development of hypercalcemia. The latter increases the risk of fatal arrhythmias in patients receiving digoxin and reduces the effectiveness of calcium channel blockers.
• Thiazide diuretics - reduce calcium excretion, which is associated with an increased risk of hypercalcemia. It is important for patients receiving these drugs to monitor serum calcium levels regularly.

We have listed only the most common drug interactions; their full list is much more extensive. And in order to prevent them, it is important to persistently recommend that the client take any medications separately from calcium and vitamin D preparations. And to make it easier for you to navigate the fairly large assortment, we have prepared a table for downloading, in which we have collected currently registered medications containing colecalciferol and calcium with dosages of active ingredients and indications. We hope that this information will help you easily and quickly select a drug for appropriate requests.

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Pharmacodynamics and pharmacokinetics

The substance accelerates the absorption of calcium in the digestive tract and activates the reabsorption of phosphorus in the renal tubules. Under the influence of this vitamin , normal formation of the bone skeleton and teeth occurs, and the correct bone structure is maintained. Colecalciferol increases the permeability of mitochondrial and cellular membranes on the intestinal epithelium, which greatly facilitates the transport of calcium cations and activates the processes of secondary absorption of phosphates. Stimulates ossification .

The drug is absorbed in the distal part of the small intestine in the presence of bile, then penetrates into the lymphatic system, into the general bloodstream and liver tissue. The substance is distributed throughout almost the entire body (liver, kidneys, skeletal muscles, adrenal glands, adipose tissue, myocardium), and has a high degree of binding to albumin and globulins .

The maximum concentration of the vitamin in the blood is observed 5 hours after ingestion. Then this indicator decreases slightly, but remains at a high level. Polar metabolites of the drug are concentrated in cell membranes, microsomes , nuclei and mitochondria . Metabolism occurs in the kidneys and liver with the formation of active metabolites.

The substance is excreted with bile into the intestines, where its derivatives can be reabsorbed or excreted from the body with feces.

Sources of Vitamin D3

Let's look at what foods contain cholecalciferol.

1. Fish and products made from it. The largest amount of the vitamin compound is found in fish oil. To meet the daily requirement of an adult (10 mcg), you need to drink eight drops of this substance daily. The most fish oil is found in herring, sardine - 1.5 - 2.5 g per 100 g of product, salmon - 1.3 - 2.2, mackerel - 1.2 - 2.0, halibut - 0.8 - 1 .4, tuna – 0.3 – 1.3 g; cod – 0.2 – 0.3. 5 cod livers, 125 g of black caviar, 200 g of red caviar, 150 g of salmon fillet, 50 g of sprat in oil, 850 g of whiting fillet contain the daily norm of cholecalciferol. Additional benefits of fish are the abundance of fatty acids and vitamin A, which have a healing, strengthening effect on the human body. The disadvantages of products in this category include: fat content of products, high cholesterol levels, which pose a potential danger for the development of obesity and problems with blood vessels.
2. Meat and offal. The tenderloin contains a small amount of a beneficial compound (up to 0.2 mcg per 100 g of product), while in beef liver this figure increases to 1.2, in lamb liver - up to 1, in lamb kidneys - up to 0.5. These products are rich not only in vitamin D3, but also in vitamins A, B, K. However, it is important to remember that by consuming only meat and offal, it is extremely difficult to fully satisfy the body’s need for cholecalciferol.
3. Chicken eggs. One yolk contains 2 mcg of cholecalciferol. Goose, quail, and turkey eggs also contain D3, but in very small quantities.
4. Dairy products. 100 g of ghee contains 1.8 mcg of the nutrient (560 g is required to meet the daily requirement), butter - 1.5 mcg (670 g), Dutch and Swiss cheese - 1 mcg (1000 g). In 100 g/ml of fermented baked milk, cottage cheese, milk, kefir, the level of cholecalciferol ranges from 0.05 to 0.1 mcg. Despite the fact that the content of the vitamin compound in these products is small, if you consume a large amount of lactic acid products, you can half satisfy the adult body’s need for the substance (5 mcg).
5. Mushrooms. 100 grifol contains 63 mcg of cholecalciferol (to “repay” the daily requirement of D3, it is enough to eat 16 g of the product daily), chanterelles - 8.8 mcg (130 g), morels - 6.3 mcg (150 g), oyster mushrooms - 2.6 mcg (400 g). However, when purchasing, it is important to consider that the vitamin is produced in the fruiting bodies of only those mushrooms that are grown in the sun. If chanterelles, champignons, and oyster mushrooms were grown on farms under “artificial” conditions, ergosterol in them is not converted into D3, and as a result, they do not compensate for the lack of this nutrient in the body.
6. Plant products (horsetail, nettle, alfalfa, parsley) - up to 0.01 mcg of vitamin per 100 g.

Thus, the largest amount of cholecalciferol is found in animal by-products (kidneys, liver) and in fatty sea fish - blue whiting, haddock, cod, salmon, and the smallest amount is in vegetables, berries, fruits, and herbs.

Due to the fact that vitamin D3 is resistant to heat treatment, after boiling and frying foods rich in the beneficial compound, the loss of the nutrient is 2-3%, which does not lead to a significant decrease in the substance in the finished dish.

Indications for use

The medicine is prescribed:

• for the prevention and treatment of hypovitaminosis and vitamin D deficiency;
• for rickets , spasmophilia , osteoporosis , osteomalacia ;
• patients with nephrogenic osteopathy ;
• with unbalanced and inadequate nutrition (diet, including vegetarian, parenteral nutrition );
• patients with hypocalcemia , hypophosphatemia ;
• with insufficient insolation;
• alcoholics;
• for liver diseases, including cirrhosis and obstructive jaundice ;
• patients with diseases of the digestive tract, persistent diarrhea , celiac enteropathy , tropical sprue , Crohn's disease , malabsorption ;
• while taking barbiturates and mineral oils;
• as a prophylactic agent during treatment with anticonvulsants, primidone , phenytoin ;
• for postoperative, idiopathic hypoparathyroidism , tetany ;
• patients with pseudohypoparathyroidism .

Contraindications

Colecalciferol is contraindicated for use:

• in the presence of hypersensitivity reactions to the substance;
• patients with hypercalciuria , hypercalcemia , calcium nephrourolithiasis ;
• in large dosages in bedridden patients;
• for hyperphosphatemia , renal osteodystrophy ;
• patients with sarcoidosis ;
• with an active form of pulmonary tuberculosis .

Side effects

Colecalciferol rarely causes adverse reactions. Most often, they occur due to drug abuse, with hypercalcemia or hypercalciuria .

However, during vitamin treatment the following may occur:

• headaches , exacerbation of pulmonary tuberculosis ;
• diarrhea , constipation, side effects from the digestive tract, nausea;
• kidney irritation;
• vomiting , disturbances in the functioning of the cardiovascular system, general weakness and irritability.

Our own “sunshine” vitamin

When creating a diet rich in vitamin D3, it is important to consider that the required amount of cholecalciferol for the human body is difficult to obtain solely from food. For example, it is not always possible to eat 850 g of cod or 1000 g of Swiss cheese every day. Therefore, remember, to cover the daily requirement, it is important to be in the sun more often, since the body is able to synthesize the compound in the skin on its own.

Outdoor sports and a balanced diet are the ideal combination for the proper development and maintenance of bone and muscle tone.

Let's consider what conditions should be observed so that the human body does not experience cholecalciferol deficiency all year round, without being tied to the diet.

1. Walk outside for 2-3 hours every day.
2. In late spring, summer, early autumn, keep as much of the skin as possible open so that sunlight can easily penetrate the upper layers of the epithelium.
3. Temper yourself, take walks in the winter, when the body most acutely lacks vitamin compounds.

Remember, D3 can accumulate in adipose tissue, liver and be consumed during the cold season. From this it follows that in order to have a supply of nutrients in the body for the next 3-6 months, it is enough to take an intensive walk every day in the summer on sunny days.

Colecalciferol, instructions for use (Method and dosage)

The drug is prescribed for oral administration. At the same time, it is used in a daily dosage of 400 to 600 IU.

200 thousand IU are administered intramuscularly. Dosage depends on age and indications.

To treat spasmophilia , rickets and calcium deficiency in the body, 200 thousand IU is used every 7 days in combination with calcium salts for two weeks.

For osteomalacia and osteoporosis - 200 thousand IU, every 2 weeks, course of treatment - 3 months.

Daily requirement

The daily dosage of cholecalciferol is:

• for infants and infants up to 1 year – 400 IU (10 mcg);
• for children from 1 to 10 years – 600 IU (15 mcg);
• for adolescents under 18 years of age, as well as adults, pregnant and lactating women – 650 IU (16.25 mcg);
• for older people (over 65 years) – 800 IU (20 mcg).

Until what age should I take vitamin D3 and how should I give it?

To build and renew bone tissue, the human body needs cholecalciferol at any age. To fully meet your daily nutrient requirements, it is important to spend at least 90 minutes daily in the sun with bare areas of the body (arms, legs, back), eat foods containing a beneficial compound (usually of animal origin) or take active supplements during food.

To absorb the synthetic substance, when using a D3-containing drug, it is important to simultaneously eat a fatty product (for example, three grams of butter or five milliliters of vegetable oil).

The body's need for vitamin D3 is influenced by the geography of your residence: the closer to the north, the more cholecalciferol you need. Thus, from the thirty-seventh parallel during the winter period, a person practically does not receive a beneficial connection from natural sunlight.

In addition, it is important to remember that people with dark skin synthesize the vitamin worse, and as a result, to meet their daily needs, it is better for them to live closer to the equator.

According to research, sunscreens interfere with the full production of the nutrient in the upper layers of the epithelium. And a product labeled SPF8 completely blocks the production of the vitamin in the skin.

For diagnostic purposes, the content of cholecalciferol in the body is usually determined together with ergocalciferol and their products produced in serum. The total concentration of compounds normally ranges from one to two nanograms per milliliter.

Overdose

Symptoms of overdose also appear when the patient is hypersensitive to this substance. Observed: nausea, heart rhythm disturbances, headaches , vomiting, general weakness, weight loss, irritability, thirst, frequent urination, urolithiasis , anorexia , increased blood pressure , constipation, kidney disease.

Chronic poisoning with Colecalciferol leads to demineralization of bones, deposition of calcium salts in the heart, kidneys, lungs, and digestive tract; to disruption of the functioning of these organs, including death.

As therapy, the medication is discontinued and vitamin E , corticosteroids, magnesium, vitamin C , potassium, thiamine and retinol .

Drugs containing (Analogs)

Level 4 ATX code matches:
Etalfa

Dihydrotachysterol

Oksidevit

Tevabon

Alpha D3-Teva

Ergocalciferol

Aquadetrim

Vigantol

Medicines that contain this substance: Vigantol , Videhol solution in oil, Vitamin D3 100 SD/S dry , Vitamin D3 aqueous solution , Aquadetrim , Videhol , Vitamin D3 , Vitamin D3 BON , Cholecalciferol .

Calcium carbonate and Colecalciferol are included in the preparations: Revital Calcium D3 , Ideos , Calcium D3 Classic , Calcium-D3 Nycomed Forte , Complivit calcium D3 , Complivit calcium D3 forte , Revital Calcium D3 , Calcium + Vitamin D3 Vitrum , Calcium-D3 Nycomed , Calcium -D3-MIK , Complivit Calcium D3 for babies, Natekal D3 .

Vitamin D3 in combination with calcium carbonate and ascorbic acid is part of the drug Calcium SEDICO .

In combination with alendronic acid, Fosavance Forte tablets .

On guard of skin immunity

The skin is the body's first line of defense against viruses, bacteria and pathogens. At the same time, 95% of the dermis consists of protective cells - keratinocytes, involved in immune processes. These organelles have special “sensors” to respond to changes in microbial flora and receive various signals from the outside. After a skin lesion, keratinocytes surrounding the wound increase the cells' genetic coding to create peptides and antimicrobial receptors. Vitamin D3 potentiates the ability of these “agents” to recognize pathogenic microorganisms, resulting in the formation of a protective clot. At the same time, keratinocytes and cholecalciferol create an almost impenetrable barrier to infection inside the skin. However, the full course of such reactions is possible only if there is a sufficient amount of vitamin D3 in the body.

Let's consider the mechanism of activation of cholecalciferol.

Natural production of the nutrient occurs in the deepest layers of the skin: the spinous (stratum spinosum) and germinal (stratum basale), containing maximum concentrations of the compound 7-dehydrocholesterol. This substance, absorbing ultraviolet radiation (type B), changes its structure, as a result of which the prohormone is synthesized - vitamin D3. Cholecalciferol is then transported to the liver to form the next form of vitamin D, calcidiol. When the microbial flora on the skin changes, “sensors” transmit danger signals to the brain, as a result of which the component is transported from the liver to the kidneys, where it is converted into the active form, calcitriol.

After the final conversion, the “sunshine” vitamin again enters the bloodstream, from where, with the help of transport proteins, it is delivered to the organs. In regions with long winters, the natural production of prohormone slows down, provoking the development of D3 hypovitaminosis, and as a result, a weakening of the innate immunity of the skin. Therefore, to maintain the barrier function of the dermis, it is advisable to take medicinal analogues of cholecalciferol. One such drug is topical calcipotriol (calcipotriene), which modulates the differentiation and proliferation of epidermal keratinocytes. This property of the substance is used to normalize inflammatory processes in skin affected by psoriasis and vitiligo.

Vitamin D3, in addition to protecting the dermis, is involved in the processes of growth, regulation and replacement of dead skin cells. If there is a deficiency of this prohormone in the human body, a change in the structure of epidermal cells occurs. At the same time, the outer layers of the skin lose turgor, elasticity and strength, and dryness and parchment appear in certain areas of the skin. In view of this, cholecalciferol is used in cosmetology as an external agent for strengthening and growing hair.

Vitamin D3, along with oral administration, is added to hair balms, shampoos and serums.

Mask for thick hair with vitamin D3

Ingredients:

• olive oil – 5 milliliters;
• burdock oil – 5 milliliters;
• vitamin D3 (alfacalcidol) – 5-6 drops (half an ampoule).

These components are thoroughly mixed and applied to the root zone for 30 minutes. This mask eliminates excessive dryness of the skin, strengthens hair follicles and gives dull hair additional shine. To obtain a lasting effect, the procedure is used once a week.

Remember, it is important for every person to monitor the intake of vitamin D3 in the body, since it activates over 2,000 genes, which is about 10% of the human genotype.