Vitamin Supplimentary Case No 2.Calcium Supplimentary.

Hello I'm Raiyyan Tahsan

Brand Model and Executive

Vitamin Supplimentary Case No 2.Calcium Supplimentary.

ক্যালসিয়াম সাপ্লিমেন্টারী যেসব ওরাল সোর্স মার্কেটে পাওয়া যায় তা হচ্ছে-–

১.. Calcium carbonate. (40% Calcium থাকে)

২.. calcium citrate (20 %Calcium থাকে)

৩.. Calcium orotate (10% Calcium থাকে)

ক্যালসিয়াম কার্বোনেট এর একটা সাইড ইফেক্ট হচ্ছে কোষ্ঠকাঠিন্য করা,

Calbo-D, calcin-D, Calbo, fossical -D, এইসব কিছু calcium carbonate, এইগুলি কোনো পেশেন্ট এর constipation থাকলে কিংবা IBS type -C থাকলে দেওয়া যাবেনা,

*** যাদের কোষ্ঠকাঠিন্য রয়েছে, অথবা যারা high dose এ PPI খায়, তারা ক্যালসিয়াম খেলে কোষ্ঠকাঠিন্য হতে পারে, আবার PPI খাওয়ার কারণে absorption ও হবেনা তাদের ক্ষেত্রে করনীয় কি?

উত্তর– আইফোন -১০ এ যাদের সমস্যা, তারা আপডেট ভার্সন আইফোন ১২ /১৩ ইত্যাদিতে যাবে।

আই মিন, ক্যালসিয়াম কার্বোনেটে সমস্যা হবে যাদের, তারা আপডেট ভার্সন Calcium citrate খাবে,

Calcium citrate.

এখানে ক্যালসিয়াম Citrate এর সাথে bind করে থাকে, ২১ % ক্যালসিয়াম থাকে-

এইটা absorption হবার জন্য acidic ph এর দরকার হয়না, তাই যারা PPI খায়, তাদের কে দেওয়া যায়, এইটার কোষ্ঠকাঠিন্য ইফেক্ট নাই, absorption rate 90-95%.

তবে এইটার দাম অনেক বেশি,

ক্যালসিয়াম কার্বোনেট যেই ডোজে নিবে, এইটা তার ডাবল ডোজে নিতে হবে,

ক্যালসিয়াম কার্বোনেট দৈনিক ১২০০ খেলে ৫০০ মিঃগ্রাঃ ক্যালসিয়াম পাওয়া যায়,

সেই ক্ষেত্রে ক্যালসিয়াম সাইট্রেট দৈনিক ২৪০০ mg খেলে ২১% ক্যালসিয়াম পাওয়া যাবে,

মানে ৫০৪ mg calcium,

osteoporosis patient কে দৈনিক মিনিমাম 1000- 1200 mg supplementary দিতে হবে,

যদি সে orally ভালো feeding না পায়, তাহলে 1000 mg calcium supplementary এর জন্য

Calcium citrate 4800 mg দিলে হবে,৷ Calcium citrate এ মাত্র ২০ % calcium থাকে, তাই Calcium citrate ৪৮০০ mg দিলে ১০০০ mg calcium পাবে,

বাজারে যেই নামে পাওয়া যায়-

Calbotol 1200

2+0+2 এই ভাবে দিবে,

osteoporosis এ এইটা বেস্ট অপশন

Osteoporosis এ Vitamin D deficiency থাকতে পারে, অথবা Vitamin D Lower base line এ চলে আসে, সেই ক্ষেত্রে Vitamin D supplementary লাগবে,

Vitamin D supplementary এর Daily maximum dose হচ্ছে 4000 IU,

Vitamin D level 30 ng/ml এর নিছে থাকলে 1500-2000 IU Daily recommended,

আর 30 ng/ml এর উপরে থাকলে 1000-1500 mg recommended..

তাহলে একটা osteoporosis patient with constipation এর চিকিৎসা হবে…

1.. Identify The cause and treat it

Tablet 1:- calbotol (1200 mg+0.25mg) AS A (Calcium Citrate+Calcitriol) (AS A Specific mineral & vitamin combined preparations).

Indications of Tab:- calbotol (1200 mg+0.25mg) AS A (Calcium Citrate+Calcitriol) (AS A Specific mineral & vitamin combined preparations).

The combination of Calcium Citrate and Calcitriol is used to prevent or treat low blood calcium levels in people who do not get enough calcium from their diets. It may be used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia, rickets), decreased activity of the parathyroid gland (hypoparathyroidism) and a certain muscle disease (latent tetany). It may also be used in certain patients to make sure they are getting enough calcium (e.g. postmenopausal).

Pharmacology of Tab:- calbotol (1200 mg+0.25mg) AS A (Calcium Citrate+Calcitriol) (AS A Specific mineral & vitamin combined preparations).

Calcium plays a very important role in the body. It is necessary for normal functioning of nerves, cells, muscle, and bone. If there is not enough calcium in the blood, then the body will take calcium from bones, thereby weakening bones. Having the right amount of calcium is important for building and keeping strong bones. Calcium citrate is well absorbed on an empty stomach and does not constipate. Calcium citrate is less dependent on stomach acid for absorption.

Calcitriol is the most active known form of vitamin D 3 in stimulating intestinal calcium transport. It is normally formed in the kidneys from its immediate precursor, 25-hydroxycholecalciferol. In physiological amounts it augments the intestinal absorption of calcium and phosphate and plays a significant part in the regulation of bone mineralization. The defective production of calcitriol in chronic renal failure contributes to the abnormalities of mineral metabolism found in that disorder.

The biological effects of calcitriol are mediated by the vitamin D receptor, a nuclear hormone receptor expressed in most cell types and functioning as a ligand-activated transcription factor that binds to DNA sites to modify the expression of target genes. Oral administration of Calcitriol to patients with chronic renal failure compensates for impaired endogenous production of calcitriol which is decreased when the glomerular filtration rate falls below 30 ml/min. Consequently, intestinal malabsorption of calcium and phosphate and the resulting hypocalcemia are improved, thereby reversing the signs and symptoms of bone disease.

In patients with established post-menopausal osteoporosis, Calcitriol increases calcium absorption, elevates circulating levels of calcitriol and reduces vertebral fracture frequency.

Dosage & Administration of Tab:- calbotol (1200 mg+0.25mg) AS A (Calcium Citrate+Calcitriol) (AS A Specific mineral & vitamin combined preparations).

1-4 tablets daily with or without food depending on clinical situation or as directed by the registered physician.

Contraindications of Tab:- calbotol (1200 mg+0.25mg) AS A (Calcium Citrate+Calcitriol) (AS A Specific mineral & vitamin combined preparations).

This drug is contraindicated for the patients with hypercalcaemia, hypercalciuria, hypophosphatemia.

Side Effects of Tab:- calbotol (1200 mg+0.25mg) AS A (Calcium Citrate+Calcitriol) (AS A Specific mineral & vitamin combined preparations).

The side efects of Calbotol are-constipation, nausea, abdominal pain, hypercalcaemia, hypercalciuria, headache, muscle weakness.

Pregnancy & Lactation of Tab:- calbotol (1200 mg+0.25mg) AS A (Calcium Citrate+Calcitriol) (AS A Specific mineral & vitamin combined preparations).

Pregnancy category C. It should be used as directed by the registered physician during pregnancy and lactation.

Therapeutic Class of Tab:- calbotol (1200 mg+0.25mg) AS A (Calcium Citrate+Calcitriol) (AS A Specific mineral & vitamin combined preparations).

Specific mineral & vitamin combined preparations

2+0+2 (চলবে)….

Capsule 2.- D-cap (800 IU) (AS A Cholecalciferol (Vitamin D3) AS A Vitamin in bone formation, Vitamin-D preparations).

Indications of Capsule:- D-cap (800 IU) (AS A Cholecalciferol (Vitamin D3) AS A Vitamin in bone formation, Vitamin-D preparations).

Vitamin D3 deficiency can occur in people whose exposure to sunlight is limited and in those whose diet is deficient in vitamin D3.
Vitamin D3 is essential for the effective calcium and phosphate absorption required for healthy bones and teeth, preventing rickets, osteomalacia and osteoporosis.
Vitamin D3 is also essential to prevent pre-eclampsia during pregnancy and breast feeding as it is an essential nutrient for a growing infant.
Vitamin D3 has vital role on immunity boost up.

Pharmacology of Capsule:- D-cap (800 IU) (AS A Cholecalciferol (Vitamin D3) AS A Vitamin in bone formation, Vitamin-D preparations).

The active form of Vitamin D3, Calcitriol, exerts its effect by binding to the Vitamin D receptors (VDRs) which are widely distributed through many body tissues.Vitamin D3 has a half life of about 50 days as it is fat soluble.Vitamin D3 is absorbed in the small intestine and bound to specific a-globulins and transported to the liver where it is metabolised to 25-hydroxy Vitamin D3 (Calcidiol). A second hydroxylation to 1,25-dihydroxy Vitamin D3 (Calcitriol) occurs in the kidney. This metabolite is responsible for the vitamin’s ability to increase the absorption of calcium. Non-metabolised Vitamin D3 is stored in tissues such as fat and muscle.Vitamin D3 is eliminated via faeces and urine.

Dosage & Administration of Capsule:- D-cap (800 IU) (AS A Cholecalciferol (Vitamin D3) AS A Vitamin in bone formation, Vitamin-D preparations).

For capsule: Adults:

Treatment of Vitamin D3 deficiency: 40000 IU once weekly for 7 weeks. Doses for maintenance therapy is 1400-2000 IU/day. To confirm the target level of 25 hydroxyvitamin D, measurement of it should be determined 3-4 months after initiating the maintenance therapy.
Prevention of Vitamin D3 deficiency: 20000 IU every 4 weeks. Higher doses may be required in certain situations.
Addition to specific therapy for osteoporosis: 20000 IU once a month.

For capsule: Children (12-18 years):

Treatment of Vitamin D3 deficiency: 20000 IU once every 2 weeks for 6 weeks.
Prevention of Vitamin D3 deficiency: 20000 IU every 6 weeks.

For film-coated tablet: 1000 IU (1-2 tablets) daily, or as directed by physician. Take the medicine with food or within 1 hour after a meal.

For oroflash or chewable tablets: 1000 IU to 2000 IU daily, or as directed by physician. Take the medicine with food or within 1 hour after a meal. Place the tablet in mouth swallow after chewing.

For Syrup:
For patients with risk of Cholecalciferol deficiency:

0-1 yr: 400 IU/ day (2 ml)
>1 Yr: 600 lU/ day (3 ml)

For Cholecalciferol deficient patients:

0-1 yr: 2000 IU/ day (+50000 IU/week ) for 6 weeks
1 -18 yrs: 2000 IU/ day for 6 weeks.

Injection: Prevention:

Infants receiving Vitamin D enriched milk: ½ ampoule (0.5 ml) i.e. 1,00000 I.U. every 6 months.
Nursed infants or infants not receiving Vitamin D enriched milk or young children up to 5 years of age: 1 ampoule (1 ml) i.e. 2,00000 I.U. every 6 months.
Adolescents: 1 ampoule (1 ml) i.e. 2,00000 I.U. every 6 months during winter.
Pregnancy: ½ ampoule (0.5 ml) i.e. 1,00000 I.U. from the 6th or 7th month of pregnancy.
Elderly: ½ ampoule (0.5 ml) i.e. 1,00000 I.U. every 3 months. Digestive disorders, concomitant treatment with antiepileptics & other particular condition not described above; ½ ampoule (0.5 ml) i.e. 1,00000 I.U. or 1 ampoule (1 ml) i.e. 2,00000 I.U. every 3 or 6 months.

Injection: Vitamin D deficiency:

1 ampoule (1 ml) i.e. 2,00000 I.U. which can be repeated 1 to 6 months later. Or, as directed by the registered physician.

Interaction of Capsule:- D-cap (800 IU) (AS A Cholecalciferol (Vitamin D3) AS A Vitamin in bone formation, Vitamin-D preparations).

Many drugs cause Vitamin D3 deficiencies because they interfere with the absorption and metabolism of Vitamin D3 and includes Magnesium containing Antacids, Digoxin, Thiazide Diuretics, Cholestyramine, Cholistipol, Phenytoin, Phenobarbital, Orlistat,and Mineral Oil. Also, Corticosteroids, such as Prednisolone increase the need for Vitamin D3.

Contraindications of Capsule:- D-cap (800 IU) (AS A Cholecalciferol (Vitamin D3) AS A Vitamin in bone formation, Vitamin-D preparations).

Vitamin D3 is contraindicated in all diseases associated with hypercalcaemia. It is also contraindicated in patients with known hypersensitivity to Vitamin D3 (or medicines of the same class) and any of the excipients. It is contraindicated if there is evidence of Vitamin D3 toxicity.

Side Effects of Capsule:- D-cap (800 IU) (AS A Cholecalciferol (Vitamin D3) AS A Vitamin in bone formation, Vitamin-D preparations).

Symptoms rarely include anorexia, lassitude, nausea & vomiting, diarrhea, constipation, weight loss, polyuria, sweating, headache, thirst, vertigo, and raised concentrations of calcium and phosphate in plasma and urine.

Pregnancy & Lactation of Capsule:- D-cap (800 IU) (AS A Cholecalciferol (Vitamin D3) AS A Vitamin in bone formation, Vitamin-D preparations).

Studies have shown safe use of doses up to 4000 IU during pregnancy. The recommended daily intake for pregnant women is 400 IU, however, in women who are considered to be Vitamin D3 deficient a higher dose may be required. During pregnancy women should follow the advice of their medical practitioner as their requirements may vary depending on the severity of their disease and their response to treatment

Vitamin D3 and its metabolites are excreted in breast milk. Overdose in infants induced by nursing mothers has not been observed; however, when prescribing additional vitamin D3 to a breast-fed child the practitioner should consider the dose of any additional vitamin D3 given to the mother.

Therapeutic Class of Capsule:- D-cap (800 IU) (AS A Cholecalciferol (Vitamin D3) AS A Vitamin in bone formation, Vitamin-D preparations).

Vitamin in bone formation, Vitamin-D preparations

1+0+1 (continue) and Follow up 12 weeks interval

General Quaries:- calcium orotate Calbostar 400 mg নামে পাওয়া যায়, 10% calcium থাকে,।

1 tablet থেকে 40 mg পাবেন, Calcium

Tablet 3. Calbostar 400mg (As a calcium orotate AS A Minerals in bone formation, Specific mineral preparations).

Indications of Tablet:- Calbostar 400mg (As a calcium orotate AS A Minerals in bone formation, Specific mineral preparations).

Calbostar tablet is used to prevent or treat low blood calcium levels in people who do not get enough calcium from their diets. To fulfill the calcium deficiency or meet extra need of calcium, it may be used in conditions like osteoporosis, osteomalacia, rickets, latent tetany, postmenopausal osteoporosis, senile osteoporosis, juvenile osteoporosis, drug (phenytoin, phenobarbital, or prednisone) induced osteoporosis, pregnancy and lactation, premenstrual syndrome (PMS), hypoparathyroidism and hip joint plastic surgery.

Calbostar acts against a number of inflammatory diseases like arthritis, psoriasis, lupus, spondylitis, various cardiovascular ailments, encephalitis, retinitis, phlebitis, colitis, and multiple sclerosis. Calbostar helps in controlling weight by suppressing the habit of frequent appetite of chronic overeaters. It is also beneficial in reducing the effects of mood swings and is proved to be quite effective in cognitive enhancement. Calbostar protects the heart by enhancing the efficiency of cardiac muscles. Recent studies on Calbostar indicate its potential to minimize the risk of colon cancer

Pharmacology of Tablet:- Calbostar 400mg (As a calcium orotate AS A Minerals in bone formation, Specific mineral preparations).

This contains Calcium Orotate, a calcium supplement with a functional amino acid chelating ligand- orotic acid. Orotic acid assists the transport of calcium through cellular membrane structures, thus facilitating the intracellular uptake of calcium, particularly in bone. Calcium Orotate also helps in the maintenance of healthy cartilage. Furthermore, Orotate is involved in the synthesis of DNA (deoxyribonucleic acid) and RNA (ribonucleic acid) of the various calcium supplements on the market, Calcium Orotate gets high marks because of the compound’s ability to penetrate complex cell membranes so that it can be metabolized in cartilage.

Dosage & Administration of Tablet:- Calbostar 400mg (As a calcium orotate AS A Minerals in bone formation, Specific mineral preparations).

Calcium Orotate 400 mg: As an addition to the daily diet, 2-3 tablets are usually recommended with meal or as directed by a physician.

Calcium Orotate 740 mg: As an addition to the daily diet, 1-2 tablets are usually recommended with meal or as directed by a physician.

Interaction of Tablet:- Calbostar 400mg (As a calcium orotate AS A Minerals in bone formation, Specific mineral preparations).

Calbostar can decrease absorption of the following drugs when taken together: biphosphonates (e.g., alendronate), quinolone antibiotics (e.g., ciprofloxacin, levofloxacin), and tetracycline antibiotics (e.g., doxycycline, minocycline), levothyroxine, phenytoin (an anticonvulsant), and tiludronate disodium (to treat Paget’s disease). Thiazide-type diuretics can interact with Calbostar supplements, increasing the risks of hypercalcemia and hypercalciuria. Both aluminum- and magnesium-containing antacids increase urinary calcium excretion. Mineral oil and stimulant laxatives decrease calcium absorption. Glucocorticoids, such as prednisone, can cause calcium depletion and eventually osteoporosis when they are used for months. Oral contraceptives as well as estrogen compounds reduce calcium. Anti-inflammatories such as NSAIDs, Aspirin, Ibuprofen deplete calcium. Corticosteroids deplete calcium.

Contraindications of Tablet:- Calbostar 400mg (As a calcium orotate AS A Minerals in bone formation, Specific mineral preparations).

Calcium Orotate is contraindicated in conditions like incomplete or infrequent bowel movements, kidney stone, kidney disease, increased activity of the parathyroid gland, high amount of Calcium in urine, high amount of Calcium in the blood, extreme loss of body water.

Side Effects of Tablet:- Calbostar 400mg (As a calcium orotate AS A Minerals in bone formation, Specific mineral preparations).

Bloating and swelling in the abdomen are common side effects of Calbostar. Loss of appetite, upset stomach, constipation, nausea, vomiting, unusual weight loss, increased thirst/urination, weakness, unusual tiredness, formation of kidney stones may occur infrequently.

Pregnancy & Lactation of Tablet:- Calbostar 400mg (As a calcium orotate AS A Minerals in bone formation, Specific mineral preparations).

Women who are pregnant and breast-feeding need more calcium. Pregnancy related high blood pressure is a common and serious risk for women and their babies, and taking supplemental forms of Calcium Orotate can help to reduce this risk.

Therapeutic Class of Tablet:- Calbostar 400mg (As a calcium orotate AS A Minerals in bone formation, Specific mineral preparations).

Minerals in bone formation, Specific mineral preparations

Calbo D 500 mg ১ টা সমান calboster 400 mg ৫ টা but aitar akta best benefits hosse aita

constipation korena.

Tablet 4. Calbo D (500mg+200IU)AS A (Elemental Calcium +Vitamin D3).(AS A Specific mineral & vitamin combined preparations).

Indications of Tablet:- Calbo D (500mg+200IU)AS A (Elemental Calcium +Vitamin D3).(AS A Specific mineral & vitamin combined preparations).

Calbo-D is used for treatment of osteoporosis, osteomalacia, rickets, tetany and in parathyroid disease. Calcium supplements are often used to ensure adequate dietary intake in conditions such as pregnancy & lactation, osteogenesis and tooth formation (adjunct with definite treatment) and therapy with anti-seizure medications. It is also used as routine supplement and phosphate binder in chronic renal failure.

Pharmacology of Tablet:- Calbo D (500mg+200IU)AS A (Elemental Calcium +Vitamin D3).(AS A Specific mineral & vitamin combined preparations).

This is the preparation of Calcium Carbonate and Vitamin D3 (Cholecalciferol). Calcium is necessary for many normal functions of our body, especially bone formation and maintenance. Vitamin D3 helps for the absorption & reabsorption of Calcium. Vitamin D3 also stimulates bone formation. Clinical studies showed that Calcium and Vitamin D3 all together helps in bone growth, and in prevention of osteoporosis & bone fracture.

Dosage & Administration of Tablet:- Calbo D (500mg+200IU)AS A (Elemental Calcium +Vitamin D3).(AS A Specific mineral & vitamin combined preparations).

Calcium 500 mg and Vitamin D3 200 IU Tablet: 2 tablets daily or 1 tablet twice daily. It is best taken with or just after a meal to improve absorption.

Calcium 500 mg and Vitamin D3 400 IU Tablet: 1 tablet twice daily. It is best taken with or just after a meal to improve absorption.

Interaction of Tablet:- Calbo D (500mg+200IU)AS A (Elemental Calcium +Vitamin D3).(AS A Specific mineral & vitamin combined preparations).

It has possible interaction with calcium, aluminium or magnesium containing antacids & other calcium supplements, calcitriol & other vitamin D3 supplements; digoxin, tetracycline, doxycycline, minocycline or oxytetracycline.

Contraindications of Tablet:- Calbo D (500mg+200IU)AS A (Elemental Calcium +Vitamin D3).(AS A Specific mineral & vitamin combined preparations).

It is contraindicated in case of hypercalcaemia, hyperthyroidism, renal calculi & nephrolithiasis and Zollinger-Ellison Syndrome.

Side Effects of Tablet:- Calbo D (500mg+200IU)AS A (Elemental Calcium +Vitamin D3).(AS A Specific mineral & vitamin combined preparations).

It is generally well tolerated. If there is experience like nausea, vomiting, stomach cramps, dry mouth, increased thirst, increased urination while taking, noticed to physicians. Constipation may occur.

Pregnancy & Lactation of Tablet:- Calbo D (500mg+200IU)AS A (Elemental Calcium +Vitamin D3).(AS A Specific mineral & vitamin combined preparations).

This combination should be used as directed by physician during pregnancy or while breast-feeding.

Therapeutic Class of Tablet:- Calbo D (500mg+200IU)AS A (Elemental Calcium +Vitamin D3).(AS A Specific mineral & vitamin combined preparations).

Specific mineral & vitamin combined preparations

2.Calcium citrate pregnancy te deoa jabe?

Answer is:hm jabe

Raiyyan Tahsan Date:20-01-2025 Monday Time:8-57-55PM

Raiyyan Tahsan

Raiyyan Tahsan