Caltreat Uses, Dosage, Side Effects and more

Alfacalcidol is a precursor of the active calcitriol. It does not require renal hydroxylation but requires 25-hydroxylation in the liver for conversion to calcitriol.

Alfacalcidol works to increase serum levels of calcium by stimulating intestinal calcium absorption, reabsorption of calcium from bone, and possibly the renal reabsorption of calcium. It also modestly promotes intestinal phosphorus absorption. In patients with renal failure, alfacalcidol increased intestinal calcium and phosphorus absorption in a dose-related manner. This increase in calcium and phosphorus levels occurs within three days following drug administration: this effect was reversed within three days of drug discontinuation. In patients with chronic renal failure, serum calcium levels were elevated while parathyroid hormone and alkaline phosphatase levels returned to normal levels within five days following alfacalcidol administration. Since alfacalcidol suppresses parathyroid hormone, a reduction in parathyroid hormone levels is achieved more rapidly in patients on intermittent intravenous therapy, with significant reductions occurring within three months of therapy. In patients receiving daily oral therapy of alfacalcidol, the time it takes alfacalcidol to normalize plasma calcium levels may be up to several months, possibly reflecting calcium being utilized for bone mineralization. In patients with nutritional osteomalacia, alfacalcidol increased calcium absorption with six hours of oral administration and the effects peaked at 24 hours.

Calcium citrate is a salt typically used as a source of calcium in a variety of over the counter supplements.

Increases plasma calcium levels leading to a decrease in calcium flux and increase in calcium deposition into bone

Zinc is an essential trace mineral, which means that it must be obtained from the diet since the body cannot make enough. Next to iron, zinc is the most abundant trace mineral in the body. Stored primarily in muscle, zinc is also found in high concentrations in red and white blood cells, the retina of the eye, bones, skin, kidneys, liver, and pancreas. Some of the symptoms of zinc deficiency include loss of appetite, poor growth, weight loss, impaired taste or smell, poor wound healing, skin abnormalities (such as acne, atopic dermatitis and psoriasis), hair loss, night blindness, hypogonadism and delayed sexual maturation, white spots on the fingernails and feelings of depression.

Trade Name	Caltreat
Generic	Calcium Citrate + Magnesium Hydroxide / Milk Of Magnesia + Zinc Sulphate Monohydrate + Alfacalcidol
Weight	1000mg
Type	Tablet
Therapeutic Class
Manufacturer	Matrix Healthcare
Available Country	India
Last Updated:	January 7, 2025 at 1:49 am

Uses

Alfacalcidol is used for:

It is used to increase the amount of vitamin D in your body. This often increases calcium levels as well which can help in treatment of certain illnesses.
In general this drug is used to treat diseases where the amount of calcium and phosphate (which is controlled by the level of vitamin D) in your body needs changing.
Benefits of being on this drug can include control of the levels of calcium and phosphate in your body.
Treat and prevent bone conditions that are caused by kidney failure (osteodystrophy)
Treat illnesses and abnormalities affecting the parathyroid glands which make a substance called the parathyroid hormone.
Correct low levels of calcium in the blood of newborn babies (hypocalcaemia)
Treat the softening and deformity of the bones due to lack of calcium (rickets or osteomalacia)

Calcium citrate is an ingredient found in a variety of supplements and vitamins.

For use as an over the counter calcium supplement.

Zinc Sulphate is used for Recurrent Respiratory Tract Infections; Diarrhoea; Loss of appetite; Severe growth retardation; Deformed bone formation; Impaired immunological response; Acrodermatitis enteropathica; Parakeratatic skin lesions; Defective and delayed wound healing; Anaemia; Night blindness; Mental disturbances

Caltreat is also used to associated treatment for these conditions: Hypocalcemia, Hypophosphatemic Rickets, Hypovitaminosis D, Nutritional Rickets, Osteodystrophy, Osteomalacia, Secondary Hyperparathyroidism (SHPT), Hypophosphatemic osteomalaciaCalcium Deficiency, Deficiency of Vitamin D3, Deficiency, Vitamin D, Folate deficiency, Hypocalcemia, Iron Deficiency (ID), Osteoporosis

How Caltreat works

In conditions like chronic renal failure, renal bone disease, hypoparathyroidism, and vitamin D dependent rickets, the kidneys' capacity for 1α-hydroxylation is impaired, leading to reduced production of endogenous 1,25-dihydroxyvitamin D and aberrated mineral metabolism. As an active and potent analog of vitamin D, alfacalcidol works to restore the functions and activities of endogenous 1,25-dihydroxyvitamin D.

Calcium citrate increases plasma calcium levels. This reduces calcium flux from osteocyte activity by reducing the secretion of parathyroid hormone (PTH) . Calcium does this by stimulating a G-protein coupled calcium receptor on the surface of parathyroid cells. The reduction in calcium flux increases the amount of calcium deposited in bone resulting in an increase in bone mineral density. The reduction in PTH secretion also reduces the amount of vitamin D metabolized to its active form, calcidiol. Since calcidiol increases the expression of calcium dependent ATPases and transient receptor potential cation channel subfamily V member 6 (TRPV6) both of which are involved in calcium uptake from the gut, a reduction in calcidiol results in less calcium absorption. Additionally, TRPV5, the channel responsible for calcium reabsorption in the kidney, is downregulated when PTH secretion is reduced thus increasing calcium excretion via the kidneys. Another hormone, calitonin, is likely involved in the reduction of bone resorption during periods of high plasma calcium.

Dosage

Caltreat dosage

Adults: The usual starting dose is 1 microgram each day. People usually take between 1 and 3 micrograms each day. Most people take between 0.25 and 1 microgram each day once the blood test results show the medicine is working.

If you have very low levels of calcium in your blood, your doctor may prescribe between 3 and 5 microgram each day. Your doctor may prescribe another medicine called a calcium supplement to take as well as Alfacalcidol. This will help to keep the right amount of calcium level in your blood.

Elderly: The usual starting dose is 0.5 microgram each day.

Children:

Newborn and premature babies: The usual starting dose is 0.05 to 0.1 microgram per kilogram of body weight each day. If the level of calcium in their blood is very low, up to 2 micrograms per kilogram of body weight may be needed each day. A dose of 0.1 microgram per kilogram body weight each day is used to stop low blood calcium levels in premature babies.
Children weighing less than 20 kilograms: The usual starting dose is 0.05 microgram per kilogram body weight each day.
Children weighing more than 20 kilograms: The usual starting dose is 1 microgram each day.

Syrup-

Children under 10 kg: One teaspoonful 2 times daily.
Children within 10 to 30 kg: Two teaspoonful 1-3 times daily.
Adults and children over 30 kg body weight: Four teaspoonful 1-3 times daily.

Tablet-In the treatment of Diarrhoea Zinc should be given as soon as diarrhoea starts:

For infants between 2 to 6 months of age: 10 mg Zinc once daily for 10-14 days.
For children between 6 months to 5 years of age: 20 mg Zinc once daily for 10-14 days.

For other indications:

The recommended dose for children: 2 to 2.5 mg/kg/day.
Children under 10 kg: 10 mg Zinc 2 times daily.
Children within 10 to 30 kg: 20 mg Zinc 1-3 times daily.
Adults and children over 30 kg body weight: 40 mg Zinc 1-3 times daily.

Dispersible Tablet-

Place the tablet in a teaspoon
Add adequate amount of water
Let the tablet dissolve completely
Give the entire spoonful solution

Side Effects

Anorexia, nausea, vomiting, diarrhoea, lassitude, polyuria, sweating, headache, thirst, vertigo, pruritus, rash, urticaria. Hypercalcaemia, hypercalciuria and ectopic calcification.

In case of renal impairment, hyperphosphataemia. In hypercalcaemic dialysis patients, possibility of calcium influx from the dialysate should be considered.

In case of zinc mild side effects such as gastric ulcer, nausea, vomiting, metallic taste, headache, drowsiness have been observed.

Toxicity

There is a discrepancy across a number of reported LD₅₀ values for alfacalcidol, which can be attributed to differences in the procedures used in laboratories. Oral LD₅₀ in mice ranges from 440 to 490 mcg/kg. Intravenous in mice was 290 mcg/kg; however, another source presented 56 mcg/kg in female mice and 71 mcg/kg in male mice. Oral LD₅₀ in rats ranges from 340 to 720 mcg/kg.

In case of an acute accidental overdose following oral administration, emesis or gastric lavage can be induced to prevent further drug absorption. Mineral oil may be used to promote fecal drug elimination in instances where the drug was already absorbed in the stomach.

Alfacalcidol overdose can lead to hypercalcemia, hypercalciuria, and hyperphosphatemia. Similarly, a high intake of calcium and phosphate concurrently with a therapeutic dose of alfacalcidol can result in those conditions. Hypercalcemia most commonly presents with headache, weakness, hypertension, somnolence, dizziness, sweating, anorexia, nausea, vomiting, diarrhea, constipation, polyuria, polydipsia and muscle and bone pain, and metallic taste. Hypercalcemia should be responded to with discontinuation of alfacalcidol, a low calcium diet and withdrawal of calcium supplements. Prolonged hypercalcemia can lead to nephrocalcinosis, nephrolithiasis, and reduced kidney function. In cases of severe hypercalcemia, general supportive measures are recommended, which may include forced diuresis and close monitoring of renal function, electrolytes, and electrocardiographs. Monitoring for abnormalities is especially critical in patients receiving digitalis glycosides. Management with glucocorticosteroids, loop diuretics, bisphosphonates, and calcitonin, as well as hemodialysis with low calcium content, may be considered.

Patients taking more than 4g of calcium a day are at risk of hypercalcemia and metabolic alkalosis . Chronic intake of calcium supplements is associated with adverse gastrointestinal symptoms such as constipation and flatulence .

Precaution

Pregnancy, lactation, renal impairment, infants, elderly. Monitor serum levels of calcium in patients with renal failure. Caution in hypercalciuria in those with history of renal calculi. Avoid in patients with hypersensitivity to inj. containing propylene glycol.

Concurrent administration of Zinc salt with penicillamine might diminish the effect of Penicillamine. The absorption of Zinc, although poor, may be decreased by various compounds including some foods. Chelation may occur with tetracyclines.

Interaction

Thiazides may increase the risk of hypercalcaemia. Some antiepileptics e.g. carbamazepine, phenobarbital, phenytoin and primidone may increase vitamin D requirements. Rifampicin, isoniazid and corticosteroids may reduce the efficacy of vitamin D.

Zinc may inhibit the absorption of concurrently administered tetracyclines, when both are being given an interval of at least 3 hours.

Elimination Route

Alfacalcidol is absorbed passively and almost completely in the small intestine.

The percentage of calcium absorbed varies inversely with intake . Tmax of about 3.5-5h varying with formulation .

Half Life

The half-life of alfacalcidol ranges from three to four hours.

Elimination Route

Cleared via the kidneys but largely reabsorbed (98-99%) under normal conditions .

Pregnancy & Breastfeeding use

FDA has not yet classified the drug into a specified pregnancy category.

Pregnant women and nursing mothers should avoid zinc doses higher than RDA amounts.

Contraindication

Hypercalcaemia, metastatic calcification, hyperphosphataemia (except when occurring with hypoparathyroidism), hypermagnesaemia.

It is contraindicated in patients with hypersensitivity to Zinc.

Acute Overdose

Zinc sulphate is corrosive in overdose. Symptoms are corrosion and inflammation of the mucous membrane of the mouth and stomach; ulceration of the stomach followed by perforation may occur. Gastric lavage and emesis should be avoided. Demulcents such as milk should be given. Chelating agents such as sodium edetate may be useful.