Livon

Uses

Calcium Lactate is used for heartburn, calcium supplement, calcium deficiencies.

Iron-deficiency anemia.

Livon is also used to associated treatment for these conditions: Calcium DeficiencyFolate deficiency, Iron Deficiency (ID), Iron Deficiency Anemia (IDA), Zinc Deficiency, Mineral supplementation

How Livon works

In aqueous environments such as the gastrointestinal (GI) tract, calcium lactate will dissociate into calcium cation and lactic acid anions, the conjugate base of lactic acid. Lactic acid is a naturally-occurring compound that serves as fuel or energy in mammals by acting as an ubiquitous intermediate in the metabolic pathways . Lactic acid diffuses through the muscles and is transported to the liver by the bloodstream to participate in gluconeogenesis .

Iron is necessary for the production of hemoglobin. Iron-deficiency can lead to decreased production of hemoglobin and a microcytic, hypochromic anemia.

Dosage

Livon dosage

19-50 year: 1,000 mg elemental Calcium Lactate per day.

>50 year: 1,200 mg elemental Calcium Lactate per day.

Iron-deficiency anaemia:

• Adult:60 mg bid up to 60 mg 4 times daily. Prevention: 60 mg daily.
• Child:Severe: 4-6 mg/kg/day in 3 divided doses; Mild to moderate: 3 mg/kg/day in 1-2 divided doses. Prevention: 1-2 mg/ kg/ day.

Should be taken on an empty stomach. Best taken on an empty stomach. May be taken with meals to reduce GI discomfort.

Side Effects

Gl discomfort e.g. nausea, vomiting, constipation; bradycardia, arrhythmias. Dry mouth, increased thirst or increased urination. Mental confusion, milk-alkali syndrome.

GI symptoms e.g. stomach cramping, constipation, nausea, vomiting, dark stools, heartburn, diarrhea, teeth staining, urine discoloration.

Toxicity

The LDLo of calcium lactate pentahydrate following intravenous administration in mouse is 140 mg/kg .

Acute iron overdosage can be divided into four stages. In the first stage, which occurs up to six hours after ingestion, the principal symptoms are vomiting and diarrhea. Other symptoms include hypotension, tachycardia and CNS depression ranging from lethargy to coma. The second phase may occur at 6-24 hours after ingestion and is characterized by a temporary remission. In the third phase, gastrointestinal symptoms recur accompanied by shock, metabolic acidosis, coma, hepatic necrosis and jaundice, hypoglycemia, renal failure and pulmonary edema. The fourth phase may occur several weeks after ingestion and is characterized by gastrointestinal obstruction and liver damage. In a young child, 75 milligrams per kilogram is considered extremely dangerous. A dose of 30 milligrams per kilogram can lead to symptoms of toxicity. Estimates of a lethal dosage range from 180 milligrams per kilogram and upwards. A peak serum iron concentration of five micrograms or more per ml is associated with moderate to severe poisoning in many.

Precaution

Sarcoidosis; history of nephrolithiasis. Avoid IV admin of calcium in patients on cardiac glycosides. Increased risk of hypercalcaemia and hypercalciuria in hypoparathyroid patients receiving high doses of vitamin D. Caution when used in patients with history of kidney stones. Patients should be advised to administer vitamin D concurrently to optimise calcium absorption. Pregnancy.

Avoid in patients with peptic ulcer, enteritis, or ulcerative colitis and those who receive frequent blood transfusions. Not to be used in premature infants until the vitamin E stores (deficient at birth) are replenished. Avoid prolonged treatment (>6 mth) except in patients with continuous menorrhagia or bleeding.

Interaction

May reduce the efficacy of calcium-channel blockers. Concurrent admin of IV calcium salt with cardiac glycosides may lead to serious adverse events. Increased risk of hypercalcaemia when used with thiazide diuretics. May reduce absorption of tetracycline, alendronate, atenolol, iron, quinolone antibiotics, sodium fluoride and zinc.

Concurrent admin with antacids/ H2 antagonists may reduce absorption of iron. Chloramphenicol may delay response to iron. Iron may reduce the absorption of levodopa, methyldopa and penicillamine when given together. Absorption may be reduced when used with quinolones or tetracyclines. Concurrent admin with vitamin C may increase iron absorption.

Volume of Distribution

The majority of calcium absorbed (99%) is stored in the skeleton and teeth for structural integrity .

Elimination Route

In order to be absorbed, calcium must be in its freely soluble form (Ca2+) or bound to a soluble organic molecule. Calcium absorption mainly occurs at the duodenum and proximal jejunum due to more acidic pH and the abundance of the calcium binding proteins . The mean calcium absorption is about 25% of calcium intake (range is 10 – 40%) in the small intestine, and is mediated by both passive diffusion and active transport .

The efficiency of absorption depends on the salt form, the amount administered, the dosing regimen and the size of iron stores. Subjects with normal iron stores absorb 10% to 35% of an iron dose. Those who are iron deficient may absorb up to 95% of an iron dose.

Half Life

No pharmacokinetic data available.

Clearance

No pharmacokinetic data available.

Elimination Route

Following oral administration to a human volunteer, 20 to 30% of a dose of lactic acid of up to 3000 mg was excreted via the urine during a period of 14 hours .

Pregnancy & Breastfeeding use

Pregnancy Category-C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks

Pregnancy Category- A. Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Contraindication

Conditions associated with hypercalcaemia and hypercalciuria.

Haemochromatosis, haemolytic anemia.

Acute Overdose

Overdose may lead to severe iron toxicity, espcially in children.

Innovators Monograph

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