Calcium-D3 Nycomed forte chewable tablets lemon, 60 pcs.

The human body at any age contains about 1200 mg of calcium. It is mainly found in the teeth and skeletal system. Present in small quantities in urine, blood and saliva. With frequent physical activity and during pregnancy, the body needs more calcium. To compensate for its deficiency, experts often prescribe Calcium D3 Nycomed.

Symptoms of mineral deficiency

Calcium deficiency can be determined by the following signs:

• pain in the bones, which is explained by weight loss and thinning of the bones;
• deterioration of hair condition (dull, brittle);
• problematic skin of the face and body;
• pronounced toxicosis in pregnant girls;
• weakened immune system;
• formation of tartar and caries;
• the appearance of fungus on the nails.

The drug Calcium D3 Nycomed will help compensate for the lack of the mineral.

Now Foods, Calcium Hydroxyapatite

This is an American calcium preparation of animal origin, which means it is ideal for strengthening teeth (97% of our tooth enamel is calcium). Now Foods are powder capsules. This form of release allows you to protect calcium from the aggressive influence of the gastric environment, so calcium is absorbed almost completely. You can take Now Foods calcium from the age of 18, it reduces the amount of plaque on your teeth, makes them smoother, enamel defects become less noticeable, and the likelihood of developing caries is reduced.

Now Foods Calcium Hydroxyapatite

Now Foods, USA

Calcium hydroxyapatite contains macroelements, which is a balanced mixture of minerals necessary for the body.
111

• Like
• Write a review

Signs of excess calcium

Excess calcium can be associated with taking medications, as well as as a result of the appearance of malignant or benign neoplasms. This can be determined by the following signs:

• confused mind, problems with coordination;
• gag reflex after eating;
• stomach upset;
• increased weakness;
• problems with the heart and blood vessels;
• kidney diseases.

Foods High in Calcium

You can compensate for the lack of calcium in the body through a properly balanced diet. To strengthen bones, teeth, hair and nails, include the following foods in your diet:

• almond;
• cheese;
• yogurt;
• milk
• tofu;
• greenery;
• soy;
• sardines;
• broccoli;
• bananas;
• salmon;
• pumpkin seeds;
• beans;
• lentils;
• figs;
• tuna;
• olive oil.

But remember that the body absorbs calcium only in combination with vitamin D and ascorbic acid, so do not forget about foods such as butter, egg yolk, fatty fish, and vegetables.

The presence of magnesium and phosphorus is also important for the absorption of calcium, and this is wholemeal bread, bran, nuts and the same fish. If this balance is not maintained, calcium from foods will simply be deposited in the form of stones in the kidneys or joints.

By the way, diuretics flush calcium from the body, so reduce the amount of drinks containing caffeine and alcohol.

Contraindications and adverse reactions

After taking Calcium D3 Nycomed, undesirable reactions may occur:

• from the gastrointestinal tract: upset stomach, vomiting, nausea;
• from the central nervous system: nervousness, increased feeling of agitation;
• from the metabolic side: hypercalcemia, manifested by fatigue, problems with the heart and blood vessels;
• on the skin: an allergic reaction manifested by various rashes.

The drug is strictly contraindicated in the following cases:

• excess calcium in the blood;
• chronic renal failure;
• active tuberculosis;
• allergy to the substances included in the composition, including fructose.

Mountain calcium D3

This is a complex preparation of calcium in the form of carbonate, enriched with vitamin D3 and mumiyo. “Mountain Calcium D3” from “Evalar” is perfectly absorbed, supplying the body with the daily requirement of necessary substances. Shilajit contains about 30 important elements that improve blood composition. The drug is prescribed from the age of 12, for pregnant and breastfeeding women - only after consultation with a doctor. “Mountain calcium D3” is maximally bioavailable, strengthens bones, teeth, hair and nails, is suitable for the prevention of osteoporosis, and is inexpensive. Among the disadvantages are the unpleasant taste and the large size of the tablets.

Mountain calcium D3

Evalar, Russia

The combination of tablets Mountain calcium D3 calcium, vitamin D3 and Altai mumiyo in 1 tablet 100% replenishes calcium deficiency in the body.
from 169

344

• Like
• Write a review

Is it possible to drink Calcium D3 Nycomed while breastfeeding?

Calcium D3 Nycomed is also allowed to be taken during lactation. The active substances pass into breast milk. That is why it is important to correctly consider other sources of mineral and vitamin D. When treating with this medication, it is worth familiarizing yourself with the situations in which excess calcium may develop. This will prevent a similar situation in the mother and her baby.

With proper calcium intake, the baby develops a strong skeletal system, the likelihood of fractures decreases, and girls grow beautiful hair and strong nails.

Calcium-Active Citrate

This drug contains calcium citrate and vitamin D3. It is perfectly absorbed by the body, so it is suitable for people with gastrointestinal diseases (atrophic gastritis, surgical treatment of the digestive system). You can take “Calcium-Active Citrate” regardless of meals and stomach acidity. Therefore, doctors often prescribe this calcium to elderly patients and those with low acidity. The risks of kidney stones are minimal; it can be taken during pregnancy and lactation (in consultation with your doctor). "Calcium-Active Citrate" - inexpensive calcium tablets with high bioavailability. Among the disadvantages is that one package of the drug is not enough for the course.

Calcium-Active Citrate

DIODE, Russia

Calcium-Active Citrate is a biologically active food supplement containing calcium citrate (salt, which, according to scientific research, is the best source of calcium in terms of absorption and absence of adverse reactions) and the required daily dosage of vitamin D3.
from 102

553

• Like
• Write a review

Drug interactions

If you take the medication with other medications to treat problems with the heart and blood vessels, toxic effects on the cardiovascular system and liver may develop. In the case of simultaneous use of Calcium D3 Nycomed and antibiotics, there may be a deterioration in the absorption of the latter.

When taken simultaneously with multivitamin complexes, excess calcium in the blood may appear, and the functioning of the entire body may deteriorate.

If there is an urgent need to take these drugs together, you should consult a specialist in advance.

Calcium and vitamin D3: from osteoporosis to multimorbidity of cardiovascular diseases

Osteoporosis (OP) is one of the “young” diseases in modern clinical practice. However, a “young” disease only means that we began to think about the presence of this disease in patients only in the last decade. However, in the medical literature of the early and mid-20th century, we come across the term “widow’s hump,” which suggests the formation of kyphoscoliotic deformity of the thoracic spine in elderly women due to compression fractures. And the study of this problem began in the 19th century, when Charcot and Vulpian presented a description of this disease, and Alwens W. presented a clinical picture of senile osteoporosis in a textbook of internal medicine.

For more than 120 years, scientists and experts have been studying the problem of involutive and metabolic changes in bone tissue, but the scale of the epidemic of this disease is growing exponentially.

Osteoporosis is one of the most common components of multimorbidity in modern patients. As a result, every local or practicing doctor observing a somatic patient must actively search for risk factors and symptoms of osteoporosis, as well as prescribe prevention and treatment.

There is no doubt that the prevailing number of cases of this disease is the prerogative of patients over 50 years of age, when other socially significant diseases (cardiovascular pathology, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), etc.) become an integral part of patients’ lives .

Our studies on the structure of multimorbid pathology in patients with loss of bone mineral density (BMD) demonstrate that the highest prevalence of AP and osteopenia is observed in patients with a combination of diseases.

Thus, the prevalence of AP in patients with a combination of coronary heart disease (CHD), angina pectoris, arterial hypertension (AH) and type 2 diabetes was 39.5%; with ischemic heart disease, post-infarction cardiosclerosis, hypertension and type 2 diabetes - 41.2%; and in the presence of this combination also of a previous acute cerebrovascular accident (ACVA) - 46.8%.

The highest prevalence of osteopenia was observed in patients with a history of stroke - 56.9%, as well as in patients with alcoholic polyvisceropathy - 48.8%.

Consequently, osteoporosis often occurs in patients with chronic somatic diseases. At the same time, there are a number of pathogenetic relationships (Table 1), in particular with cardiovascular diseases (CVD) - the most common somatic diseases, where endothelial dysfunction plays an important role. The latter is associated with nitric oxide deficiency, the role of which is beyond doubt in the pathogenesis of cardiovascular diseases, and in the development of osteoporosis is associated with a decrease in the synthesis and differentiation of osteoblasts.

Over the past 2–3 years, the attention of the professional medical community has been focused on the role of calcium and vitamin D3 in clinical practice. From concerns about the occurrence of urolithiasis and calcification of atherosclerotic plaques and blood vessels to evidence of reduced mortality in patients receiving calcium and vitamin D3 supplements, here is a three-year debate between international experts.

Over the past two years, the role of vitamin D3 deficiency in the development and progression of cardiovascular pathology has been widely discussed, which, from the perspective of multimorbidity in patients with a high risk of osteoporotic fractures, requires a separate discussion of the role of these drugs in the treatment of multimorbid patients.

As evidence for the effectiveness of combination therapy with calcium and vitamin D3, one should cite data from meta-analyses of randomized clinical trials (RCTs), which combined information on the effectiveness of calcium and vitamin D3 in 369,968 patients [9, 12].

The general conclusions of these meta-analyses: the use of calcium and vitamin D3 compared with placebo reduced bone loss in patients - the relative risk (RR) was 0.76 (95% confidence interval (CI): 0.62–0.91).

All endpoints (BMD loss, hip fractures, non-vertebral fractures) of the RCT in 369,968 patients showed a benefit from calcium and vitamin D3 supplementation.

One of the key issues remains the dosage of calcium and vitamin D3. Particular attention should be paid to the fact that most recommendations (USA, UK, Scotland, France, Italy, etc.) indicate combination preparations that include calcium and vitamin D3 [1–6].

Thus, the recommended and proven doses of calcium by most professional associations are 1000 mg per day, vitamin D3 - 800 IU per day.

Considering the multimorbidity of modern patients, it should be noted that calcium is a “universal” microelement that plays a key role in most biochemical and physiological reactions.

Significant processes and effects on the development of some pathophysiological mechanisms are presented in Table. 2.

As can be seen from the above facts, calcium deficiency increases the risk of diseases associated with atherosclerosis and insulin resistance, which has a certain clinical meaning in planning a pharmacotherapy strategy in these cases.

In recent years, the issue of increasing the risk of cardiovascular accidents and associated death in patients taking calcium supplements has been discussed in European medical communities.

The most significant evidence may be a meta-analysis published by MJ Bolland in 2010 [7]. The meta-analysis included 26 studies, with a total of 20,072 patients.

From the presented data, the practitioner concludes that there is a slight increase in cardiovascular mortality in patients receiving calcium supplements. However, it should be mentioned that we are only talking about studies in which patients did not receive vitamin D3. Only one study was included in this meta-analysis [13], in which calcium was administered with vitamin D3. This study did not demonstrate an increase in the risks of cardiovascular events and death. In this study, the risk of major cardiovascular events and death did not differ from the placebo group.

The authors place special emphasis in their final conclusions: a slight increase in cardiovascular mortality when taking calcium supplements without vitamin D3.

In another analysis, the same professor [8] demonstrates that calcium doses of 1000 mg/day in the WHI study (total number of patients - 36,282) did not demonstrate a significant effect on cardiovascular events - the risk of major cardiovascular events and death was lower compared with placebo group.

Another study by Professor V. M. Tang [9] especially emphasizes the role of prescribing a combined calcium and vitamin D3 preparation for the prevention and treatment of osteoporosis, since monotherapy with one or the other in most analyzed RCTs is always worse than the combination.

Thus, when deciding to prescribe calcium supplements, it is necessary to choose combination preparations containing calcium and vitamin D3, where the daily dose of calcium will be at least 1000 mg (maximum of two tablets).

The most interesting topic for discussion is the role of vitamin D3 in the development of a number of socially significant diseases.

Summarizing the known literature and our own data, we should highlight priority pathologies associated with vitamin D3 deficiency:

• muscle weakness (sarcopenia);
• falls;
• diabetes;
• oncological diseases;
• immune system disorders;
• arterial hypertension and other CVDs;
• high mortality rate.

A significant number of studies by foreign authors show the relationship between vitamin D3 deficiency and diseases not directly related to bone tissue.

There is no doubt that there is a connection between vitamin D3 deficiency and cardiovascular diseases and arterial hypertension. Decreased vitamin D3 concentrations are associated with an increased risk of metabolic syndrome, including hypertension. Normalizing vitamin D3 levels can reduce systolic blood pressure and thus reduce the risk of cardiovascular disease.

Studies have also demonstrated that correction of vitamin D3 deficiency prevents further hypertrophy of cardiomyocytes in patients with arterial hypertension.

Because vitamin D3 deficiency affects cardiotonic properties and vascular modulation, hypertension possibly increases the negative effects of vitamin D3 deficiency on the cardiovascular system. In addition, experimental and clinical data suggest that vitamin D3 deficiency directly causes the development of hypertension.

What is the prevalence of vitamin D3 deficiency in domestic patients with somatic pathology? To answer this question, we undertook a study of the prevalence of vitamin D3 deficiency in patients in a therapeutic hospital.

We examined 134 patients, of which 44 (32.8%) were men, average age 51.6 ± 15.2. The average body mass index in patients was 28.2 kg/m2.

Among somatic diseases, cardiovascular diseases were found in most cases - 126 (94.02%). All patients had arterial hypertension, and 24 (17.9%) also had coronary artery disease, post-infarction cardiosclerosis, and chronic heart failure of functional classes II–III.

18 (13.4%) patients had type 2 diabetes as a background pathology. Among other diseases, diseases of the gastrointestinal tract were noted (chronic gastritis, peptic ulcer of the stomach or duodenum, less often in combination with chronic cholecystitis) in 16.4% of cases and COPD in 14.2% of patients.

When analyzing the daily calcium intake of the subjects, it was found that all patients received an extremely low amount of it - the average intake was 278.4 ± 117.4 mg per day (recommended calcium intake is 1000–1500 mg per day).

It should be noted that calcium intake varied between men and women:

• men - 196.3 ± 148.4 mg/day;
• women - 360.5 ± 86.7 mg/day.

There were several objective reasons for such a low calcium intake:

• 47 (35.1%) patients do not consume dairy products (including cheeses);
• 56 (41.8%) - consume greens only in the summer;
• 73 (54.5%) - consume sea fish less than once a week;
• 68 (50.7%) - rarely consume nuts, dried fruits, etc.

However, it should be recognized that low calcium intake undeniably requires additional daily calcium supplementation.

Among all those examined, only 4 patients had vitamin D3 levels that corresponded to the reference values, in accordance with the recommendations of the International Osteoporosis Foundation (2010) - more than 75 nmol/l, averaging 86.7 nmol/l. In general, more than 97% of patients with chronic somatic diseases have low vitamin D3 concentrations.

The average level of 25-hydroxyvitamin D (25 (OH)D) in the blood serum was 43.4 ± 7.6 nmol/L, with 47.8 ± 9.2 nmol/L among patients under 50 years of age.

Among our patients, 56 people were under the age of 50 years, the average age was 43.7 ± 4.5 years. Here, 3 (5.4%) patients did not have vitamin D3 deficiency, while in the group over 50 years old (here the average age was 63.2 ± 5.7 years) only 1 (1.3%) patient did not have a deficiency vitamin D3.

A number of patients (n = 34) had hypercholesterolemia; the average value of total blood cholesterol was 7.1 ± 0.9 mmol/l. We found a significant (r = -0.23, p = 0.04) negative correlation between the level of total cholesterol and the level of vitamin D3.

Among patients with type 2 diabetes (n = 18), we also obtained a significant (r = -0.34, p = 0.043) negative correlation between blood glucose levels and vitamin D3 levels.

When analyzing densitometry (central densitometry, Lunar DPX BRAVO device), patients were diagnosed with osteoporosis in 51 (38.1%) cases, and osteopenia in 62 (46.3%) cases (here the average value for the general T-criterion in the spine was - 1.9 SD).

All patients diagnosed with loss of bone mineral density were found to be vitamin D3 deficient.

Thus, almost all patients with chronic somatic diseases have a deficiency of vitamin D3. At the same time, a significant deficiency of vitamin D3 was noted: the average value was 43.4 nmol/l, with a norm of at least 75 nmol/l.

We found negative correlations between vitamin D3 levels and total blood cholesterol and blood glucose. Most patients showed loss of bone mineral density.

Consequently, our data indicate the need to correct vitamin D3 deficiency in patients with somatic pathology.

It should be assumed that the administration of vitamin D3 will lead to a reduction in mortality in patients with somatic multimorbidity. This is evidenced by one of the latest meta-analyses [10], which included more than 50 RCTs, with a total number of patients - 94,148 people, mostly elderly women.

Cholecalciferol (vitamin D3) supplementation was shown to indeed reduce mortality (RR = 0.94, 95% CI 0.91 to 0.98; 74,789 participants, 32 trials). This fact has not been confirmed for alfacalcidol, calcitriol and vitamin D2.

Thus, to create an effective concentration of vitamin D3 in a patient and achieve pharmacological effects (including reducing mortality), it is necessary to prescribe drugs containing cholecalciferol.

However, it must be clarified that most controlled studies show significantly greater evidence of a reduction in mortality with the use of combination calcium and vitamin D3 supplements.

The most important issue for a practicing physician is the specific choice of a calcium and vitamin D3 drug from a huge number of similar drugs offered on the pharmaceutical market.

The first criterion is the analysis of RCTs regarding the composition and doses of calcium and vitamin D3:

• The above material demonstrated that the most proven are combination preparations of calcium and vitamin D3.
• The most proven doses of calcium and vitamin D3 are 1000 mg/800 IU per day, respectively.

The second criterion is the prescription of medications. Unfortunately, most forums on the Internet are full of recommendations for prescribing drugs containing oyster calcium, etc. Most of these drugs contain no more than 100 mg of calcium, with the recommended dose being 3-4 tablets per day. Considering the extremely low bioavailability of calcium from the proposed form, it should be assumed that its content will still not be sufficient.

The third criterion is the analysis of the pharmacokinetic and structural characteristics of the drug. When choosing this drug, you must clearly understand that vitamin D3 is not resistant to light and is easily oxidized. Therefore, vitamin D3 must be stabilized by fatty ingredients (vegetable oils) or antioxidants. The drug Calcium-D3 Nycomed Forte meets these criteria:

• combination drug;
• 2 tablets of the drug per day - calcium/vitamin D3 - 1000 mg/800 IU;
• Vitamin D3 is in solid encapsulated form, which protects from interaction with other components of the drug, and is stabilized by several fatty ingredients and antioxidants.

An analysis of RCTs [12] demonstrates that to date, evidence has been accumulated from studies of combined calcium and vitamin D3 preparations in 356,724 (!) patients. It should be noted that approximately a third of patients were prescribed Calcium-D3 Nycomed Forte.

One of the latest studies published by Karkkainen et al. (Osteoporos Int. 2010; 21: 2047–2055), with a three-year follow-up of the effectiveness of the drug Calcium-D3 Nycomed Forte (there were 267 patients in the study group and 306 in the control group), demonstrated a 30% reduction in the risk of all fractures (p = 0.034) .

Regarding the pharmacological correction of vitamin D3 deficiency, from a practical point of view it is necessary to comply with the main criterion for choosing a drug - a high content of D3 in the drug (at least 400 IU). Because, according to the position of the International Osteoporosis Foundation, which published an expert consensus in May 2010, the daily requirement for vitamin D3 is 800–1000 IU.

In summary, studies and meta-analyses published over the past year demonstrate growing interest in combination calcium and vitamin D3 supplements. Meta-analyses including more than 360,000 patients confirm the effectiveness of the drugs in the prevention of osteoporotic fractures and a satisfactory safety profile. However, calcium monotherapy may slightly increase cardiovascular risk, but in combination with vitamin D3 this fact is not confirmed.

Considering the pathophysiological role of vitamin D3 deficiency in the development of other somatic pathologies, as well as the high prevalence of vitamin D3 deficiency among patients with cardiovascular diseases, it should be assumed that the administration of combined preparations of calcium (in a daily dose of 1000 mg) and vitamin D3 (in a daily dose of at least 800 IU) will be useful not only in the prevention of osteoporotic fractures, but also in the strategic management of patients with somatic multimorbidity.

Literature

1. National Institute for Health and Clinical Excellence // Technology Appraisal 160. 2008, October (amended January 2010).
2. National Institute for Health and Clinical Excellence // Technology Appraisal 161. 2008. October (amended January 2010).
3. IMS BPI Data. 2010, September.
4. National Osteoporosis Guideline Group. Osteoporosis: clinical guideline for prevention and treatment // Executive Summary. Updated July 2010.
5. Scottish Intercollegiate Guidelines Network. Management of Osteoporosis. A National Clinical Guideline. SIGN 71. June 2003.
6. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2010.
7. Bolland MJ, Avenell A., Baron JA, Gray A., MacLennan GS, Gamble GD, Reid IR Effect of calcium supplements on the risk of myocardial infarction and cardiovascular events: meta-analysis // BMJ. 2010; 341: c. 3691.
8. Bolland MJ, Gray A., Avenell A., Gamble GD, Reid IR Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women's Health Initiative limited access dataset and meta-analysis // BMJ. 2011; 342 (apr19): d2040.

For the rest of the bibliography, please contact the editor.

A. V. Naumov, Doctor of Medical Sciences, Professor

GBOU VPO MGMSU Ministry of Health and Social Development of Russia, Moscow

Contact information about the author for correspondence