9.5.1 Calcium and magnesium

9.5.1.1 Calcium supplements

Patients should be encouraged to increase their dietary intake of calcium. Calcium supplements are usually only required where dietary calcium intake is deficient. Patients with coeliac disease are at increased risk of osteoporosis due to malabsorption of calcium, weight loss and low BMI. With a good response to a gluten free diet, bone mineral density increases. However, many coeliacs require supplementary calcium (see section 9.6 Vitamins)

Approximately 700mg of calcium is required per day. In osteoporosis, double the recommended daily amount reduces the risk of bone loss. For specific advice on the use of calcium in treatment and prophylaxis of osteoporosis see Chapter 6 section 6.6 Drugs affecting bone metabolism .

Calcium and vitamin D products are included in section 9.6 Vitamins.

Adcal®
  • Chewable tablets calcium carbonate containing 600mg calcium (£4.87 = two daily)
Calcichew®
  • Chewable tablets containing 500mg calcium (£5.22 = two daily)
Calcichew Forte®
  • Chewable tablets containing 1000mg calcium (£6.58 = one daily)

Notes

  1. Calcichew® is included here as one of the calcium products that is used as a first line phosphate-binder by renal specialists (for other phosphate – binders see below)
Sandocal-1000®
  • Effervescent tablets containing 1000mg calcium (£8.98 = one daily)
Calcium Gluconate 10%
  • 10ml ampoule
  • Infusion 50ml
Calcium chloride 10%
  • Min-I-jet 10ml

9.5.1.2 Hypercalcaemia and hypercalciuria

Bisphosphonates are usually used in the treatment of Hypercalaemia of Malignancy. Refer to section 6.6 Drugs affecting bone metabolism

Cinacalcet
  • Tablets 30mg, 60mg, 90mg (£231.97 = 60mg daily)

Notes

  1. NICE TA117: Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy (Jan 2007)
  2. Cinacalcet is commissioned by NHS England for complex primary hyperparathyroidism in adults and secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy. All new patients should receive treatment from secondary care Please refer to the primary hypoparathyroidism policy.
  3. Please refer to the Shared Care Guidance for Cinacalcet (Plymouth Hospitals NHS Trust)
Etelcalcetide
  • 5mg/ml solution for injection 0.5ml, 1ml, 2ml vial

Notes

  1. NICE TA448: Etelcalcetide for treating secondary hyperparathyroidism (June 2017)

9.5.1.3 Magnesium

Magnaspartate® and Neomag® are licensed for treatment and prevention of magnesium deficiency. When Magnaspartate® is not suitable/appropriate; Neomag® may be considered as an alternative, for those patients who cannot tolerate high sugar content, or prefer a tablet formulation as opposed to drinking a solution.

No new patients should commence treatment with the unlicensed preparations.

Magnaspartate® Granules
  • Magnesium aspartate dihydrate equivalent to 243mg (10mmol) magnesium (£8.95 = 10 sachets)

Indication

  • treatment and prevention of magnesium deficiency

Notes

  1. Renal patients: contraindicated in patients with severe renal impairment (eGFR less than 30); no dose adjustment necessary in mild to moderate renal impairment
  2. Please be aware of the high sugar content, each sachet contains 2.706g sucrose
Neomag®
  • Tablets (chewable) magnesium glycerophosphate equivalent to 97mg (4mmol) magnesium (£22.77 = 50)

Indication

  • Treatment of chronic magnesium loss or hypomagnesaemia

Notes

  1. Renal patients: contraindicated in patients with severe renal impairment; no dose adjustment necessary in mild to moderate renal impairment
  2. Tablets may be broken into quarters and chewed or swallowed with water
  3. Neomag® is not recommended for use in children under 4 years of age
Magnesium sulfate
  • Injection 50% (approximately 2mmol magnesium per mL)
  • Injection 1g in 10ml (10%W/V) – used in Plymouth Hospitals NHS Trust

Notes

  1. Magnesium sulfate may be used to treat pre-eclamptic arrhythmias

 

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