Calcium and vitamin D (Formulary)

TAM (Treatments and Medicines) NHS Highland
NHS Highland

Those at risk of osteoporosis should maintain an adequate dietary intake of calcium and vitamin D.

Calcium and vitamin D must be prescribed with all oral and intravenous bone active therapies unless: 

  • a patient is hypercalcaemic
  • or has a risk of hypercalcaemia, eg sarcoidosis
  • has had renal stones in the past year
  • or where renal impairment dictates that alfacalcidol should be an alternative.
  • Where patients on bone-active therapy for osteoporosis are intolerant of Adcal D3®/Calci-D®, consider colecalciferol capsules/tablets 800 units daily. For further information on the use of vitamin D outwith this patient group, see: Vitamin D (Formulary)
  • The dose should be to the equivalent of 1000mg of calcium per day and 20 micrograms (800 units) of vitamin D
  • To avoid any potential interaction when taken within 4 hours of a bisphosphonate, consider prescribing calcium and vitamin D supplements to be taken at bedtime, when the stomach is more likely to be empty, to minimise calcium loss.
  • For patients with peanut/soya allergy prescribe Adcal D3® caplets, Calci-D® tablets or colecalciferol tablets.
  • Calcium and vitamin D as monotherapy has only been shown to be effective in osteoporosis in ambulant nursing home residents however this should not be used in place of a proper fracture assessment in these individuals.
  • For further information refer to The Royal Osteoporosis Guidelines: Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management.

COLECALCIFEROL WITH CALCIUM CARBONATE - (First line)

Therapy notes

Formulation and dosage details

Formulation:

Chewable tablets (Adcal-D3®) (calcium 600mg (15mmol) vitamin D 10 micrograms (400 units)/tablet) (lemon or tutti-frutti flavour)

Dosage:

  • 2 tablets at bedtime or one tablet twice daily.  
  • Advise patients to avoid taking within 4 hours of a bisphosphonate.

Formulation and dosage details

Formulation:

Caplets (Adcal-D3®) (calcium 300mg (7·5mmol), vitamin D 5 micrograms (200 units)/caplet)

Dosage:

  • 2 caplets twice daily.  
  • Advise patients to avoid taking within 4 hours of a bisphosphonate.

Formulation and dosage details

Formulation:

Effervescent tablets (Adcal-D3®) (calcium 600mg (15mmol), vitamin D 10 micrograms (400 units)/tablet) (contain 52mg sodium per tablet)

Dosage:

  • 2 tablets at bedtime or one tablet twice daily.  
  • Advise patients to avoid taking within 4 hours of a bisphosphonate.

Formulation and dosage details

Formulation:

Chewable tablets (Calci-D®) (calcium 1000mg (25mmol), vitamin D 25 micrograms (1000 units)/tablet)

Dosage:

  • 1 tablet in the evening.  
  • Advise patients to avoid taking within 4 hours of a bisphosphonate.

Editorial Information

Document Id: F185