9.5.1.1 Calcium supplements
For calcium plus vitamin D3 products see section 9.6.4 Vitamin D
Calcium carbonate
Indications
Notes
- Where a preferred brand is recommended for a particular presentation, prescribing by brand helps ensure cost-efficient use of local NHS resources (see preferred brand link above)
Calvive 1000
(Calcium carbonate with calcium lactate gluconate)
- Effervescent tablets 1000mg (£13.17 = one daily)
Indications
Notes
- Each effervescent tablet contains 2,263mg of calcium lactate gluconate and 1,750mg of calcium carbonate (equivalent to 1000mg or 25mmol of calcium)
- Formerly known as Sandocal 1000 Tablets
Calcium gluconate
Notes
- National Patient Safety Alert (27 June 2023): Potential risk of underdosing with calcium gluconate in severe hyperkalaemia
- MHRA Drug Safety Update (June 2023): Calcium chloride, calcium gluconate: potential risk of underdosing with calcium gluconate in severe hyperkalaemia
Calcium chloride
- Injection 10% syringe (MiniJet)
- Injection 13.4% amp
Notes
- National Patient Safety Alert (27 June 2023): Potential risk of underdosing with calcium gluconate in severe hyperkalaemia
- MHRA Drug Safety Update (June 2023): Calcium chloride, calcium gluconate: potential risk of underdosing with calcium gluconate in severe hyperkalaemia
9.5.1.2 Hypercalcaemia and hypercalciuria
Cinacalcet
- Tablets 30mg, 60mg, 90mg (£25.53 = 60mg daily)
Notes
- All new patients should receive treatment from secondary care. Existing patients may continue to receive treatment in primary care.
- NICE TA117: Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy (January 2007):
- Cinacalcet is not recommended for the routine treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy.
- Cinacalcet is recommended for the treatment of refractory secondary hyperparathyroidism in patients with end-stage renal disease (including those with calciphylaxis) only in those:
- who have 'very uncontrolled' plasma levels of intact parathyroid hormone (defined as greater than 85 pmol/litre [800 pg/ml]) that are refractory to standard therapy, and a normal or high adjusted serum calcium level, and
- in whom surgical parathyroidectomy is contraindicated, in that the risks of surgery are considered to outweigh the benefits.
- Refer to TA117
for treatment continuation criteria and other considerations.
- NHS England (NHSE) will commission cinacalcet for complex primary hyperparathyroidism in adults (see NHSE Commissioning Policy for more details).
Etelcalcetide
- 5mg/ml solution for injection 0.5ml, 1ml, 2ml vial
Notes
- NICE TA448: Etelcalcetide for treating secondary hyperparathyroidism (June 2017)
9.5.1.3 Magnesium
Magnaspartate
(Magnesium aspartate dihydrate)
- Oral powder sachets (£9.45 = 10 sachets)
Indication
- Treatment and prevention of magnesium deficiency
Notes
- Renal patients: contraindicated in patients with severe renal impairment; no dose adjustment necessary in mild to moderate renal impairment
- Each 6.5g sachet of powder contains 243mg (10mmol) magnesium
- Please be aware of the high sugar content
Neomag
(Magnesium glycerophosphate)
- Chewable tablets 4mmol (£22.77 = 50 chewable tablets)
Indication
- Treatment of chronic magnesium loss or hypomagnesaemia
Notes
- Renal patients: contraindicated in patients with severe renal impairment; no dose adjustment necessary in mild to moderate renal impairment
- Each chewable tablet contains 97mg (4mmol) magnesium
- Tablets may be broken into quarters and chewed or swallowed with water
- Neomag is not recommended for use in children under 4 years of age
Magnesium sulfate
- Injection 50% (2 mmol/ml)
Notes
- MHRA Drug Safety Update (May 2019): Magnesium sulfate: risk of skeletal adverse effects in the neonate following prolonged or repeated use in pregnancy