Becoral D

Indications

Becoral D is prescribed for the management and prevention of various conditions including osteoporosis, osteomalacia, tetany, hypoparathyroidism, and disorders of osteogenesis. It is also recommended as a supplement in cases of inadequate calcium intake in children, rickets, pregnancy, lactation, and for elderly patients. Additionally, Becoral D can be used as a phosphate binder in chronic renal failure and in conditions such as pancreatitis.

Composition

Each tablet of Becoral D contains 1250 mg of Calcium Carbonate (from coral source), which is equivalent to 500 mg of elemental calcium and 200 IU of Vitamin D. Each DX tablet contains 1500 mg of Calcium Carbonate (from coral source), equivalent to 600 mg of elemental calcium and 400 IU of Vitamin D. Each effervescent tablet contains 1500 mg of Calcium Carbonate (from coral source), equivalent to 600 mg of elemental calcium and 400 IU of Vitamin D3.

Pharmacology

Calcium is vital for various bodily functions, and its deficiency can lead to significant health issues. Clinical evidence suggests that adequate calcium intake helps prevent and treat osteoporosis and associated fractures. Vitamin D plays a crucial role in calcium absorption from the gastrointestinal tract and stimulates bone formation. The coral calcium used in Becoral D has a chemical structure similar to human bone, which promotes better absorption. Vitamin D3 further aids in maintaining calcium balance in the body.

Dosage & Administration

The recommended dosage is one tablet once or twice daily with plenty of water. For optimal absorption, it is advised to take the tablet with a full stomach. Effervescent tablets should be dissolved in a glass of water before drinking, ensuring to stir well. Consuming these tablets with a full stomach improves absorption.

Interactions

Thiazide diuretics can decrease calcium excretion, raising the risk of hypercalcemia; therefore, regular monitoring of serum calcium levels is necessary. Systemic corticosteroids may reduce calcium absorption, possibly requiring an increase in calcium dosage. Concurrent use of ion exchange resins or laxatives might lower vitamin D absorption. Calcium carbonate can interfere with tetracycline absorption; hence, it is advisable to space out the intake by at least 2 hours. Hypercalcemia may enhance the toxicity of cardiac glycosides, so monitoring of ECG and serum calcium levels is recommended. If using bisphosphonates or sodium fluoride, Becoral D should be administered at least three hours before to avoid reduced gastrointestinal absorption. Foods high in oxalic and phytic acids should not be consumed within two hours of taking calcium supplements.

Contraindications

Becoral D is contraindicated in individuals with hypercalcemia, hyperparathyroidism, hypercalciuria, nephrolithiasis, hypersensitivity to any component of the preparation, severe renal insufficiency, and those on concurrent digoxin therapy, which requires careful monitoring.

Side Effects

Possible side effects include gastrointestinal irritation, constipation, allergic reactions, nausea, vomiting, decreased appetite, and drowsiness. A skin rash may also occur following Vitamin D supplementation.

Pregnancy & Lactation

During pregnancy, the daily intake of calcium should not exceed 1500 mg and vitamin D should not exceed 600 IU. Overdosing on calcium and vitamin D should be avoided due to potential adverse effects on fetal development. Vitamin D at therapeutic doses is not expected to be teratogenic, but caution is advised. Becoral D can be used during breastfeeding, keeping in mind that calcium and vitamin D pass into breast milk and should be considered when supplementing the infant.

Precautions & Warnings

For long-term treatment, monitoring of serum calcium levels and renal function is essential, especially in elderly patients, those on cardiac glycosides or diuretics, and individuals prone to calculus formation. In cases of hypercalcemia or renal impairment, dosage adjustments or discontinuation of treatment may be required. Vitamin D should be used cautiously in patients with renal impairment and other forms of vitamin D might be necessary. Patients with sarcoidosis need careful monitoring due to increased vitamin D metabolism. Caution is also needed for immobilized osteoporosis patients due to the risk of hypercalcemia. Additional doses of calcium or vitamin D should be administered under close medical supervision, with regular monitoring of serum calcium and urinary calcium excretion.

Overdose Effects

An overdose of Becoral D can lead to hypervitaminosis D and hypercalcemia, with symptoms including anorexia, thirst, nausea, vomiting, constipation, abdominal pain, muscle weakness, fatigue, mental disturbances, and severe cases like cardiac arrhythmias or renal damage. Persistent high calcium levels may cause irreversible renal damage and soft tissue calcification. Management of hypercalcemia involves discontinuation of calcium and related treatments, rehydration, and, if necessary, treatment with diuretics, bisphosphonates, calcitonin, or corticosteroids. Serum electrolytes and renal function should be monitored, and in severe cases, ECG and central venous pressure should be assessed.

Therapeutic Class

Specific mineral and vitamin combined preparations.

Storage Conditions

Store at a temperature below 30°C, protected from light and moisture. Keep out of reach of children.