Serious allergic (hypersensitivity) reactions such as swelling of the face,lips or tongue, kidney stone, bloodphosphate level above normal(hyperphosphatemia). If you are allergic to calciumcarbonate or colecalciferol (vitaminD3) or any of the other ingredients ofthis medicine (listed in section 6); A clinical study of institutionalised patients suffering from vitamin D deficiency indicated that a daily intake of 1000 mg calcium and 800 IU vitamin D for six months normalised the value of the 25-hydroxylated metabolite of vitamin D 3 and reduced secondary hyperparathyroidism and alkaline phosphatases. This is not a list of all drugs or health problems that interact with Calci-Chew (calcium carbonate chewable tablets). orlistat (a medicine used to treatobesity), bile acid sequestrants (usedto treat high blood cholesterol levels,for example cholestyramine,colestipol), steroids (such ascortisone), mineral oils (such asparaffin oil used as a laxative orstool softener): these medicines maydecrease the absorption of thevitamin D3.

Some diuretics (furosemide, ethacrynic acid), antacids containing aluminium salts and thyroid hormones can inhibit calcium absorption and increase renal and faecalexcretion. Thiazide diuretics can reduce urinary excretion of calcium and can inducehypercalcaemia, some antibiotics such as penicillin, neomycin and chloramphenicolcan increase its absorption. Monitoring of the serum calcium levels during prolongedtreatment is recommended. Calcichew-D 3 Once Daily chewable tablets should be used cautiously in immobilised patients with osteoporosis due to increased risk of hypercalcaemia. Calcium carbonate may interfere with the absorption of concomitantly administered tetracycline preparations. For this reason, tetracycline preparations should be administered at least two hours before or four to six hours after oral intake of calcium carbonate.

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The efficacy of levothyroxine can be reduced by the concurrent use of calcium, due to decreased levothyroxine absorption. Administration of calcium and levothyroxine should be separated by at least four hours. During pregnancy the daily intake should not exceed 1,500 mg calcium and 600 IU vitamin D. Studies in animals have shown reproductive toxicity of high doses ofvitamin D (see section 5.3). In pregnant women, overdoses of calcium andColecalciferol should be avoided as permanent hypercalcaemia has been related toadverse effects on the developing fetus. There are no indications that vitamin D attherapeutic doses is teratogenic in humans. CALCI-D can be used during pregnancy,in case of a calcium and vitamin D deficiency.

Thiazide diuretics reduce the urinary excretion of calcium, therefore, due to increased risk of hypercalcaemia, serum calcium should be regularly monitored during concomitant use of thiazide diuretics. The MHRA has taken the decision to approve Pharmacy legal status for Calci-D chewable tablets under the following conditions: Tell your doctor and ask for advice before taking any other productcontaining vitamin D or its derivativeswhile taking CALCI-D.The label has been updated to reflect the requirements for a P product as set out in The Human Medicines Regulation 2012. In particular, the indications, full dosage instructions and relevant warnings for the medicine in language that will be understood by the patient have been included on the outer label.

Calcium is secreted into the gastro-intestinal tract via the saliva, bile and pancreatic secretion. Calcium from these sources, along with the calcium that is not absorbedcomprises the portion excreted in the faeces. Of the portion of calcium excreted viathe renal system, approximately 2/3 of the filtered calcium is reabsorbed. Undesirable effects are listed below by system organ class and frequency. Frequencies are defined as: very common (> 1/10), common (> 1/100, <1/10),uncommon (> 1/1,000, <1/100), rare (> 1/10,000, <1/1,000), very rare (<1/10,000),not known (cannot be estimated from the available data).bisphosphonates (medicines used totreat or prevent osteoporosis) andsodium fluoride: when taking theseleave at least three hours beforetaking CALCI-D.