Topic Contents

Calcium

Uses

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

This supplement has been used in connection with the following health conditions:

Used for	Why
3 Stars Gestational Hypertension 1,200 to 1,500 mg daily	Supplementing with calcium may reduce the risk of gestational hypertension. Calcium deficiency has been implicated as a possible cause of GH.¹ ^{, 2} In two preliminary studies, women who developed GH were found to have significantly lower dietary calcium intake than did pregnant women with normal blood pressure.³ ^{, 4} Calcium supplementation has significantly reduced the incidence of GH in preliminary studies⁵ and in many,⁶ ^{, 7} ^{, 8} ^{, 9} ^{, 10} ^{, 11} though not all,¹² double-blind trials. Calcium supplements may be most effective in preventing GH in women who have low dietary intake of calcium. The National Institutes of Health (NIH) recommends an intake of 1,200 to 1,500 mg of calcium daily during normal pregnancy.¹³ In women at risk of GH, studies showing reduced incidence have typically used 2,000 mg of supplemental calcium per day,¹⁴ ^{, 15} ^{, 16} ^{, 17} ^{, 18} ^{, 19} without any reported maternal or fetal side effects.²⁰ ^{, 21} Nonetheless, many doctors continue to suggest amounts no higher than 1,500 mg per day.
3 Stars Lactose Intolerance 500 to 1,200 mg daily depending on age and other calcium sources	As lactose-containing foods are among the best dietary sources of calcium, lactose-intolerant people may want to use calcium supplements as an alternative source. Caution: Calcium supplements should be avoided by prostate cancer patients. Researchers have yet to clearly determine whether lactose-intolerant people absorb less calcium . As lactose-containing foods are among the best dietary sources of calcium, alternative sources of calcium (from food or supplements) are important for lactose-intolerant people. A typical amount of supplemental calcium is 1,000 mg per day.
3 Stars Osteoporosis 800 to 1,500 mg daily depending on age and dietary calcium intake	Calcium supplements help prevent osteoporosis, especially for girls and premenopausal women. It is often recommended to help people already diagnosed with osteoporosis. Caution: Calcium supplements should be avoided by prostate cancer patients. Although insufficient when used as the only intervention, calcium supplements help prevent osteoporosis.²² Though some of the research remains controversial, the protective effect of calcium on bone mass is one of very few health claims permitted on supplement labels by the U.S. Food and Drug Administration. In some studies, higher calcium intake has not correlated with a reduced risk of osteoporosis—for example, in women shortly after becoming menopausal ²³ or in men.²⁴ However, after about three years of menopause, calcium supplementation does appear to take on a protective effect for women.²⁵ Even the most positive trials using isolated calcium supplementation show only minor effects on bone mass. Nonetheless, a review of the research shows that calcium supplementation plus hormone replacement therapy is much more effective than hormone replacement therapy without calcium.²⁶ Double-blind research has found that increasing calcium intake results in greater bone mass in girls.²⁷ An analysis of many trials investigating the effects of calcium supplementation in premenopausal women has also shown a significant positive effect.²⁸ Most doctors recommend calcium supplementation as a way to partially reduce the risk of osteoporosis and to help people already diagnosed with the condition. In order to achieve the 1,500 mg per day calcium intake many researchers deem optimal, 800 to 1,000 mg of supplemental calcium are generally added to the 500 to 700 mg readily obtainable from the diet. While phosphorus is essential for bone formation, most people do not require phosphorus supplementation, because the typical western diet provides ample or even excessive amounts of phosphorus. One study, however, has shown that taking calcium can interfere with the absorption of phosphorus, potentially leading to phosphorus deficiency in elderly people, whose diets may contain less phosphorus.²⁹. The authors of this study recommend that, for elderly people, at least some of the supplemental calcium be taken in the form of tricalcium phosphate or some other phosphorus-containing preparation. One trial studying postmenopausal women combined hormone replacement therapy with magnesium (600 mg per day), calcium (500 mg per day), vitamin C , B vitamins , vitamin D, zinc, copper, manganese, boron , and other nutrients for an eight- to nine-month period.³⁰ In addition, participants were told to avoid processed foods, limit protein intake, emphasize vegetable over animal protein, and limit consumption of salt, sugar, alcohol, coffee, tea, chocolate, and tobacco. Bone density increased a remarkable 11%, compared to only 0.7% in women receiving hormone replacement alone.
3 Stars Preeclampsia 1,200 to 1,500 mg daily	An analysis of double-blind trials found calcium supplementation to be highly effective in preventing preeclampsia. Calcium deficiency has been associated with preeclampsia.³¹ In numerous controlled trials, oral calcium supplementation has been studied as a possible preventive measure.³² ³³ ³⁴ ³⁵ While most trials have found a significant reduction in the incidence of preeclampsia with calcium supplementation,³⁶ ³⁷ ³⁸ ³⁹ ⁴⁰ ⁴¹ One study reported that calcium supplementation reduced both the severity of preeclampsia and the mortality rate in the infants.⁴² An analysis of double-blind trials46 found calcium supplementation to be highly effective in preventing preeclampsia. However, a large and well-designed double-blind trial and a critical analysis of six double-blind trials concluded that calcium supplementation did not reduce the risk of preeclampsia in healthy women at low risk for preeclampsia.⁴³ For healthy, high-risk (in other words, calcium deficient) women, however, the data show a clear and statistically significant beneficial effect of calcium supplementation in reducing the risk of preeclampsia.⁴⁴ ⁴⁵ ⁴⁶ ⁴⁷ ⁴⁸ ⁴⁹ ⁵⁰ ⁵¹ ⁵² ⁵³ ⁵⁴ ⁵⁵ ⁵⁶ ⁵⁷ The National Institutes of Health recommends an intake of 1,200 to 1,500 mg of elemental calcium daily during normal pregnancy.⁵⁸ In women at risk of preeclampsia, most trials showing reduced incidence have used 2,000 mg of supplemental calcium per day.⁵⁹ Nonetheless, many doctors continue to suggest amounts no higher than 1,500 mg per day.
3 Stars Premenstrual Syndrome 1,000 to 1,200 mg daily	Calcium appears to reduce the risk of mood swings, bloating, headaches, and other PMS symptoms. Women who consume more calcium from their diets are less likely to suffer severe PMS.⁶⁰ A large double-blind trial found that women who took 1,200 mg per day of calcium for three menstrual cycles had a 48% reduction in PMS symptoms, compared to a 30% reduction in the placebo group.⁶¹ Other double-blind trials have shown that supplementing 1,000 mg of calcium per day relieves premenstrual symptoms.⁶² ^{, 63}
3 Stars Rickets Consult a qualified healthcare practitioner	Calcium supplements may be helpful in preventing and treating rickets. Vitamin D and calcium supplements should be used to treat rickets only if a medical professional has diagnosed rickets and has also determined the cause is a nutritional deficiency. Amounts needed to treat rickets should be determined by a doctor and will depend on the age, weight, and condition of the child. For prevention of rickets, 400 IU of vitamin D per day is considered reasonable. Doctors often suggest 1,600 IU per day for treating rickets caused by a lack of dietary vitamin D. The National Institutes of Health has stated that the following amounts of total calcium intake per day are useful to prevent rickets: • 400 mg until six months of age • 600 mg from six to twelve months • 800 mg from one year through age five • 800–1,200 mg from age six until age ten
2 Stars Breast-Feeding Support 1,000 mg daily	Continuing to take prenatal vitamins will help ensure your body gets the nutrients it needs for breast-feeding. Especially important is continued calcium intake. A woman should continue to take prenatal vitamins in order to meet the nutrient requirements of breast-feeding. Especially important is continued intake of calcium and calcium-rich foods.
2 Stars Celiac Disease Consult a qualified healthcare practitioner	The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with calcium may correct a deficiency. Caution: Calcium supplements should be avoided by prostate cancer patients. The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .⁶⁴ Zinc malabsorption also occurs frequently in celiac disease⁶⁵ and may result in zinc deficiency, even in people who are otherwise in remission.⁶⁶ People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient. After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.⁶⁷
2 Stars High Cholesterol 800 to 1,000 mg daily	Some trials have shown that supplementing with calcium reduces cholesterol levels. Caution: Calcium supplements should be avoided by prostate cancer patients. Some preliminary⁶⁸ and double-blind⁶⁹ ^{, 70} trials have shown that supplemental calcium reduces cholesterol levels. Possibly the calcium is binding with and preventing the absorption of dietary fat.⁷¹ However, other research has found no substantial or statistically significant effects of calcium supplementation on total cholesterol or HDL (“good”) cholesterol.⁷² Reasonable supplemental levels are 800 to 1,000 mg per day.
2 Stars High Triglycerides 800 mg daily	Calcium supplementation has been shown to reduce triglyceride levels. Caution: Calcium supplements should be avoided by prostate cancer patients. In a preliminary trial, supplementation with 800 mg of calcium per day for one year resulted in a statistically significant 35% reduction in the average TG level among people with elevated cholesterol and triglycerides.⁷³ However, in another trial, calcium supplementation had no effect on TG levels.⁷⁴ One of the differences between these two trials was that more people in the former trial had initially elevated TG levels.
2 Stars Hypertension 800 to 1,500 mg daily	Calcium supplementation has been shown to lower blood pressure in people with hypertension. Caution: Calcium supplements should be avoided by prostate cancer patients. Calcium supplementation—typically 800–1,500 mg per day—may lower blood pressure. However, while an analysis of 42 trials reported that calcium supplementation led to an average drop in blood pressure that was statistically significant, the actual decrease was small (in medical terms, a drop of 1.4 systolic over 0.8 diastolic pressure).⁷⁵ Results might have been improved had the analysis been limited to studies of people with hypertension, since calcium has almost no effect on the blood pressure of healthy people. In the analysis of 42 trials, effects were seen both with dietary calcium and with use of calcium supplements. A 12-week trial of 1,000 mg per day of calcium accompanied by blood pressure monitoring is a reasonable way to assess efficacy in a given person.
2 Stars Obesity 800 mg daily	In a study of obese people following a low-calorie diet, those receiving a calcium supplement lost significantly more weight than those given a placebo. Caution: Calcium supplements should be avoided by prostate cancer patients. In a study of obese people consuming a low-calorie diet for 24 weeks, those receiving a calcium supplement (800 mg per day) lost significantly more weight than those given a placebo.⁷⁶ Calcium was effective when provided either as a supplement, or in the form of dairy products. In a second study, however, the amount of weight loss resulting from calcium supplementation (1,000 mg per day) was small and not statistically significant.⁷⁷ In that study, participants' typical diet contained more calcium than in the study in which calcium supplementation was more effective. Thus, it is possible that calcium supplementation enhances weight loss only when the diet is low in calcium.
2 Stars Pregnancy and Postpartum Support Obtain a total of 1,500 to 2,000 mg daily, including both supplement and food sources	Calcium needs double during pregnancy. Supplementing with calcium may reduce the risk of preeclampsia and pre-term delivery and improve the bone strength of the fetuses. Calcium needs double during pregnancy.⁷⁸ Low dietary intake of this mineral is associated with increased risk of preeclampsia , a potentially dangerous (but preventable) condition characterized by high blood pressure and swelling. Supplementation with calcium may reduce the risk of pre-term delivery, which is often associated with preeclampsia. Calcium may reduce the risk of pregnancy-induced hypertension ,⁷⁹ though these effects are more likely to occur in women who are calcium deficient.⁸⁰ ^{, 81} Supplementation with up to 2 grams of calcium per day by pregnant women with low dietary calcium intake has been shown to improve the bone strength of the fetuses.⁸² Pregnant women should consume 1,500 mg of calcium per day from all sources—food plus supplements. Food sources of calcium include dairy products, dark green leafy vegetables, tofu, sardines (canned with edible bones), salmon (canned with edible bones), peas, and beans.
2 Stars Tension Headache (Vitamin D) 1,000 to 1,500 mg per day (plus the same amount of calcium)	In preliminary research, people with chronic tension-type headaches who were also suffering from severe vitamin D deficiency experienced an improvement in their symptoms after supplementing with vitamin D and calcium. In a preliminary trial, eight patients had chronic tension-type headache in association with severe vitamin D deficiency. In each case, the headaches resolved after treatment with vitamin D3 (1,000 to 1,500 IU per day) and calcium (1,000 to 1,500 mg per day).⁸³
1 Star Amenorrhea and Osteoporosis (Vitamin D) Refer to label instructions	Despite the lack of evidence that calcium and vitamin D supplements alone are helpful to amenorrheic women, they are still generally recommended to prevent the added burden of calcium and vitamin D deficiency from further contributing to bone loss. A preliminary trial showed that bone loss occurred over a one-year period in amenorrheic exercising women despite daily supplementation with 1,200 mg of calcium and 400 IU of vitamin D .⁸⁴ In a controlled study of amenorrheic nursing women, who ordinarily experience brief bone loss that reverses when menstruation returns, bone loss was not prevented by a multivitamin supplement providing 400 IU of vitamin D along with 500 mg twice daily of calcium or placebo.⁸⁵ Despite the lack of evidence that calcium and vitamin D supplements alone are helpful to amenorrheic women, they are still generally recommended to prevent the added burden of calcium and vitamin D deficiency from further contributing to bone loss.⁸⁶ Amounts typically recommended are 1,200 to 1,500 mg calcium and 400 to 800 IU vitamin D daily.
1 Star Colon Cancer Refer to label instructions	Through a variety of mechanisms, calcium appears to reduce precancerous conditions in the colon and the risk of colon cancer. Caution: Calcium supplements should be avoided by prostate cancer patients. Through a variety of mechanisms, calcium may have anticancer actions within the colon. Most,⁸⁷ ^{, 88} ^{, 89} but not all,⁹⁰ preliminary studies have found associations between taking calcium supplements and a reduced risk of colon cancer or precancerous conditions in the colon. In double-blind trials, calcium supplementation has significantly protected against precancerous changes in the colon in some,⁹¹ ^{, 92} but not all, reports.⁹³ ^{, 94} While most evidence examining the ability of calcium supplementation to help prevent colon cancer appears hopeful, no research findings yet support the use of calcium supplements in people already diagnosed with colon cancer.
1 Star Depression Refer to label instructions	Taken with vitamin D, calcium significantly improved mood in people without depression in one study. Caution: Calcium supplements should be avoided by prostate cancer patients. In one double-blind trial, people without depression took 600 IU of vitamin D along with 1,000 mg of calcium , or a placebo, twice daily for four weeks.⁹⁵ Compared to the placebo, combined vitamin D and calcium supplementation produced significant elevations in mood that persisted at least one week after supplementation was discontinued.
1 Star Dysmenorrhea Refer to label instructions	Muscles that are calcium-deficient tend to be hyperactive and therefore might be more likely to cramp. Calcium may help prevent menstrual cramps by maintaining normal muscle tone. In theory, calcium may help prevent menstrual cramps by maintaining normal muscle tone. Muscles that are calcium-deficient tend to be hyperactive and therefore might be more likely to cramp. Calcium supplementation was reported to reduce pain during menses in one double-blind trial,⁹⁶ though another such study found that it relieved only premenstrual cramping, not pain during menses.⁹⁷ Some doctors recommend calcium supplementation for dysmenorrhea, suggesting 1,000 mg per day throughout the month and 250–500 mg every four hours for pain relief, during acute cramping (up to a maximum of 2,000 mg per day).
1 Star Gingivitis Refer to label instructions	Some doctors recommend calcium to people with gum diseases. Calcium given to people with periodontal disease has been shown to reduce bleeding of the gums and loose teeth. Caution: Calcium supplements should be avoided by prostate cancer patients. Some,⁹⁸ but not all,⁹⁹ research has found that giving 500 mg of calcium twice per day for six months to people with periodontal disease results in a reduction of symptoms (bleeding gums and loose teeth). Although some doctors recommend calcium supplementation to people with diseases of the gums, supportive scientific evidence remains weak.
1 Star Insulin Resistance Syndrome Refer to label instructions	One study found that supplementing with calcium improved insulin sensitivity in people with hypertension. Caution: Calcium supplements should be avoided by prostate cancer patients. One double blind trial found that 1,500 mg per day of calcium improved insulin sensitivity in people with hypertension.¹⁰⁰ No research on the effects of calcium in people with IRS has been done.
1 Star Kidney Stones in People Who Are Not Hyperabsorbers of Calcium Refer to label instructions	Calcium appears to interfere with the absorption of oxalate, which reduces the risk of stone formation. Caution: Calcium supplements should be avoided by prostate cancer patients. In the past, doctors have sometimes recommended that people with a history of kidney stones restrict calcium intake because a higher calcium intake increases the amount of calcium in urine. However, calcium (from supplements or food) binds to oxalate in the gut before either can be absorbed, thus interfering with the absorption of oxalate. When oxalate is not absorbed, it cannot be excreted in urine. The resulting decrease in urinary oxalate actually reduces the risk of stone formation,¹⁰¹ and the reduction in urinary oxalate appears to outweigh the increase in urinary calcium.¹⁰² In clinical studies, people who consumed more calcium in the diet were reported to have a lower risk of forming kidney stones than people who consume less calcium.¹⁰³ ^{, 104} ^{, 105} However, while dietary calcium has been linked to reduction in the risk of forming stones, calcium supplements have been associated with an increased risk in a large study of American nurses.¹⁰⁶ The researchers who conducted this trial speculate that the difference in effects between dietary and supplemental calcium resulted from differences in timing of calcium consumption. Dietary calcium is eaten with food, and so it can then block absorption of oxalates that may be present at the same meal. In the study of American nurses, however, most supplemental calcium was consumed apart from food.¹⁰⁷ Calcium taken without food will increase urinary calcium, thus increasing the risk of forming stones; but calcium taken without food cannot reduce the absorption of oxalate from food consumed at a different time. For this reason, these researchers speculate that calcium supplements were linked to increased risk because they were taken between meals. Thus, calcium supplements may be beneficial for many stone formers, as dietary calcium appears to be, but only if taken with meals. When doctors recommend calcium supplements to stone formers, they often suggest 800 mg per day in the form of calcium citrate or calcium citrate malate, taken with meals. Citrate helps reduce the risk of forming a stone (see “Dietary changes that may be helpful” above).¹⁰⁸ Calcium citrate has been shown to increase urinary citrate in stone formers, which may act as protection against an increase in urinary calcium resulting from absorption of calcium from the supplement.¹⁰⁹ Despite the fact that calcium supplementation taken with meals may be helpful for some, people with a history of kidney stone formation should not take calcium supplements without the supervision of a healthcare professional. Although the increase in urinary calcium caused by calcium supplements can be mild or even temporary,¹¹⁰ some stone formers show a potentially dangerous increase in urinary calcium following calcium supplementation; this may, in turn, increase the risk of stone formation.¹¹¹ People who are “hyperabsorbers” of calcium should not take supplemental calcium until more is known. Using a protocol established years ago in the Journal of Urology, 24-hour urinary calcium studies conducted both with and without calcium supplementation determine which stone formers are calcium “hyperabsorbers.”¹¹² Any healthcare practitioner can order this simple test.
1 Star Migraine Headache Refer to label instructions	Taking large amounts of the combination of calcium and vitamin D has been reported to produce a marked reduction in the incidence of migraines in several women. Caution: Calcium supplements should be avoided by prostate cancer patients. Taking large amounts of the combination of calcium (1,000 to 2,000 mg per day) and vitamin D has been reported to produce a marked reduction in the incidence of migraines in several women.¹¹³ ^{, 114} However, the amount of vitamin D given to these women (usually 50,000 IU once a week), can cause adverse reactions, particularly when used in combination with calcium. This amount of vitamin D should be used only under medical supervision. Doctors often recommend that people take 800 to 1,200 mg of calcium and 400 IU of vitamin D per day. However, it is not known whether theses amounts would have an effect on migraines.
1 Star Multiple Sclerosis Refer to label instructions	Calcium levels have been reported to be low in people with MS. In one study, people given a combination of cod liver oil, magnesium, and calcium had a significantly reduced number of MS attacks. Caution: Calcium supplements should be avoided by prostate cancer patients. In a small preliminary trial, people with MS were given 20 grams of cod liver oil , as well as approximately 680 mg of magnesium and 1,100 mg of calcium per day in the form of dolomite tablets.¹¹⁵ After one year, the average number of MS attacks decreased significantly for each person. Unlike fish oil capsules, the cod liver oil in this trial contained not only eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), but 5,000 IU of vitamin D . Therefore, it is not known whether the vitamin D or fatty acids were responsible for the cod liver oil’s effects. (One preliminary study found that giving vitamin D-like drugs to animals with MS was helpful.)¹¹⁶ It is also possible that the magnesium and/or calcium given to these people reduced MS attacks. Magnesium¹¹⁷ and calcium¹¹⁸ levels have been reported to be lower in the nerve tissue of people with MS compared with healthy people.

How It Works

How to Use It

The National Academy of Sciences has established guidelines for calcium that are 25–50% higher than previous recommendations. For ages 19 to 50, calcium intake is recommended to be 1,000 mg daily; for adults over age 51, the recommendation is 1,200 mg daily.¹¹⁹ The most common supplemental amount for adults is 800–1,000 mg per day.¹²⁰ General recommendations for higher daily intakes (1,200–1,500 mg) usually include the calcium most people consume from their diets. Studies indicate the average daily amount of calcium consumed by Americans is about 500–1,000 mg.

Where to Find It

Most dietary calcium comes from dairy products. The myth that calcium from dairy products is not absorbed is not supported by scientific research.¹²¹ ^{, 122} Other good sources include sardines, canned salmon, green leafy vegetables, and tofu.

Possible Deficiencies

Severe deficiency of either calcium or vitamin D leads to a condition called rickets in children and osteomalacia in adults. Since vitamin D is required for calcium absorption, people with conditions causing vitamin D deficiency (e.g., pancreatic insufficiency) may develop a deficiency of calcium as well. Vegans (pure vegetarians), people with dark skin, those who live in northern latitudes, and people who stay indoors almost all the time are more likely to be vitamin D deficient than are other people. Vegans often eat less calcium and vitamin D than do other people. Most people eat well below the recommended amount of calcium. This lack of dietary calcium is thought to contribute to the risk of osteoporosis , particularly in white and Asian women.

Interactions

Interactions with Supplements, Foods, & Other Compounds

Some studies have shown that calcium competes for absorption with a number of other minerals, while other studies have found no such competition. To be on the safe side, some doctors recommend that people taking calcium for long periods of time should also take a multimineral supplement.

One study has shown that taking calcium can interfere with the absorption of phosphorus, which, like calcium, is important for bone health.¹²³. Although most western diets contain ample or even excessive amounts of phosphorus, older people who supplement with large amounts of calcium may be at risk of developing phosphorus deficiency. For this reason, the authors of this study recommend that, for elderly people, at least some of the supplemental calcium be taken in the form of tricalcium phosphate or some other phosphorus-containing preparation.

Vitamin D ’s most important role is maintaining blood levels of calcium. Therefore, many doctors recommend that those supplementing with calcium also supplement with 400 IU of vitamin D per day.

Animal studies have shown that essential fatty acids (EFAs) increase calcium absorption from the gut, in part by enhancing the effects of vitamin D and reducing loss of calcium in the urine.¹²⁴

Lysine supplementation increases the absorption of calcium and may reduce its excretion.¹²⁵ As a result, some researchers believe that lysine may eventually be shown to have a role in the prevention and treatment of osteoporosis .¹²⁶

Interactions with Medicines

Certain medicines interact with this supplement.

What Are Drug Interactions

Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

Albuterol

Therapeutic amounts of intravenous salbutamol (albuterol) in four healthy people were associated with decreased plasma levels of calcium , magnesium , phosphate, and potassium .¹²⁷ Decreased potassium levels have been reported with oral,¹²⁸ intramuscular, and subcutaneous albuterol administration.¹²⁹ How frequently this effect occurs is not known; whether these changes are preventable through diet or supplementation is also unknown.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Aluminum Hydroxide

Aluminum hydroxide may increase urinary and stool loss of calcium.¹³⁰ Also, aluminum is a toxic mineral, and a limited amount of aluminum absorption from aluminum-containing antacids does occur.¹³¹ As a result, most doctors do not recommend routine use of aluminum-containing antacids.¹³² Other types of antacids containing calcium or magnesium instead of aluminum are available.
Beclomethasone

Most of an inhaled dose of beclomethasone is actually swallowed, which may lead to reduced absorption of calcium.¹³³ Health practitioners may recommend calcium supplementation to individuals using beclomethasone inhalers.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Budesonide

Most of an inhaled dose of beclomethasone is actually swallowed, which may lead to reduced absorption of calcium.¹³⁴ Health practitioners may recommend calcium supplementation to individuals using beclomethasone inhalers.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Busulfan

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹³⁵

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Caffeine

In 205 healthy postmenopausal women, caffeine consumption (three cups of coffee per day) was associated with bone loss in women with calcium intake of less than 800 mg per day.¹³⁶ In a group of 980 postmenopausal women, lifetime caffeine intake equal to two cups of coffee per day was associated with decreased bone density in those who did not drink at least one glass of milk daily during most of their life.¹³⁷ However, in 138 healthy postmenopausal women, long-term dietary caffeine (coffee) intake was not associated with bone density.¹³⁸ Until more is known, postmenopausal women should limit caffeine consumption and consume a total of approximately 1,500 mg of calcium per day (from diet and supplements).
Capecitabine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁴⁰

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Carboplatin

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁴¹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Carmustine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁴²

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Chlorambucil

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁴³

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Cholestyramine

Bile acid sequestrants may prevent absorption of folic acid and the fat-soluble vitamins A , D , E , and K .¹⁴⁴ ^{, 145} Other medications and vitamin supplements should be taken one hour before or four to six hours after bile acid sequestrants for optimal absorption.¹⁴⁶ Animal studies suggest calcium and zinc may also be depleted by taking cholestyramine.¹⁴⁷

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Cisplatin

Cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁴⁸

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Cladribine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁴⁹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Colesevelam

Bile acid sequestrants may prevent absorption of folic acid and the fat-soluble vitamins A , D , E , and K .¹⁵⁰ ^{, 151} Other medications and vitamin supplements should be taken one hour before or four to six hours after bile acid sequestrants for optimal absorption.¹⁵² Animal studies suggest calcium and zinc may also be depleted by taking cholestyramine.¹⁵³

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Colestipol

Bile acid sequestrants, including colestipol, may prevent absorption of folic acid and the fat-soluble vitamins A , D , E , K .¹⁵⁴ ^{, 155} People taking colestipol should consult with their doctor about vitamin malabsorption and supplementation. People should take other drugs and vitamin supplements one hour before or four to six hours after colestipol to improve absorption.¹⁵⁶

Animal studies suggest calcium and zinc may be depleted by taking cholestyramine, another bile acid sequestrant. ¹⁵⁷ Whether these same interactions would occur with colestipol is not known.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Cortisone

Oral corticosteroids reduce absorption of calcium¹⁵⁸ and interfere with the activation and metabolism of the vitamin,¹⁵⁹ ^[REF] ¹⁶⁰ ^{, 161} increasing the risk of bone loss. Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists; if so, activated vitamin D is only available by prescription. A study of rheumatoid arthritis patients treated with low amounts of prednisone found that those who received 1,000 mg of calcium per day plus 500 IU of vitamin D per day for two years experienced no bone loss during that time period.¹⁶² An analysis of properly conducted trials concluded that supplementation with vitamin D and calcium was more effective than placebo or calcium alone in protecting against corticosteroid-induced osteoporosis .¹⁶³ Most doctors recommend 1,000 mg of calcium and 400–800 IU vitamin D per day for the prevention of osteoporosis.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Cycloserine

Cycloserine may interfere with calcium and magnesium absorption.¹⁶⁴ The clinical significance of these interactions is unclear.

Cycloserine may interfere with the absorption and/or activity of folic acid, vitamin B6, and vitamin B12.¹⁶⁵ ^{, 166} The clinical importance of this interaction is unclear.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Cytarabine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁶⁷

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Dexamethasone

Oral corticosteroids reduce absorption of calcium¹⁷⁵ and interfere with the activation and metabolism of the vitamin,¹⁷⁶ ^{, 177} ^{, 178} ^{, 179} increasing the risk of bone loss. Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists; if so, activated vitamin D is only available by prescription. A study of rheumatoid arthritis patients treated with low amounts of prednisone found that those who received 1,000 mg of calcium per day plus 500 IU of vitamin D per day for two years experienced no bone loss during that time period.¹⁸⁰ An analysis of properly conducted trials concluded that supplementation with vitamin D and calcium was more effective than placebo or calcium alone in protecting against corticosteroid-induced osteoporosis .¹⁸¹ Most doctors recommend 1,000 mg of calcium and 400–800 IU vitamin D per day for the prevention of osteoporosis.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Diclofenac

Diclofenac decreases the amount of calcium lost in the urine,¹⁸² which may help prevent bone loss in postmenopausal women.¹⁸³
Docetaxel

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁸⁴

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Felodipine

A study of felodipine indicated that the drug caused increased excretion of calcium.¹⁸⁵ Whether this effect could lead to increased bone loss is unknown, but some health practitioners may recommend calcium supplementation to individuals taking felodipine. Although the effectiveness of some calcium channel blockers may be reduced with calcium supplementation,¹⁸⁶ this effect has not been observed in people taking felodipine.
Floxuridine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁸⁷

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Fludarabine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁸⁸

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Flunisolide

Most of an inhaled dose of beclomethasone is actually swallowed, which may lead to reduced absorption of calcium.¹⁸⁹ Health practitioners may recommend calcium supplementation to individuals using beclomethasone inhalers.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Flurbiprofen

Elevated calcium and vitamin D blood levels are commonly found in people with sarcoidosis. In one individual with sarcoidosis, taking flubiprofen lowered elevated blood calcium levels, but did not alter the concentration of vitamin D.¹⁹⁰ One controlled study showed that flurbiprofen reduced blood levels of vitamin D in people with frequent calcium kidney stones .¹⁹¹ Further research is needed to determine whether flurbiprofen reduces blood calcium and vitamin D levels in healthy people.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Fluticasone

Most of an inhaled dose of beclomethasone is actually swallowed, which may lead to reduced absorption of calcium.¹⁹² Health practitioners may recommend calcium supplementation to individuals using beclomethasone inhalers.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Furosemide

Calcium depletion, in some cases severe, has been observed in some people taking loop diuretics.¹⁹³ People taking loop diuretics should ask their doctor whether they should take a calcium supplement or have their blood level of calcium monitored.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Gabapentin

Individuals on long-term multiple anticonvulsant therapy may develop below-normal blood levels of calcium, which may be related to drug-induced vitamin D deficiency.¹⁹⁴ Two infants born to women taking high doses of phenytoin and phenobarbital while pregnant developed jitteriness and tetany (a syndrome characterized by muscle twitches) cramps, and spasm during the first two weeks of life.¹⁹⁵ Controlled research is needed to determine whether pregnant women who are taking anticonvulsant medications should supplement with additional amounts of calcium and vitamin D.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Gentamicin

Gentamicin has been associated with hypocalcemia (low calcium levels) in humans.¹⁹⁶ In a study using rats, authors reported oral calcium supplementation reduced gentamicin-induced kidney damage.¹⁹⁷ The implications of this report for humans are unclear. People receiving gentamicin should ask their doctor about monitoring calcium levels and calcium supplementation.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Hydrocodone

Normally, the active form of vitamin D increases the absorption of calcium into the body. In a 45-year-old woman with sarcoidosis, taking hydroxychloroquine blocked the formation of active vitamin D, which helped normalize elevated blood levels of calcium in this case.¹⁹⁸ Whether hydroxychloroquine has this effect in people who don’t have sarcoidosis or elevated calcium is unknown. Until controlled research explores this interaction more thoroughly, people taking hydroxychloroquine might consider having their vitamin D and/or calcium status monitored by a health practitioner.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Hydroxyurea

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.¹⁹⁹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Ifosfamide

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²⁰⁰

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Indomethacin

Indomethacin has been reported to decrease absorption of folic acid and vitamin C .²⁰¹ Under certain circumstances, indomethacin may interfere with the actions of vitamin C.²⁰² Calcium and phosphate levels may also be reduced with indomethacin therapy.²⁰³ It remains unclear whether people taking this drug need to supplement any of these nutrients.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Isoniazid

Isoniazid may interfere with the activity of other nutrients, including vitamin B3 (niacin) , vitamin B12 , vitamin D , and vitamin E , folic acid , calcium , and magnesium .²⁰⁴ ^{, 205} Supplementation with vitamin B6 is thought to help prevent isoniazid-induced niacin deficiency; however, small amounts of vitamin B6 (e.g. 10 mg per day) appear to be inadequate in some cases.²⁰⁶ People should consider using a daily multivitamin-mineral supplement during isoniazid therapy.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Levalbuterol

Most of an inhaled dose of beclomethasone is actually swallowed, which may lead to reduced absorption of calcium.²⁰⁷ Health practitioners may recommend calcium supplementation to individuals using beclomethasone inhalers.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Lomustine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²⁰⁸

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Mechlorethamine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²⁰⁹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Melphalan

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²¹⁰

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Mercaptopurine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²¹¹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Methotrexate

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²¹⁶

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Mineral Oil

Mineral oil has interfered with the absorption of many nutrients, including beta-carotene , calcium , phosphorus , potassium , and vitamins A , D , K , and E in some,²²⁴ but not all,²²⁵ research. Taking mineral oil on an empty stomach may reduce this interference. It makes sense to take a daily multivitamin-mineral supplement two hours before or after mineral oil. It is important to read labels, because many multivitamins do not contain vitamin K or contain inadequate (less than 100 mcg per day) amounts.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Neomycin

Neomycin can decrease absorption or increase elimination of many nutrients, including calcium , carbohydrates, beta-carotene , fats, folic acid , iron , magnesium , potassium , sodium, and vitamin A , vitamin B12 , vitamin D , and vitamin K .²²⁶ ^{, 227} Surgery preparation with oral neomycin is unlikely to lead to deficiencies. It makes sense for people taking neomycin for more than a few days to also take a multivitamin-mineral supplement.
Omeprazole

In a study of elderly women, administration of omeprazole decreased the absorption of calcium,²²⁸ presumably because the drug decreased the stomach's production of hydrochloric acid, which is necessary for calcium absorption. The form of calcium used in the study to test calcium absorption was calcium carbonate. Drugs that reduce stomach acid secretion may not inhibit other forms of calcium, such as calcium citrate.²²⁹
Phenobarbital

Individuals on long-term multiple anticonvulsant therapy may develop below-normal blood levels of calcium, which may be related to drug-induced vitamin D deficiency.²³⁰ Two infants born to women taking high doses of phenytoin and phenobarbital while pregnant developed jitteriness and tetany (a syndrome characterized by muscle twitches), cramps, and spasms that can be caused by calcium deficiency during the first two weeks of life.²³¹ Controlled research is needed to determine whether pregnant women who are taking anticonvulsant medications should supplement with additional amounts of calcium and vitamin D.
Phenytoin

Individuals on long-term multiple anticonvulsant therapy may develop below-normal blood levels of calcium, which may be related to drug-induced vitamin D deficiency.²³² Two infants born to women taking high doses of phenytoin and phenobarbital while pregnant developed jitteriness and tetany (a syndrome characterized by muscle twitches, cramps, and spasm) during the first two weeks of life.²³³ Controlled research is needed to determine whether pregnant women who are taking anticonvulsant medications should supplement with additional amounts of calcium and vitamin D.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Polifeprosan 20 with Carmustine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²³⁴

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Prednisolone

Oral corticosteroids reduce absorption of calcium²³⁵ and interfere with the activation and metabolism of the vitamin,²³⁶ ^[REF] ²³⁷ ^{, 238} increasing the risk of bone loss. Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists; if so, activated vitamin D is only available by prescription. A study of rheumatoid arthritis patients treated with low amounts of prednisone found that those who received 1,000 mg of calcium per day plus 500 IU of vitamin D per day for two years experienced no bone loss during that time period.²³⁹ An analysis of properly conducted trials concluded that supplementation with vitamin D and calcium was more effective than placebo or calcium alone in protecting against corticosteroid-induced osteoporosis .²⁴⁰ Most doctors recommend 1,000 mg of calcium and 400–800 IU vitamin D per day for the prevention of osteoporosis.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Prednisone

Oral corticosteroids reduce absorption of calcium²⁴¹ and interfere with the activation and metabolism of the vitamin,²⁴² ^{, 243} ^{, 244} ^{, 245} increasing the risk of bone loss. Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists; if so, activated vitamin D is only available by prescription. A study of rheumatoid arthritis patients treated with low amounts of prednisone found that those who received 1,000 mg of calcium per day plus 500 IU of vitamin D per day for two years experienced no bone loss during that time period.²⁴⁶ An analysis of properly conducted trials concluded that supplementation with vitamin D and calcium was more effective than placebo or calcium alone in protecting against corticosteroid-induced osteoporosis .²⁴⁷ Most doctors recommend 1,000 mg of calcium and 400–800 IU vitamin D per day for the prevention of osteoporosis.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Sucralfate

Slight increases in blood calcium levels may occur in people taking sucralfate, which could be aggravated by calcium supplementation.²⁴⁸ Therefore, people taking calcium supplements and sucralfate should have their blood calcium levels monitored by their healthcare practitioner and may need to avoid calcium supplementation.
Sulfamethoxazole

Sulfonamides, including sulfamethoxazole, can decrease absorption of calcium, magnesium, and vitamin B12.²⁴⁹ This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

Note: Since sulfamethoxazole is often prescribed in combination with trimethoprim (for example, in Bactrim or Septra), it may be easy to associate this interaction with trimethoprim. However, this interaction is not known to occur with trimethoprim alone.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Thioguanine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²⁵⁰

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Thiotepa

Cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²⁵¹

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Tobramycin

Calcium , magnesium , and potassium depletion requiring prolonged replacement were reported in a child with tetany who had just completed a three-week course of i.v. tobramycin.²⁵² The authors suggest this may have been due to kidney damage related to the drug. Seventeen patients with cancer developed calcium, magnesium, and potassium depletion after treatment with aminoglycoside antibiotics, including tobramycin.²⁵³ The authors suggested a possible potentiating action of tobramycin-induced mineral depletion by chemotherapy drugs, especially doxorubicin (Adriamycin®).

Until more is known, people receiving i.v. tobramycin should ask their doctor about monitoring calcium, magnesium, and potassium levels and the possibility of mineral replacement.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Triamterene

A review of the research literature indicates that triamterene may increase calcium loss.²⁵⁴ The importance of this information is unclear.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Trimethoprim/ Sulfamethoxazole

Sulfonamides, including sulfamethoxazole , can decrease absorption of calcium, magnesium, and vitamin B12.²⁵⁵ This is generally not a problem when taking sulfamethoxazole for two weeks or less. People taking sulfamethoxazole for longer than two weeks should ask their doctor about nutrient monitoring and supplementation.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Uracil Mustard

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²⁵⁶

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Vinblastine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²⁵⁷

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Vincristine

The chemotherapy drug cisplatin may cause kidney damage, resulting in depletion of calcium and phosphate.²⁵⁸

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

Metformin

Metformin therapy has been shown to deplete vitamin B12,²¹² and sometimes, but not always,²¹³ folic acid as well.²¹⁴ This depletion occurs through the interruption of a calcium-dependent mechanism. Supplementation with calcium has reversed this effect in a clinical trial.²¹⁵ People taking metformin should supplement vitamin B12 and folic acid or ask their doctor to monitor folic acid and vitamin B12 levels.
Methylprednisolone

Oral corticosteroids reduce absorption of calcium²¹⁷ and interfere with the activation and metabolism of the vitamin,²¹⁸ ^{, 219} ^{, 220} ^{, 221} increasing the risk of bone loss. Doctors can measure levels of activated vitamin D (called 1,25 dihydroxycholecalciferol) to determine whether a deficiency exists; if so, activated vitamin D is only available by prescription. A study of rheumatoid arthritis patients treated with low amounts of prednisone found that those who received 1,000 mg of calcium per day plus 500 IU of vitamin D per day for two years experienced no bone loss during that time period.²²² An analysis of properly conducted trials concluded that supplementation with vitamin D and calcium was more effective than placebo or calcium alone in protecting against corticosteroid-induced osteoporosis .²²³ Most doctors recommend 1,000 mg of calcium and 400–800 IU vitamin D per day for the prevention of osteoporosis.

Support Medicine

Calcitonin

Supplementation with 1,500 mg per day of calcium enhances the effects of nasal calcitonin on bone mass of the lumbar spine.¹³⁹ Women who take a calcitonin nasal product for osteoporosis should also take calcium.

Reduces Effectiveness

Ciprofloxacin

Calcium supplements are known to interfere with the absorption of ciprofloxacin. The same interference has been shown to occur when calcium-fortified orange juice is taken at the same time as ciprofloxacin.²⁶⁰
Demeclocycline

Taking mineral supplements or antacids that contain aluminum, calcium , iron , magnesium , or zinc at the same time as tetracyclines inhibits the absorption of the drug.²⁶¹ Therefore, individuals should take tetracyclines at least two hours before or after products containing minerals.
Doxycycline

Many minerals can decrease the absorption and reduce effectiveness of doxycycline, including calcium , magnesium , iron , zinc , and others.²⁶² To avoid these interactions, doxycycline should be taken two hours before or two hours after dairy products (high in calcium) and mineral-containing antacids or supplements.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Gemifloxacin

A recent study showed that taking calcium carbonate and gemifloxacin at the same time results in a significant reduction in blood levels of the drug.²⁶³ Consequently, gemifloxacin and calcium supplements should not be taken at the same time.
Nadolol

Calcium supplements, if taken at the same time as some beta-blocker drugs, may reduce blood levels of the drug.²⁶⁴ However, whether calcium affects nadolol in this manner is unknown. Until more information is available, people on nadolol should take calcium supplements an hour before or two hours after the drug.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Ofloxacin

Minerals including calcium , iron , magnesium , and zinc can bind to fluoroquinolones, including ofloxacin, greatly reducing drug absorption.²⁶⁵ Ofloxacin should be taken four hours before or two hours after consuming antacids (Maalox®, Mylanta®, Tumms®, Rolaids® and others) that may contain these minerals and mineral-containing supplements .²⁶⁶
Sotalol

One controlled study showed that taking sotalol with a calcium gluconate solution dramatically reduces the absorption of the drug.²⁶⁷ Consequently, people who take a calcium supplement should take sotalol an hour before or two hours after the calcium.
Tetracycline

Many minerals can decrease the absorption of tetracycline, thus reducing its effectiveness. These minerals include aluminum (in antacids), calcium (in antacids, dairy products, and supplements), magnesium (in antacids and supplements), iron (in food and supplements), zinc (in food and supplements), and others.

Potential Negative Interaction

Calcium Acetate

People with kidney failure may develop high blood levels of calcium while taking calcium acetate. Since calcium acetate is a source of supplemental calcium, people taking the drug should avoid taking additional calcium supplements.²⁵⁹ People experiencing adverse effects of high blood calcium—such as loss of appetite, mental depression, poor memory, and muscle weakness—should notify their healthcare practitioner.

Explanation Required

Alendronate

Calcium supplements may interfere with alendronate absorption.²⁶⁸ However, one researcher suggested that addition of large amounts of supplemental calcium to alendronate therapy in patients with bone metastases (with evidence of osteomalacia ) related to prostate cancer might improve the clinical outcome.²⁶⁹ Moreover, both calcium and alendronate are commonly used in the treatment of osteoporosis in the same people. To prevent potential interactions, alendronate should be taken two hours before or after calcium supplements.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Bendroflumethiazide

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys.²⁷⁰ As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.
Carbamazepine

Individuals on long-term multiple anticonvulsant therapy may develop below-normal blood levels of calcium, which may be related to drug-induced vitamin D deficiency.²⁷¹ Two infants born to women taking high doses of phenytoin and phenobarbital while pregnant developed jitteriness and tetany (a syndrome characterized by muscle twitches, cramps, and spasm) during the first two weeks of life.²⁷² Controlled research is needed to determine whether pregnant women who are taking anticonvulsant medications should supplement with additional amounts of calcium and vitamin D.
Chlorothiazide

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys.²⁷³ As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.
Chlorthalidone

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys.²⁷⁴ As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.
Desogestrel-Ethinyl Estradiol

A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.²⁷⁵ ^{, 276} ^{, 277} OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .²⁷⁸ ^{, 279} ^{, 280} OCs may interfere with manganese absorption.²⁸¹ The clinical importance of these actions remains unclear.
Dessicated Thyroid

Thyroid hormones have been reported to increase urinary loss of calcium.²⁸² However, recent research suggests that, under most circumstances, taking thyroid hormones may not be associated with reduced bone density.²⁸³ ^{, 284} Calcium supplementation for people taking long-term thyroid medication has not yet been proven to be either helpful or necessary.

Simultaneous ingestion of some calcium formulations with levothyroxine has been reported to reduce the effectiveness of levothyroxine.²⁸⁵ For example, 1,200 mg per day of calcium as calcium carbonate, taken along with levothyroxine, significantly reduced absorption of the thyroid hormone.²⁸⁶ Levothyroxine activity will not be blocked if it is taken in the morning and calcium carbonate is taken after lunch and dinner. Separating these medications by at least four hours is recommended.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Erythromycin

Erythromycin may interfere with the absorption and/or activity of calcium , folic acid , magnesium , vitamin B6 and vitamin B12 ,²⁸⁷ which may cause problems, especially with long-term erythromycin treatment. Until more is known, it makes sense for people taking erythromycin for longer than two weeks to supplement with a daily multivitamin-multimineral .
Ethinyl Estradiol and Levonorgestrel

A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.²⁸⁸ ^{, 289} ^{, 290} Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .²⁹¹ ^{, 292} ^{, 293} Oral contraceptives may interfere with manganese absorption.²⁹⁴ The clinical importance of these actions remains unclear.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Ethinyl Estradiol and Norethindrone

A review of literature suggests that women who use oral contraceptives may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.²⁹⁵ ^{, 296} ^{, 297} Oral contraceptive use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .²⁹⁸ ^{, 299} ^{, 300} Oral contraceptives may interfere with manganese absorption.³⁰¹ The clinical importance of these actions remains unclear.
Ethinyl Estradiol and Norgestrel

A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.³⁰² ^{, 303} ^{, 304} OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .³⁰⁵ ^{, 306} ^{, 307} OCs may interfere with manganese absorption.³⁰⁸ The clinical importance of these actions remains unclear.
Etidronate

Calcium supplements may interfere with alendronate absorption.³⁰⁹ However, one researcher suggested that addition of large amounts of supplemental calcium to alendronate therapy in patients with bone metastases (with evidence of osteomalacia ) related to prostate cancer might improve the clinical outcome.³¹⁰ Moreover, both calcium and alendronate are commonly used in the treatment of osteoporosis in the same people. To prevent potential interactions, alendronate should be taken two hours before or after calcium supplements.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Felbamate

Individuals on long-term multiple anticonvulsant therapy may develop below-normal blood levels of calcium, which may be related to drug-induced vitamin D deficiency.³¹¹ Two infants born to women taking high doses of phenytoin and phenobarbital while pregnant developed jitteriness and tetany (a syndrome characterized by muscle twitches, cramps, and spasm) during the first two weeks of life.³¹² Controlled research is needed to determine whether pregnant women who are taking anticonvulsant medications should supplement with additional amounts of calcium and vitamin D.
Hydrochlorothiazide

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys.³¹³ As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.
Hydroflumethiazide

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys.³¹⁴ As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Indapamide

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys.³¹⁵ As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.
Lactase

Dairy products are rich in calcium. Lactase-deficient people may not consume milk and therefore have fewer dietary sources of calcium available to them. Lactase products allow lactase-deficient people to digest milk products, increasing their sources and intake of dietary calcium.
Levetiracetam

Individuals on long-term multiple anticonvulsant therapy may develop below-normal blood levels of calcium, which may be related to drug-induced vitamin D deficiency.³¹⁶ Two infants born to women taking high doses of phenytoin and phenobarbital while pregnant developed jitteriness and tetany (a syndrome characterized by muscle twitches, cramps, and spasm) during the first two weeks of life.³¹⁷ Controlled research is needed to determine whether pregnant women who are taking anticonvulsant medications should supplement with additional amounts of calcium and vitamin D.
Levonorgestrel

A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.³¹⁸ ^{, 319} ^{, 320} OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .³²¹ ^{, 322} ^{, 323} OCs may interfere with manganese absorption.³²⁴ The clinical importance of these actions remains unclear.
Levonorgestrel-Ethinyl Estrad

A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.³²⁵ ^{, 326} ^{, 327} OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .³²⁸ ^{, 329} ^{, 330} OCs may interfere with manganese absorption.³³¹ The clinical importance of these actions remains unclear.
Levothyroxine

Thyroid hormones have been reported to increase urinary loss of calcium.³³² However, recent research suggests that, under most circumstances, taking thyroid hormones may not be associated with reduced bone density.³³³ ^{, 334} Calcium supplementation for people taking long-term thyroid medication has not yet been proven to be either helpful or necessary.

Simultaneous ingestion of some calcium formulations with levothyroxine has been reported to reduce the effectiveness of levothyroxine.³³⁵ For example, 1,200 mg per day of calcium as calcium carbonate, taken along with levothyroxine, significantly reduced absorption of the thyroid hormone.³³⁶ Levothyroxine activity will not be blocked if it is taken in the morning and calcium carbonate is taken after lunch and dinner. Separating these medications by at least four hours is recommended.
Liothyronine

Thyroid hormones have been reported to increase urinary loss of calcium.³³⁷ However, recent research suggests that, under most circumstances, taking thyroid hormones may not be associated with reduced bone density.³³⁸ ^{, 339} Calcium supplementation for people taking long-term thyroid medication has not yet been proven to be either helpful or necessary.

Simultaneous ingestion of some calcium formulations with levothyroxine has been reported to reduce the effectiveness of levothyroxine.³⁴⁰ For example, 1,200 mg per day of calcium as calcium carbonate, taken along with levothyroxine, significantly reduced absorption of the thyroid hormone.³⁴¹ Levothyroxine activity will not be blocked if it is taken in the morning and calcium carbonate is taken after lunch and dinner. Separating these medications by at least four hours is recommended.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Liotrix

Thyroid hormones have been reported to increase urinary loss of calcium.³⁴² However, recent research suggests that, under most circumstances, taking thyroid hormones may not be associated with reduced bone density.³⁴³ ^{, 344} Calcium supplementation for people taking long-term thyroid medication has not yet been proven to be either helpful or necessary.

Simultaneous ingestion of some calcium formulations with levothyroxine has been reported to reduce the effectiveness of levothyroxine.³⁴⁵ For example, 1,200 mg per day of calcium as calcium carbonate, taken along with levothyroxine, significantly reduced absorption of the thyroid hormone.³⁴⁶ Levothyroxine activity will not be blocked if it is taken in the morning and calcium carbonate is taken after lunch and dinner. Separating these medications by at least four hours is recommended.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Mestranol and Norethindrone

A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.³⁴⁷ ^{, 348} ^{, 349} OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .³⁵⁰ ^{, 351} ^{, 352} OCs may interfere with manganese absorption.³⁵³ The clinical importance of these actions remains unclear.
Methyclothiazide

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys.³⁵⁴ As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.
Metolazone

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys.1 As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.
Minocycline

Taking calcium, iron, magnesium, or zinc at the same time as minocycline can decrease the absorption of both the drug³⁵⁵ ^{, 356} and the mineral. Therefore, calcium, iron, magnesium, or zinc supplements, if used, should be taken an hour before or after the drug.
Norgestimate-Ethinyl Estradiol

A review of literature suggests that women who use OCs may experience decreased vitamin B1 , B2 , B3 , B12 , C , and zinc levels.³⁵⁷ ^{, 358} ^{, 359} OC use has been associated with increased absorption of calcium and copper and with increased blood levels of copper and vitamin A .³⁶⁰ ^{, 361} ^{, 362} OCs may interfere with manganese absorption.³⁶³ The clinical importance of these actions remains unclear.
Oxcarbazepine

Individuals on long-term multiple anticonvulsant therapy may develop below-normal blood levels of calcium, which may be related to drug-induced vitamin D deficiency.³⁶⁴ Two infants born to women taking high doses of phenytoin and phenobarbital while pregnant developed jitteriness and tetany (a syndrome characterized by muscle twitches, cramps, and spasm) during the first two weeks of life.³⁶⁵ Controlled research is needed to determine whether pregnant women who are taking anticonvulsant medications should supplement with additional amounts of calcium and vitamin D.
Pamidronate

Calcium supplements may interfere with alendronate absorption.³⁶⁶ However, one researcher suggested that addition of large amounts of supplemental calcium to alendronate therapy in patients with bone metastases (with evidence of osteomalacia ) related to prostate cancer might improve the clinical outcome.³⁶⁷ Moreover, both calcium and alendronate are commonly used in the treatment of osteoporosis in the same people. To prevent potential interactions, alendronate should be taken two hours before or after calcium supplements.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Polythiazide

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys.³⁶⁸ As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.
Primidone

Individuals on long-term multiple anticonvulsant therapy may develop below-normal blood levels of calcium, which may be related to drug-induced vitamin D deficiency.³⁶⁹ Two infants born to women taking high doses of phenytoin and phenobarbital while pregnant developed jitteriness and tetany (a syndrome characterized by muscle twitches, cramps, and spasm) during the first two weeks of life.³⁷⁰ Controlled research is needed to determine whether pregnant women who are taking anticonvulsant medications should supplement with additional amounts of calcium and vitamin D.
Risedronate

Short-term treatment with risedronate in people with hyperparathydoidism—a disorder characterized by high blood levels of calcium—resulted in lower calcium blood levels.³⁷¹ Additional research is needed to determine whether people taking risedronate for Paget’s disease might develop low blood calcium levels. As a precaution, people with Paget’s disease should take supplemental calcium and vitamin D if dietary intake is inadequate. However, taking risedronate at the same time as calcium supplements reduces absorption of the drug.³⁷² Therefore, people taking risedronate for Paget’s disease should take calcium supplements an hour before or two hours after taking the drug.

The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
Sodium Fluoride

Research shows that calcium from leg bones may be transferred to bones in the spine causing stress fractures when fluoride is taken alone. However, supplementing with 1,500 mg of calcium each day together with slow-release forms of fluoride increases the bone density of the lumbar spine without causing fractures.³⁷³ Therefore, people taking sodium fluoride to treat osteoporosis should probably supplement with calcium to prevent this adverse effect. However, taking fluoride and calcium at the same time significantly reduces the absorption of fluoride;³⁷⁴ consequently, they should be taken at least an hour apart.
Topiramate

Individuals on long-term multiple anticonvulsant therapy may develop below-normal blood levels of calcium, which may be related to drug-induced vitamin D deficiency.³⁷⁵ Two infants born to women taking high doses of phenytoin and phenobarbital while pregnant developed jitteriness and tetany (a syndrome characterized by muscle twitches, cramps, and spasm) during the first two weeks of life.³⁷⁶ Controlled research is needed to determine whether pregnant women who are taking anticonvulsant medications should supplement with additional amounts of calcium and vitamin D.
Trichlormethiazide

Thiazide diuretics decrease calcium loss in the urine due to actions on the kidneys.³⁷⁷ As a result, it may be less important for some people taking thiazide diuretics to supplement calcium than it is for other people.
Valproate

Individuals on long-term multiple anticonvulsant therapy may develop below-normal blood levels of calcium, which may be related to drug-induced vitamin D deficiency.³⁷⁸ Two infants born to women taking high doses of phenytoin and phenobarbital while pregnant developed jitteriness and tetany (a syndrome characterized by muscle twitches), cramps, and spasms that can be caused by calcium deficiency during the first two weeks of life.³⁷⁹ Controlled research is needed to determine whether pregnant women who are taking anticonvulsant medications should supplement with additional amounts of calcium and vitamin D.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

Side Effects

Constipation , bloating, and gas are sometimes reported with the use of calcium supplements.³⁸⁰ A very high intake of calcium from dairy products combined with large amounts of supplemental calcium carbonate (used as an antacid) was reported in the past to cause a condition called “milk alkali syndrome.” This toxicity is rarely reported today because most medical doctors no longer tell people with ulcers to use this approach as treatment for their condition.

People with hyperparathyroidism, chronic kidney disease, or kidney stones should not supplement with calcium without consulting a physician. For other adults, the highest amount typically suggested by doctors (1,200 mg per day) typically does not cause side effects. People with prostate cancer should avoid supplementing with calcium without medical supervision.

A combined analysis of 15 controlled trials found that long-term calcium supplementation was associated with a significant increase of approximately 30% in the incidence of myocardial infarctions (heart attacks).³⁸¹ Since these studies were not designed to examine the effect of calcium on heart attack risk, it is possible that the findings in this post hoc (after the fact) analysis were due to chance. A more recent study found that long-term calcium supplementation did not result in an increased incidence of cardiovascular disease-related death or hospitalization.³⁸² Moreover, a pooled analysis of randomized controlled trials found that supplementing elderly individuals with a combination of calcium and vitamin D significantly decreased the mortality rate by 7%.³⁸³

In the past, calcium supplements in the forms of bone meal (including microcrystalline hydroxyapatite [MCHC]), dolomite, and oyster shell have sometimes had higher lead levels than permitted by stringent California regulations, though generally less than the levels set by the federal government.³⁸⁴ “Refined” forms (which would include calcium citrate malate [CCM], calcium citrate, and most calcium carbonate) have low levels of lead.³⁸⁵ More recently, a survey of over-the-counter calcium supplements found low or undetectable levels of lead in most products,³⁸⁶ representing a sharp decline in lead content of calcium supplements since 1993. People who decide to take bone meal, dolomite, oyster shell, or coral calcium for long periods of time can contact the supplying supplement company to request independent laboratory analysis showing minimal lead levels.

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339. Franklyn JA, Betteridge J, Daykin J, et al. Long-term thyroxine treatment and bone mineral density. Lancet 1992;340:9–13.

340. Schneyer CR. Calcium carbonate and reduction of levothyroxine efficacy. JAMA 1998;279:750.

341. Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. JAMA 2000;283:2822–5.

342. Kung AWC, Pun KK. Bone mineral density in premenopausal women receiving long-term physiological doses of levothyroxine. JAMA 1991;265:2688–91.

343. Schneider DL, Barrett-Connor EL, Morton DJ. Thyroid hormone use and bone mineral density in elderly men. Arch Intern Med 1995;155:2005–7.

344. Franklyn JA, Betteridge J, Daykin J, et al. Long-term thyroxine treatment and bone mineral density. Lancet 1992;340:9–13.

345. Schneyer CR. Calcium carbonate and reduction of levothyroxine efficacy. JAMA 1998;279:750.

346. Singh N, Singh PN, Hershman JM. Effect of calcium carbonate on the absorption of levothyroxine. JAMA 2000;283:2822–5.

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348. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

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350. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

351. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

352. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

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360. Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997, 210–1 [review].

361. Wynn V. Vitamins and oral contraceptive use. Lancet 1975;1:561–4.

362. Berg G, Kohlmeier L, Brenner H. Effect of oral contraceptive progestins on serum copper concentration. Eur J Clin Nutr 1998;52:711–5.

363. Holt GA. Food & Drug Interaction. Chicago: Precept Press, 1998, 197.

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378. Bouillon R, Reynaert J, Claes JH, et al. The effect of anticonvulsant therapy on serum levels of 25-hydroxy-vitamin D, calcium, and parathyroid hormone. J Clin Endocrinol Metab 1975;41:1130–5.

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Last Review: 11-07-2012

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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2013.

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Topic Contents

Calcium

Uses

This supplement has been used in connection with the following health conditions:

How It Works

How to Use It

Where to Find It

Possible Deficiencies

Interactions

Interactions with Supplements, Foods, & Other Compounds

Interactions with Medicines

Replenish Depleted Nutrients

Reduce Side Effects

Support Medicine

Reduces Effectiveness

Potential Negative Interaction

Explanation Required

Side Effects

Side Effects

Related Information

References