Natemille tabs 600mg + 1000me #30

Natemille instruction

You can buy Natemille here

Composition

One tablet contains:
Active ingredients: calcium carbonate - 1500 mg (equivalent to calcium 600 mg), colecalciferol -1000 ME (0.025 mg).
Excipients: maltodextrin 166 mg; aspartame 8.67 mg; hyprolosis 106.07 mg; lactose monohydrate 57.65 mg; anhydrous citric acid 208.11 mg; orange flavoring 4.20 mg; stearic acid 42.03 mg; alpha-tocopherol 0.02 mg; soy bean oil partially hydrogenated 0.75 mg; gelatin 3.80 mg; sucrose 3.80 mg; corn starch 1.605 mg.

pharmachologic effect

Calcium-phosphorus metabolism regulator

Pharmacodynamics

Combined drug that regulates the exchange of calcium and phosphorus in the body. Reduces resorption (resorption) and increases bone density, replenishing the lack of calcium and colecalciferol (vitamin D3) in the body.
Calcium is involved in the regulation of nerve conduction, muscle contraction, hormone production and is a component of the blood coagulation system. Vitamin D3 increases calcium absorption in the gastrointestinal tract and its binding to bone tissue. The use of calcium and vitamin D3 prevents the increase in the production of parathyroid hormone (PTH), which is a stimulator of increased bone resorption (leaching of calcium from the bones).

Pharmacokinetics

Calcium

Absorption: Calcium is absorbed in the ionized form in the proximal small intestine through an active, D-vitamin dependent transport mechanism. Absorption from the gastrointestinal tract, is approximately 30% of the dose. When taken together with food, the bioavailability of calcium increases slightly.
Distribution and metabolism: 99% of calcium in the body is concentrated in the rigid skeleton of bones and teeth. The remaining 1% is in intra-and extracellular fluids. About 50% of the total calcium in the blood is in a physiologically active ionized form, including about 10% in combination with citrate, phosphate or other anions, the remaining 40% are associated with proteins, primarily albumin.
Excretion: Calcium is excreted in the feces, urine and sweat glands. Renal excretion depends on glomerular filtration and tubular calcium reabsorption.

Colecalciferol (Vitamin D3)

Absorption: Colecalciferol (Vitamin D3) is well absorbed from the small intestine.
Distribution and metabolism: Colecalciferol and its metabolites circulate in the blood in a bound state with a specific globulin. Colecalciferol is metabolized in the liver by hydroxylation to the active form 25-hydroxycolecalciferol, then converted in the kidney to the active form 1,25-hydroxycolecalciferol. 1,25-hydroxycolecalciferol is a metabolite responsible for increasing calcium absorption. Unmetabolized vitamin D3 is deposited in adipose and muscle tissues.
Withdrawal: Colecalciferol (Vitamin D3) is excreted in the feces and urine.

Natemille, indications for use

- Complex therapy of osteoporosis of various origins and its complications;
- Completion of calcium deficiency and / or vitamin D 3 in the elderly.

Contraindications

- Hypersensitivity to one of the components of the drug
- hypersensitivity to peanuts and soy (the drug contains soy bean oil, partially hydrogenated)
- hereditary intolerance to galactose, Lapp deficiency of lactase and malabsorption of glucose-galactose (the preparation contains lactose);
- hereditary intolerance to sucrose or deficiency of sucrose-isomaltose (the product contains sucrose);
- phenylketonuria;
- hypercalcemia (elevated calcium in the blood);
- hypercalciuria (increased excretion of calcium in the urine);
- urolithiasis (formation of calcium stones);
- sarcoidosis and metastasis of tumors in the bone;
- osteoporosis due to prolonged immobilization;
- Vitamin D hypervitaminosis;
- age up to 18 years;
- active tuberculosis;
- the period of pregnancy;
- severe renal failure.

Carefully

With caution it is necessary to take the drug for people with impaired renal function, renal insufficiency, benign granulomatosis, during the breastfeeding period. The drug should be used with caution in immobilized patients with osteoporosis, due to the risk of hypercalcemia.

Dosage and administration

Inside Tablets should be absorbed, not swallowed whole. After removal from the vial, the tablet should be put on the tongue and kept in the mouth until completely dissolved. Adults and Elderly
1 tablet per day after meals. The course of treatment is determined by the doctor.

Special patient groups

Patients with impaired liver function - dose adjustment is not required.
Patients with impaired renal function - dose adjustment is not required.
Before use, consult your doctor.

Children

Data on the use of the drug Natemille children and adolescents are not available.

Use during pregnancy and lactation

Prolonged hypercalcemia adversely affects the developing fetus, so pregnant women should avoid an overdose of calcium and vitamin D3. The drug is contraindicated for use during pregnancy.
The drug can be taken with breastfeeding. Calcium and vitamin D3 penetrate into breast milk. This should be taken into account with additional intake of calcium and vitamin D 3 from other sources in the mother and child.

Side effects

The frequency of side effects of the drug is regarded as follows: very often (≥1 / 10), often (≥1 / 100,
Immune system disorders:
Frequency unknown: hypersensitivity reactions, such as angioedema or laryngeal edema.
Metabolic and nutritional disorders:
Infrequently: hypercalcemia and hypercalciuria.
Disorders of the gastrointestinal tract:
Rarely: constipation, flatulence, nausea, abdominal pain and diarrhea.
Violations of the skin and subcutaneous tissue:
Rarely: itching, rash, and urticaria.
Special categories:
Patients with renal failure have a potential risk of hyperphosphatemia, nephrolithiasis and nephrocalcinosis.

special instructions

With long-term treatment with Natemille, it is necessary to monitor calcium levels and kidney function with the determination of serum creatinine level. Monitoring is especially important in elderly patients receiving cardiac glycosides and diuretics (see section "Interaction with other drugs") and in patients with a pronounced tendency to the formation of kidney stones. In the case of hypercalciuria (if the level of calcium in the urine exceeds 7.5 mmol / day (300 mg / day)), and if signs of renal failure appear, reduce the dose or discontinue treatment with the drug.
Patients with impaired renal function, vitamin D3 is prescribed with caution, requires constant monitoring of the level of calcium and phosphate in the blood serum. The risk of soft tissue calcification should be taken into account. In patients with severe renal insufficiency, vitamin D3 in the form of colecalciferol is not normally metabolized, therefore, it is necessary to prescribe its other forms.
In order to avoid overdose, it is necessary to consider the additional intake of vitamin D3 from other sources. Do not use simultaneously with vitamin-mineral complexes containing calcium and vitamin D3.
Additional intake of calcium or vitamin D3 is possible only with careful medical supervision. In such cases, frequent monitoring of serum calcium levels and excretion of calcium in the urine is necessary.
Simultaneous administration of tetracycline or quinolones is usually not recommended or requires caution (see the section "Interaction with Other Medicines").

Interaction

Thiazide diuretics reduce urinary calcium excretion. Increasing the risk of hypercalcemia with the combined use of the drug Natemille with thiazide diuretics requires regular monitoring of serum calcium levels. The simultaneous use of the drug Natemille with phenytoin or barbiturates can reduce the effect of vitamin D3 due to an increase in its metabolism. Hypercalcemia can increase the toxicity of cardiac glycosides during calcium and vitamin D3 treatment. Control of an electrocardiogram and level of calcium in blood serum is necessary.
The effectiveness of levothyroxine may be reduced when taken simultaneously with calcium, which reduces the absorption of levothyroxine. Therefore, calcium and levothyroxine preparations should be taken at least with a 4-hour interval.
When calcium is taken simultaneously, carbonate can also affect the absorption of tetracycline, so tetracycline is taken at least 2 hours before or 4-6 hours after oral administration of calcium.
While taking a bisphosphonate with the drug Natemille, it must be taken no less than 1 hour before taking the drug Natemille, since its absorption in the gastrointestinal tract can be reduced.
Calcium salts can reduce the absorption of iron, zinc, or strontium ranelate. Therefore, the interval between taking iron, zinc or strontium ranelate and calcium supplements should be two hours.
Co-administration of calcium and quinol antibiotics may interfere with the absorption of the latter. Quinolone antibiotics should be taken 2 hours before or 6 hours after taking calcium.
Calcium can also reduce the absorption of sodium fluoride, so this drug should be taken at least 3 hours before taking the drug Natemille. Corticosteroids reduce calcium absorption. When taken simultaneously with the drug Natemille may require an increase in the dose of the drug. The simultaneous intake of orlistat, an ion exchange resin, for example, cholestyramine, laxatives, for example, castor oil, can reduce the absorption of vitamin D3 in the gastrointestinal tract.
Eating foods containing oxalates (sorrel, rhubarb, spinach) and phytin (cereals) can inhibit calcium absorption by forming insoluble complexes with calcium ions. Therefore, you should not take the drug Natemille within two hours after a meal with a high content of oxalic and phytic acids.

Overdose

Overdose can lead to hypervitaminosis and hypercalcemia. Possible symptoms of overdose: anorexia, thirst, nausea, vomiting, constipation, abdominal pain, muscle weakness, fatigue, mental disorders, polydipsia, polyuria, bone pain, nephrocalcinosis, kidney stones and, in severe cases, cardiac arrhythmias. Severe hypercalcemia can lead to coma and death.
A prolonged increase in calcium levels can cause irreversible damage to the kidneys and calcification of soft tissues.
Treatment of hypercalcemia: it is necessary to stop taking calcium and vitamin D3 preparations, as well as thiazide diuretics, lithium preparations, cardiac glycosides, consult a doctor.
Treatment: gastric lavage, rehydration, and, taking into account the severity, prescribe treatment, monotherapy or combined treatment with loop diuretics, bisphosphonates, calcitonin and corticosteroids. It is necessary to control the level of electrolytes in the blood serum, kidney function and diuresis. In severe cases, it is necessary to measure the central venous pressure and monitor the electrocardiogram (ECG).

Storage conditions

At a temperature not higher than 25 °С.
Shelf life - 2 years. Do not use after the expiration date printed on the package. Use within 60 days after the first opening of the bottle.
Keep out of the reach of children.
Keep the vial tightly closed to protect from moisture.

Terms of sell

You can buy Natemille without a prescription.