This combination medication is used to prevent or treat low blood calcium levels in people who do not get enough calcium from their diets. It may be used to treat conditions caused by low calcium levels such as bone loss (osteoporosis), weak bones (osteomalacia/rickets), decreased activity of the parathyroid gland (hypoparathyroidism), and a certain muscle disease (latent tetany). It may also be used in certain patients to make sure they are getting enough calcium (including women who are pregnant, nursing, or postmenopausal, people taking certain medications such as phenytoin, phenobarbital, or prednisone).

Calcium plays a very important role in the body. It is necessary for normal functioning of nerves, cells, muscle, and bone. If there is not enough calcium in the blood, then the body will take calcium from bones, thereby weakening bones. Vitamin D helps your body absorb calcium and phosphorus. Having the right amounts of vitamin D, calcium, and phosphorus is important for building and keeping strong bones.

Take this medication by mouth with food. If your product contains calcium citrate, then it may be taken with or without food. Follow all directions on the product package, or take as directed by your doctor. For best absorption, if your total daily dose is more than 600 milligrams, then divide your dose and space it throughout the day. If you have any questions, ask your doctor or pharmacist.

If you are using the liquid form of this medication, carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose.

If you are taking the chewable form of this medication, chew thoroughly before swallowing. If you are taking capsules, swallow each capsule whole.

Do not crush or chew extended-release tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Swallow the whole tablet without crushing or chewing.

Use this medication regularly to get the most benefit from it. To help you remember, take it at the same time(s) each day.

If your doctor has recommended that you follow a special diet, it is very important to follow the diet to get the most benefit from this medication and to prevent serious side effects. Do not take other supplements/vitamins unless ordered by your doctor.

Calcium supplements come in different forms that contain different amounts of calcium/vitamin D. Ask your doctor or pharmacist to help select the best product for you.

If you think you may have a serious medical problem, get medical help right away.

Constipation or stomach upset may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

If your doctor has directed you to use this medication, remember that your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including:

• nausea/vomiting
• loss of appetite
• unusual weight loss
• mental/mood changes
• signs of kidney problems (such as change in the amount of urine)
• bone/muscle pain
• headache
• increased thirst
• increased urination
• weakness
• tiredness
• fast/pounding heartbeat

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including:

• rash
• itching/swelling (especially of the face/tongue/throat)
• severe dizziness
• trouble breathing

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Before taking this medication, tell your doctor or pharmacist if you are allergic to it; or to other vitamin D products (such as calcitriol); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of:

• high calcium/vitamin D levels (hypercalcemia/hypervitaminosis D)
• difficulty absorbing nutrition from food (malabsorption syndrome)
• heart/blood vessel disease
• kidney disease (including kidney stones)
• certain immune system disorder (sarcoidosis)
• liver disease
• certain bowel diseases (Crohn's disease, Whipple's disease)
• little or no stomach acid (achlorhydria)
• low levels of bile
• untreated phosphate imbalance

Chewable tablets may contain sugar or aspartame. Caution is advised if you have diabetes, phenylketonuria (PKU), or any other condition that requires you to limit/avoid these substances in your diet. Ask your doctor or pharmacist about using this product safely.

Tell your doctor if you are pregnant before using this medication. During pregnancy, doses of vitamin D greater than the recommended dietary allowance should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This medication passes into breast milk. Consult your doctor before breastfeeding.

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

Some products that may interact with this drug include:

• digoxin
• phosphate binders

Calcium can decrease the absorption of other drugs such as tetracycline antibiotics (for example, doxycycline, minocycline), bisphosphonates (such as alendronate), estramustine, levothyroxine, and quinolone antibiotics (such as ciprofloxacin, levofloxacin). Also, certain medications can decrease the absorption of vitamin D (bile acid sequestrants such as cholestyramine/colestipol, mineral oil, orlistat). Separate your doses of these medications as far as possible from your doses of calcium/vitamin D. Ask your doctor or pharmacist about how long you should wait between doses and for help finding a dosing schedule that will work with all your medications.

Check the labels on all your prescription and nonprescription/herbal products (such as antacids, laxatives, vitamins) because they may contain calcium, phosphate, or vitamin D. Ask your pharmacist about using those products safely.

Vitamin D is very similar to calcitriol. Do not use medications containing calcitriol while using vitamin D.

This product may interfere with certain lab tests (such as cholesterol tests), possibly causing false test results. Make sure lab personnel and all your doctors know you use this product.

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call 1-800-222-1222. Canada residents can call 1-844-764-7669. Symptoms of overdose may include: nausea/vomiting, loss of appetite, mental/mood changes, headache, drowsiness, weakness, tiredness.

Lab and/or medical tests (such as calcium levels) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

Foods rich in vitamin D include: fortified dairy products, eggs, sardines, cod liver oil, chicken livers, and fatty fish. Vitamin D is also made by the body as a result of exposure to the sun.

Foods rich in calcium include: dairy products (such as milk, yogurt, cheese, ice cream), dark-green leafy vegetables (such as broccoli, spinach, bok choy), and calcium-fortified foods (such as orange juice).

You can decrease the risk of bone disease by being physically active, not smoking, and avoiding the use of alcohol/caffeine.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.