CX-C Plus

• Calcium Deficiency: Prevention and treatment of hypocalcemia caused by inadequate dietary intake, malabsorption, or increased physiological demand.
• Osteoporosis: Adjunct treatment to increase bone mineral density and reduce fracture risk, especially in postmenopausal women and elderly patients.
• Rickets and Osteomalacia: Management of bone disorders resulting from vitamin D and calcium deficiencies.
• Hypoparathyroidism: Correction of low serum calcium due to parathyroid hormone deficiency.
• Vitamin C Deficiency: Prevention and treatment of scurvy and enhancement of immune function.
• Vitamin D Deficiency: Prevention and treatment of vitamin D insufficiency to maintain calcium and phosphate homeostasis.
• Supportive Therapy: For bone health maintenance and tissue repair.

Adults:

• Typically provides 500–1000 mg elemental calcium daily from calcium lactate gluconate and calcium carbonate combined.
• Vitamin C dose: 60–100 mg daily.
• Vitamin D3 dose: 400–800 IU daily.
• Administer orally with meals to improve absorption and minimize gastrointestinal discomfort.
• Divide total daily dose into two or three administrations.

Pediatrics:

• Use only under medical supervision; dosing based on weight and clinical indication.

Elderly:

• Use adult dosing with regular monitoring of serum calcium and renal function.

Renal/Hepatic Impairment:

• Use cautiously; monitor calcium, phosphate, and vitamin D metabolites closely.

Route: Oral tablets, chewable tablets, or effervescent formulations.

Duration: Long-term as indicated, with periodic laboratory monitoring.

Calcium salts dissociate in the gastrointestinal tract releasing elemental calcium essential for bone mineralization, neuromuscular function, and enzymatic processes. Vitamin C supports collagen synthesis and acts as an antioxidant, promoting connective tissue repair. Vitamin D3 (cholecalciferol) undergoes hydroxylation in the liver and kidneys to active calcitriol, which enhances intestinal absorption of calcium and phosphate, facilitating bone mineralization and regulating parathyroid hormone secretion. Together, this combination restores and maintains calcium homeostasis and supports skeletal and connective tissue health.

• Calcium: Absorbed in the small intestine; bioavailability improved when taken with food. Distributed primarily to bone and extracellular fluids. Eliminated mainly via kidneys.
• Vitamin C: Rapidly absorbed; peak plasma concentration within 2–3 hours. Metabolized to dehydroascorbic acid and excreted in urine.
• Vitamin D3: Absorbed in the intestine, converted in liver and kidneys to active metabolites. Half-life of 25-hydroxyvitamin D is ~15 days; calcitriol half-life ~5–8 hours. Excreted in bile and urine.

• Pregnancy: FDA Category C. Calcium, vitamin C, and vitamin D3 are essential nutrients; supplementation is considered safe when used appropriately.
• Lactation: Components are excreted in breast milk in small amounts; generally safe but monitor infant as a precaution.

• Mineral supplement combined with vitamins.

• Hypersensitivity to any component.
• Hypercalcemia or hypercalciuria.
• Vitamin D toxicity.
• Severe renal impairment without medical supervision.
• History of calcium or oxalate kidney stones.

• Monitor serum calcium, phosphate, and renal function regularly, especially in patients with renal impairment or stone risk.
• Avoid excessive calcium intake to prevent hypercalcemia.
• High vitamin C doses may increase oxalate stone risk.
• Use cautiously with digoxin and thiazide diuretics.
• Ensure adequate hydration to reduce nephrolithiasis risk.

Common:

• Nausea, constipation, abdominal discomfort, diarrhea (mostly due to vitamin C).
• Metallic taste.

Serious/Rare:

• Hypercalcemia signs: weakness, confusion, polyuria.
• Allergic reactions (rash, swelling).
• Oxalate kidney stones with high vitamin C intake.

• Tetracyclines/Fluoroquinolones: Calcium reduces absorption; separate dosing by ≥2 hours.
• Bisphosphonates: Calcium decreases absorption; stagger administration.
• Digoxin: Hypercalcemia increases toxicity risk.
• Thiazide diuretics: Increase hypercalcemia risk.
• Iron supplements: Vitamin C enhances iron absorption; calcium may inhibit it.
• Warfarin: High-dose vitamin C may affect anticoagulation.

• Guidelines reaffirm combined calcium and vitamin D supplementation in osteoporosis prevention and treatment.
• Emphasis on individualized dosing and monitoring to avoid toxicity.
• Recommendations highlight hydration and caution in renal impairment.

• Store at 20°C to 25°C (68°F to 77°F).
• Protect from moisture and light.
• Keep container tightly closed.
• Keep out of reach of children.