Milcal250 mg+250 IU

Milcal is a calcium and vitamin D3 supplement indicated for:

• Established/first-line use: Prevention and treatment of dietary calcium and vitamin D3 deficiency in individuals with inadequate dietary intake.
• Guideline-supported use: As an adjunct to specific osteoporosis therapy (e.g., bisphosphonates, hormone therapy) to ensure adequate calcium and vitamin D3 status, per bone-health guidelines for postmenopausal women and older adults.
• Supportive/adjunct use: Maintenance of bone mineralization during periods of increased calcium demand, such as pregnancy, lactation, growth spurts in children and adolescents, and in the elderly at risk of bone loss.
• Adjunct use: Supportive therapy alongside prescribed corticosteroid treatment, where corticosteroid-induced bone loss is a concern (used together with, not instead of, physician-directed bone-protective therapy).

Milcal is not intended to treat established osteoporosis or severe calcium/vitamin D deficiency as a sole therapy; it is a supplement to be used under medical or pharmacist guidance.

Each dose of Calcium Phosphate [Milk source] + Vitamin D3 contains calcium phosphate derived from a milk-source mineral complex (providing elemental calcium and phosphorus) together with cholecalciferol (vitamin D3). Exact elemental calcium and vitamin D3 content vary by formulation and strength; refer to the product label for the precise amount per tablet/sachet/chewable unit.

Milcal is a combination supplement in which the calcium phosphate component is sourced from milk (a milk-derived mineral complex, sometimes referred to as milk-derived calcium hydroxyapatite/calcium phosphate complex), combined with vitamin D3 (cholecalciferol) to enhance intestinal calcium absorption. It is used to support bone mineralization and to correct or prevent calcium and vitamin D3 insufficiency.

Because the calcium phosphate is milk-derived, Milcal may contain trace milk proteins; this is an important consideration for patients with milk protein allergy.

Milcal belongs to the therapeutic class of mineral and vitamin supplements — specifically, calcium salts in combination with vitamin D3 (bone-health/anti-osteoporotic supportive agents).

Calcium Phosphate [Milk source] + Vitamin D3 works through the complementary actions of its two components:

• Calcium phosphate (milk-source): Provides elemental calcium and phosphate, essential minerals for bone and teeth mineralization, neuromuscular function, cardiac function, and blood clotting.
• Vitamin D3 (cholecalciferol): Is hydroxylated in the liver and kidney to its active form, calcitriol, which promotes intestinal absorption of calcium and phosphate, supports renal reabsorption of calcium, and facilitates normal bone mineralization and remodeling.

Together, the components of Calcium Phosphate [Milk source] + Vitamin D3 increase the fraction of dietary and supplemental calcium that is absorbed and made available for bone formation.

Milcal is administered orally. Tablets/chewable tablets should be chewed or swallowed with water; if a sachet/powder formulation is dispensed, dissolve in water or a soft food/drink as directed. Taking Milcal with meals improves calcium absorption and minimizes stomach upset. Doses should be spaced evenly if given more than once daily, and separated by at least 2 hours from other medicines known to interact (see Interactions).

Milcal has the following well-established clinically significant interactions:

• Tetracycline and fluoroquinolone antibiotics: Calcium in Milcal chelates with these antibiotics, substantially reducing their absorption and efficacy. Separate administration by at least 2–3 hours.
• Bisphosphonates (e.g., alendronate): Calcium markedly reduces bisphosphonate absorption. Take bisphosphonates at least 30–60 minutes before Milcal or any calcium-containing product.
• Levothyroxine: Calcium can reduce levothyroxine absorption. Separate dosing by at least 4 hours.
• Thiazide diuretics: Concurrent use with Milcal increases the risk of hypercalcemia due to reduced renal calcium excretion; calcium levels should be monitored.
• Digoxin: Hypercalcemia arising from excess intake of Milcal can potentiate digoxin toxicity and increase the risk of cardiac arrhythmia; caution is advised with concurrent use.
• Iron and zinc supplements: Calcium can reduce the absorption of oral iron and zinc; separate dosing where possible.

Milcal is generally well tolerated at recommended doses. Reported side effects include:

• Common: Mild gastrointestinal upset, constipation, bloating, flatulence, nausea.
• Uncommon: Allergic reaction in patients sensitive to milk proteins (rash, itching, swelling, or more severe hypersensitivity reactions) — see Contraindications.
• Rare (with excessive/prolonged overuse): Symptoms of hypercalcemia such as loss of appetite, excessive thirst, frequent urination, weakness, confusion, or muscle/bone pain.

Patients should report persistent gastrointestinal symptoms or any signs of allergic reaction to their physician.

Milcal may be used during pregnancy and lactation to correct dietary calcium and vitamin D3 insufficiency, but only if clearly needed and the potential benefit justifies the potential risk; excessive intake above recommended levels should be avoided as high-dose vitamin D3 and hypercalcemia have been associated with adverse fetal/infant outcomes. Total calcium and vitamin D3 intake from all sources (diet, prenatal vitamins, and Milcal) should be reviewed with a physician before use in pregnancy or breastfeeding.

Use Milcal with caution in the following situations:

• Renal impairment: Calcium and vitamin D metabolism is altered in renal disease, increasing the risk of hypercalcemia and soft-tissue calcification; use only under medical supervision with monitoring.
• Sarcoidosis or hyperparathyroidism: These conditions increase sensitivity to vitamin D3 and calcium, raising hypercalcemia risk.
• History of kidney stones: Use with caution and adequate hydration.
• Total daily intake: Avoid exceeding the recommended daily calcium and vitamin D3 intake from all combined dietary and supplemental sources, including other fortified foods or supplements, while taking Milcal.
• Concurrent thiazide diuretics: Increased risk of hypercalcemia (see Interactions).
• Milk protein sensitivity/severe lactose intolerance: Given the milk-derived source of the calcium phosphate in Milcal, patients with dairy allergy should be clearly counselled and avoid this product unless the formulation's purification has been confirmed suitable by their physician (see Contraindications).
• Immobilized patients: At increased risk of hypercalcemia; use with caution.

Overdose of Milcal can cause hypercalcemia and vitamin D toxicity, with symptoms such as nausea, vomiting, loss of appetite, constipation, excessive thirst, frequent urination, muscle weakness, confusion, and in severe cases, kidney stones, kidney damage, or cardiac arrhythmia. In case of suspected overdose, discontinue the product immediately and seek immediate medical attention or contact a poison control center; do not attempt specific home treatment.

Store at room temperature (below 30°C), away from light and moisture. Keep out of reach of children.

Renal impairment: Use Milcal with caution and medical supervision, as impaired renal clearance increases the risk of hypercalcemia and vitamin D toxicity; dose adjustment or avoidance may be needed depending on severity.

Hepatic impairment: Vitamin D3 requires hepatic activation; significant hepatic impairment may reduce efficacy, though no specific dose adjustment is well established. Use with medical guidance.

Elderly: Commonly used in this population for bone-health maintenance; monitor for hypercalcemia, particularly with concurrent thiazide use or renal impairment.

Milk protein allergy/lactose intolerance: See Contraindications — Milcal is unsuitable for patients with confirmed milk protein allergy owing to its milk-derived calcium phosphate source.

Duration of Milcal therapy depends on the indication and is determined by the prescribing physician — ranging from short-term correction of dietary deficiency to long-term maintenance therapy (months to years) in chronic conditions such as osteoporosis prevention. Periodic reassessment of calcium and vitamin D status is recommended during prolonged use.

Calcium Phosphate [Milk source] + Vitamin D3 is classified under mineral supplements (calcium salts) in fixed combination with vitamin D3 (fat-soluble vitamin/cholecalciferol analogue).

The calcium phosphate component of Calcium Phosphate [Milk source] + Vitamin D3 supplies elemental calcium and phosphate for bone mineral matrix formation, while the vitamin D3 component is converted in the body to calcitriol, which upregulates intestinal calcium-binding proteins to increase active calcium absorption and supports the renal reabsorption of calcium, together maintaining calcium homeostasis and supporting bone mineralization.

Milcal may be used in children and adolescents to support bone growth and to prevent or correct dietary calcium/vitamin D3 deficiency, with dosing adjusted according to age, body weight, and dietary intake, under the guidance of a pediatrician. Safety and efficacy of specific higher-strength formulations of Milcal have not been separately established for all pediatric age groups, and the appropriate age-specific formulation/strength should be selected by a physician. Children with milk protein allergy should not receive Milcal (see Contraindications).