Sandocal500 mg

Sandocal 500 mg is an elemental calcium preparation used both as a calcium supplement and as an antacid, depending on the strength and clinical purpose of the formulation.

250 mg / 500 mg Tablet — Calcium Supplementation

This strength is used for the treatment or prevention of calcium depletion in patients whose dietary calcium intake is inadequate to meet physiological needs. Conditions commonly associated with calcium deficiency include:

• Hypoparathyroidism
• Achlorhydria
• Chronic diarrhea
• Vitamin D deficiency
• Steatorrhea and malabsorption (sprue)
• Pregnancy and lactation
• Menopause
• Pancreatitis
• Renal failure
• Alkalosis
• Hyperphosphataemia

Sandocal 500 mg is increasingly used to manage hyperphosphataemia in chronic renal failure, including in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis. Because many patients cannot tolerate doses high enough for complete phosphate control, additional measures such as dietary phosphate restriction or low-dose aluminium hydroxide may be required alongside therapy. Sandocal 500 mg preparations can also provide short-term relief of dyspeptic symptoms, although they are no longer recommended for long-term treatment of peptic ulcer disease.

1000 mg Tablet — Antacid Use

The 1000 mg strength is indicated for the management of conditions associated with hyperacidity, offering fast relief from acid indigestion, heartburn, sour stomach, and upset stomach.

Sandocal 500 mg exerts its therapeutic effects through two complementary mechanisms: acid neutralization and calcium replenishment.

Antacid Mechanism

Sandocal 500 mg reacts directly with gastric hydrochloric acid to form a soluble salt and water, following the reaction:

CaCO₃ + 2HCl → CaCl₂ + H₂O + CO₂

Approximately two grams of Sandocal 500 mg is sufficient to raise the pH of 100 mL of hydrochloric acid above 6. This increase in gastric pH substantially reduces the proteolytic activity of pepsin, helping to relieve acid-related discomfort such as heartburn and indigestion relatively quickly after administration.

Calcium Absorption

Up to 30% of an orally administered calcium load may be absorbed, primarily in the duodenum and proximal jejunum through both active, vitamin D-dependent transport and passive paracellular diffusion. Absorbed calcium contributes to bone mineralization, neuromuscular transmission, blood clotting, and intracellular signalling.

Phosphate-Binding Action

In patients with chronic renal failure, Sandocal 500 mg binds dietary phosphate in the gastrointestinal tract to form insoluble calcium phosphate complexes, which are excreted in the stool rather than absorbed. This action helps control serum phosphate levels and reduce the risk of secondary hyperparathyroidism and renal osteodystrophy.

• Digoxin and other cardiac glycosides: Sandocal 500 mg may enhance the cardiac effects of digoxin if systemic hypercalcaemia develops, increasing the risk of cardiac arrhythmias.
• Tetracyclines: Calcium ions chelate with tetracycline antibiotics, significantly reducing their gastrointestinal absorption.
• Vitamin D therapy: In chronic renal failure, vitamin D dosing may need adjustment when Sandocal 500 mg is used as the primary phosphate binder, to avoid hypercalcaemia.
• Fluoroquinolone antibiotics: Similar to tetracyclines, calcium can form insoluble complexes with fluoroquinolones, reducing their absorption and efficacy.
• Levothyroxine and iron supplements: Sandocal 500 mg may reduce the absorption of orally administered levothyroxine and iron salts; doses should be spaced apart.
• Bisphosphonates: Co-administration may impair bisphosphonate absorption; spacing of doses is recommended.
• Thiazide diuretics: May increase the risk of hypercalcaemia when used concurrently with calcium supplements.

Orally administered Sandocal 500 mg may be irritating to the gastrointestinal tract and commonly causes:

• Constipation
• Mild gastrointestinal discomfort, bloating, or gas
• Nausea (less common)

Hypercalcaemia is rarely produced by calcium administration alone but may occur when large doses are given to patients with chronic renal failure.

Calcium-containing drugs have been widely used during pregnancy, either as oral calcium supplementation or as antacid therapy for heartburn and indigestion. Sandocal 500 mg can also be used safely in lactating women.

When hypercalcaemia occurs, discontinuing Sandocal 500 mg is usually sufficient to return serum calcium concentrations to normal. Calcium salts should be used cautiously in patients with:

• Sarcoidosis
• Renal disease
• Cardiac disease
• Concurrent use of cardiac glycosides such as digoxin

Periodic monitoring of serum calcium and phosphate levels is recommended during prolonged or high-dose therapy, particularly in patients with renal impairment. Excessive intake of calcium with alkali (such as long-term antacid overuse) may rarely lead to milk-alkali syndrome, characterised by hypercalcaemia, metabolic alkalosis, and renal dysfunction.

Excessive or prolonged intake of Sandocal 500 mg, particularly at high antacid doses, can result in hypercalcaemia and, in severe cases, milk-alkali syndrome. Signs and symptoms may include:

• Nausea, vomiting, and loss of appetite
• Confusion or altered mental status
• Excessive thirst and frequent urination
• Muscle weakness
• Metabolic alkalosis and impaired renal function

Management of overdose involves prompt discontinuation of Sandocal 500 mg, adequate hydration, and correction of electrolyte and acid-base disturbances under medical supervision. Patients with chronic renal failure are at higher risk and should be monitored closely.

• Store in a cool, dry place at controlled room temperature.
• Protect from excess moisture and direct sunlight.
• Keep out of reach of children.
• Do not use beyond the expiry date printed on the package.

Use in Children

Sandocal 500 mg has been extensively studied in children and infants with chronic renal failure and has been shown to be both safe and effective for phosphate control in this population.

Use in Elderly

Elderly patients with renal failure who take Sandocal 500 mg may experience constipation more frequently. Regular monitoring of serum calcium and phosphate levels is recommended for this group to ensure safe, effective therapy.