Calcichew-D3

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Calcichew-D3 on Prescriptsy

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Calcichew-D3 is a chewable tablet containing calcium carbonate and colecalciferol (vitamin D3), two essential nutrients required for healthy bone metabolism.

Each tablet provides 500 mg of elemental calcium and 400 IU (10 micrograms) of vitamin D3.

Calcichew-D3 is widely prescribed in the United Kingdom as an adjunct to osteoporosis therapy and for the correction of combined calcium and vitamin D deficiency, particularly in older adults, postmenopausal women, and individuals with limited dietary calcium intake or reduced sun exposure.

Calcium and vitamin D deficiency is common in the UK population, with Public Health England estimating that around 1 in 5 adults has a low vitamin D status (serum 25-hydroxyvitamin D below 25 nmol/L), rising to 1 in 3 during winter and spring months.

This page provides a detailed clinical overview of how Calcichew-D3 works, correct dosing, interactions with other medicines, side effects, warnings, and how to obtain this supplement in the UK.

Important safety information about Calcichew-D3

Before reading further, note the following key safety points regarding Calcichew-D3.

• Do not take Calcichew-D3 if you have high blood calcium (hypercalcaemia), kidney stones, or severe kidney disease without specialist supervision.
• Calcium supplements interact with many commonly prescribed medicines, including alendronate, levothyroxine, and certain antibiotics. Always leave an appropriate time gap between these medicines and Calcichew-D3.
• Total daily calcium intake from diet and supplements combined should not routinely exceed 1,500 mg.
• Some Calcichew-D3 formulations contain soya lecithin. Do not use if you are allergic to soya or peanut.

What are calcium and vitamin D and why do they matter

Calcium is the most abundant mineral in the human body. Approximately 99% of total body calcium is stored in bones and teeth, where it provides structural rigidity.

The remaining 1% circulates in the blood and is essential for nerve impulse transmission, muscle contraction (including the heartbeat), blood clotting, and enzyme function.

When dietary calcium intake is insufficient, the body draws on skeletal calcium reserves, leading to progressive bone loss over time.

Vitamin D is a fat-soluble secosteroid that plays a central role in calcium homeostasis.

It is produced in the skin following exposure to ultraviolet B (UVB) radiation from sunlight and is also obtained from dietary sources such as oily fish, egg yolks, and fortified foods.

Vitamin D undergoes two hydroxylation steps: first in the liver to form calcidiol (25-hydroxyvitamin D, the form measured in blood tests), and then in the kidneys to form calcitriol (1,25-dihydroxyvitamin D), the biologically active hormone.

Calcitriol increases intestinal calcium absorption from approximately 10 to 15% (in the vitamin D-deficient state) to 30 to 40%.

Without adequate vitamin D, even generous calcium intake fails to deliver the mineral efficiently to bone.

Combined deficiency of calcium and vitamin D leads to secondary hyperparathyroidism, accelerated bone turnover, and increased fracture risk, particularly at the hip, spine, and wrist.

Who should take Calcichew-D3

NICE, the Royal Osteoporosis Society, and the Scientific Advisory Committee on Nutrition (SACN) recommend calcium and vitamin D supplementation for several groups.

• Postmenopausal women receiving bisphosphonate or denosumab therapy for osteoporosis, to ensure adequate calcium and vitamin D levels during bone-protective treatment.
• Older adults (particularly those aged 65 and over) who have limited sun exposure, reduced dietary intake, or are living in residential or nursing care.
• Adults with confirmed vitamin D deficiency (serum 25-hydroxyvitamin D below 25 nmol/L) who also have a low dietary calcium intake.
• Patients taking corticosteroids long-term (such as prednisolone), who are at increased risk of glucocorticoid-induced osteoporosis.
• Adults with malabsorption conditions (such as coeliac disease, inflammatory bowel disease, or previous bariatric surgery) that impair calcium and vitamin D uptake.

Public Health England advises that all UK adults should consider taking a daily supplement containing 10 micrograms (400 IU) of vitamin D during autumn and winter (October to March).

Individuals who cover most of their skin for cultural or medical reasons, or who rarely go outdoors, should consider supplementation throughout the year.

How Calcichew-D3 works

The calcium carbonate component of Calcichew-D3 provides elemental calcium in a well-absorbed salt form.

Calcium carbonate is best absorbed in an acidic environment, and gastric acid facilitates its dissolution.

Taking the tablet with food stimulates gastric acid secretion and may improve calcium absorption, although the tablet can also be taken between meals.

The colecalciferol component provides preformed vitamin D3, which is identical to the vitamin D produced in the skin.

After ingestion, vitamin D3 is absorbed from the small intestine (aided by dietary fat), enters the bloodstream via chylomicrons, and is transported to the liver for the first hydroxylation step.

The resulting calcidiol is the storage form of vitamin D and the form measured in routine blood tests.

Calcidiol is subsequently converted to calcitriol in the kidneys, and calcitriol acts on vitamin D receptors in the intestinal epithelium to upregulate the expression of calcium-binding proteins and active calcium transport channels, thereby increasing calcium absorption.

By supplying both calcium and vitamin D in a single tablet, Calcichew-D3 ensures that the vitamin D is available to enhance the absorption of the co-administered calcium.

This is more effective than taking calcium alone, as clinical trials have demonstrated that combined supplementation produces a greater reduction in fracture risk than calcium supplementation without vitamin D.

Clinical evidence for calcium and vitamin D supplementation

The evidence base for combined calcium and vitamin D supplementation has been examined in several large randomised controlled trials and meta-analyses.

The RECORD trial (2005) and the Women's Health Initiative (WHI) calcium and vitamin D trial (2006) provided mixed results, but subsequent meta-analyses pooling individual patient data have consistently shown that combined calcium and vitamin D supplementation reduces the risk of hip fracture by approximately 16 to 30% and total fracture by approximately 12 to 15% in populations at high risk, particularly institutionalised elderly individuals.

NICE Technology Appraisal TA464 recommends that all patients initiated on osteoporosis therapy should receive adequate calcium and vitamin D, either through diet and sunlight or through supplementation.

The Royal Osteoporosis Society recommends a daily intake of 700 to 1,200 mg of calcium (from diet and supplements combined) and 800 to 1,000 IU of vitamin D for adults at risk of osteoporosis.

A Cochrane review (2014) of vitamin D supplementation found that vitamin D alone does not prevent fractures, reinforcing the importance of combining vitamin D with calcium. The National Osteoporosis Guideline Group (NOGG) guidelines similarly recommend combined supplementation alongside pharmacological therapy.

Dosage and administration

The standard dose of Calcichew-D3 is one tablet chewed twice daily, providing a total daily supplement of 1,000 mg elemental calcium and 800 IU (20 micrograms) vitamin D3.

The tablet should be chewed thoroughly before swallowing. Swallowing the tablet whole may reduce disintegration and impair calcium absorption.

Calcichew-D3 is available in several flavours including lemon, orange, and strawberry, to encourage adherence.

Calcichew-D3 Forte tablets contain a higher dose of vitamin D (800 IU per tablet) and may be prescribed at one tablet daily when the higher vitamin D dose is desired in a single tablet.

Timing with other medicines

Calcium interacts with the absorption of several commonly prescribed medicines. The following spacing guidelines should be observed.

• Bisphosphonates (alendronate, risedronate): take the bisphosphonate first thing in the morning with plain water. Wait at least 30 minutes (ideally 2 hours) before taking Calcichew-D3.
• Levothyroxine: leave at least 4 hours between levothyroxine and calcium.
• Tetracycline or quinolone antibiotics (doxycycline, ciprofloxacin): leave at least 2 hours before or after calcium.
• Oral iron supplements: leave at least 2 hours apart.

Taking Calcichew-D3 at lunchtime and in the evening is a practical approach for patients who take bisphosphonates or levothyroxine first thing in the morning.

Side effects of Calcichew-D3

Common side effects

The most commonly reported adverse effects of Calcichew-D3 are gastrointestinal, including constipation, flatulence, bloating, nausea, and abdominal discomfort.

These are usually mild and often improve after the first few weeks of use. Drinking adequate fluids and maintaining dietary fibre intake can help manage constipation.

Uncommon and rare side effects

Hypercalcaemia (elevated blood calcium) is rare at standard recommended doses in patients with normal kidney function.

Symptoms of hypercalcaemia include persistent thirst, increased urination, nausea, vomiting, loss of appetite, abdominal pain, constipation, muscle weakness, fatigue, confusion, and an irregular heartbeat.

If you experience these symptoms, stop taking Calcichew-D3 and contact your GP for a blood calcium test.

Hypercalciuria (elevated urinary calcium) may occur and can predispose to the formation of kidney stones (nephrolithiasis) in susceptible individuals.

Patients with a personal or family history of kidney stones should discuss the risks and benefits of calcium supplementation with their GP before starting treatment.

Allergic reactions including rash, urticaria, and pruritus are very rare. Some formulations contain soya lecithin.

If you are allergic to soya or peanut, check the ingredients list or ask your pharmacist for a soya-free alternative.

Seek emergency medical help (call 999 or attend A&E) if you develop swelling of the face, lips, tongue, or throat, or difficulty breathing.

When to seek medical advice

Contact your GP or call NHS 111 if you develop symptoms suggestive of hypercalcaemia, new or worsening kidney pain (loin pain), blood in the urine, or a suspected allergic reaction.

Report any adverse reactions via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Warnings and precautions

Contraindications

Calcichew-D3 should not be taken by patients with hypercalcaemia, hypercalciuria, nephrolithiasis (kidney stones), nephrocalcinosis, or severe renal impairment (eGFR below 30 mL/min) unless under specialist supervision.

It is also contraindicated in patients with conditions that predispose to hypercalcaemia, including sarcoidosis, overactive parathyroid glands, and certain cancers (particularly those with bone metastases that cause calcium release).

Renal impairment

Patients with mild to moderate renal impairment should have serum calcium, phosphate, and renal function monitored periodically during calcium and vitamin D supplementation.

In severe renal impairment, the kidneys cannot adequately convert calcidiol to calcitriol.

These patients may require an active vitamin D analogue (such as alfacalcidol or calcitriol) instead of, or in addition to, colecalciferol.

Your nephrologist or GP will advise on the appropriate regimen.

Drug interactions

In addition to the absorption interactions described above, calcium supplements may interact with thiazide diuretics (which reduce urinary calcium excretion and may precipitate hypercalcaemia), cardiac glycosides (hypercalcaemia potentiates the toxicity of digoxin), and certain anticonvulsants (phenytoin and carbamazepine increase vitamin D metabolism).

Patients taking any of these medicines should have calcium levels monitored during supplementation.

Pregnancy and breastfeeding

Calcium and vitamin D are essential nutrients during pregnancy and breastfeeding. NICE recommends 10 micrograms (400 IU) of vitamin D daily throughout pregnancy and while breastfeeding.

However, excessive calcium or vitamin D intake during pregnancy can cause hypercalcaemia in the foetus or neonate. Do not exceed the recommended dose without medical advice.

Healthy Start vitamins, available free to eligible pregnant women in England, provide 10 micrograms of vitamin D per tablet.

Calcichew-D3 and osteoporosis treatment

Osteoporosis affects approximately 3 million people in the United Kingdom and causes over 500,000 fragility fractures annually. Calcichew-D3 is not a treatment for osteoporosis on its own.

Rather, it is an essential adjunct to pharmacological therapies such as alendronate, risedronate, zoledronic acid, denosumab, and teriparatide, all of which require adequate calcium and vitamin D status to work effectively.

All major osteoporosis treatment guidelines, including those from NICE, NOGG, and the Royal Osteoporosis Society, specify that patients starting anti-resorptive or anabolic bone therapy should be replete in calcium and vitamin D.

Without adequate calcium and vitamin D, bisphosphonates and denosumab may be less effective, and the risk of hypocalcaemia with denosumab is increased.

DXA (dual-energy X-ray absorptiometry) scanning is used to measure bone mineral density at the hip and spine.

NICE recommends using the FRAX or QFracture tools to assess 10-year fracture probability and guide treatment decisions.

If you have been diagnosed with osteoporosis or have sustained a fragility fracture, ask your GP whether calcium and vitamin D supplementation alongside pharmacological treatment is appropriate for you.

How to get Calcichew-D3 in the UK

Calcichew-D3 is classified as a pharmacy medicine (P) in the UK and can be purchased from pharmacies without a prescription.

However, it is commonly prescribed by GPs on the NHS, particularly for patients with a confirmed diagnosis of osteoporosis or vitamin D deficiency who require long-term supplementation.

The standard NHS prescription charge in England is currently 9.90 pounds per item; prescriptions are free in Scotland, Wales, and Northern Ireland.

Prepayment certificates (PPCs) are available for patients in England who require multiple prescriptions and can reduce costs significantly.

Generic calcium and vitamin D combination tablets are also available and are often dispensed as a cost-effective alternative to the Calcichew-D3 brand.

Your pharmacist may dispense a generic equivalent unless your prescriber has specified the brand.

All products meeting UK pharmaceutical standards contain the same active ingredients in the same doses.

Living with calcium and vitamin D deficiency: practical advice

Whilst supplementation with Calcichew-D3 corrects deficiency, dietary and lifestyle measures can help maintain optimal calcium and vitamin D levels over the long term.

Good dietary sources of calcium include milk, yoghurt, cheese, fortified plant milks, canned sardines (with bones), tofu prepared with calcium sulfate, broccoli, and kale.

The Reference Nutrient Intake (RNI) for calcium in UK adults is 700 mg per day, though higher intakes (1,000 to 1,200 mg) are recommended for postmenopausal women and older adults at risk of osteoporosis.

Vitamin D is more difficult to obtain from diet alone.

Oily fish (salmon, mackerel, sardines), egg yolks, liver, and fortified foods contribute, but sun exposure during April to September (approximately 10 to 15 minutes of midday sun on exposed forearms and face, without sunscreen) remains the most efficient source for UK residents.

During October to March, UVB levels in the UK are insufficient for cutaneous vitamin D synthesis, making supplementation particularly important during these months.

Weight-bearing exercise, including walking, jogging, dancing, and stair climbing, stimulates bone formation and helps maintain bone density.

Resistance training (using weights or resistance bands) also has evidence of benefit for bone health.

Falls prevention strategies, including strength and balance exercises, vision correction, medication review, and home safety assessments, are important complementary measures for reducing fracture risk in older adults.

When to seek urgent medical advice

Contact your GP or call NHS 111 if you experience symptoms of hypercalcaemia (persistent thirst, frequent urination, nausea, confusion, muscle weakness), signs of kidney stones (severe loin or abdominal pain, blood in the urine), or a suspected allergic reaction to Calcichew-D3.

If you develop difficulty breathing, swelling of the face or throat, or severe chest pain, call 999 or attend A&E immediately.

Report any adverse reactions via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk .

Sources

• Calcichew-D3, Summary of Product Characteristics (EMC)
• Calcium carbonate with colecalciferol, British National Formulary (BNF)
• NICE TA464: Bisphosphonates for treating osteoporosis
• NICE PH56: Vitamin D, supplement use in specific population groups
• Royal Osteoporosis Society
• Calcium, NHS
• Vitamin D, NHS
• MHRA Yellow Card Scheme