8 Calcium Citrate Interactions to Know About

Calcium citrate(Citracal) is a type of calcium supplement. Your bodyneeds calciumto keep your bones, muscles, and nerves healthy. You may need a calcium citrate supplement if your blood calcium levelsare lowor you havelow bone density.

But you shouldn't take a calcium citrate supplement unless a healthcare professional recommends it. That's because there areside effectsand drug interactions to consider, which are easy things to overlook with over-the-counter (OTC) supplements. Let's take a look at eight calcium citrate interactions to be aware of before taking it.

1. Levothyroxine and other thyroid hormone medications

Levothyroxine(Synthroid, Levoxyl) is a thyroid hormone medication that's used to treathypothyroidism(low thyroid hormone levels). Other thyroid hormone medications include liothyronine (Cytomel) and desiccated thyroid (Armour Thyroid, NP Thyroid).

EXPERT PICKS: WHAT TO READ NEXT

• How much calcium is too much?Learn how much calcium you should consume daily and the risks oftaking too much.
• Calcium carbonate vs. calcium citrate:Both of these supplements can increase calcium levels, but there are someimportant differencesbetween the two.
• Calcium citrate side effects:Here are somecommon and rare side effectsto be aware of if you're taking calcium citrate.

Calcium supplements can interfere with the absorption of thyroid hormone medications. One small study found taking these two together reduced thyroid hormone levelsalmost 25%. If you don't have enough thyroid hormone,symptoms of hypothyroidismmay occur. This can include low energy, dry skin, and hair loss.

To help avoid this, you should take calcium citrate and thyroid hormone medication at least 4 hours apart.

2. Lithium

Lithium(Lithobid) is a medication that treatsbipolar disorder. Lithium canraise your calcium levels. If you also take calcium citrate, this combination mayraise your calcium levelstoo much (hypercalcemia).

Signs and symptoms of hypercalcemiainclude:

• Nausea
• Constipation
• Muscle weakness
• Bone pain
• Confusion
• Fatigue
• Feeling thirsty
• Peeing more often

If you take lithium, talk with your prescriber before taking calcium citrate. They can check your calcium levels and determine if it's a safe and necessary supplement for you.

3. Thiazide diuretics

Thiazide diuretics (or water pills) helpremove excess fluidfrom the body. But they may also increasehow much calciumyour body holds onto. Hydrochlorothiazide (Microzide) and chlorthalidone are the diuretics included in this drug class.

If you take a thiazide diuretic along with calcium citrate, it's possible your calcium levels may become too high. As mentioned, high calcium levels can cause unpleasant symptoms and may even be dangerous in severe cases.

Be sure to talk with your healthcare team before taking calcium citrate along with a thiazide diuretic to make sure it's appropriate for you.

4. Fluoroquinolone antibiotics

Fluoroquinolone antibioticstreat bacterial infections. They're typically reserved for more serious infections or when other antibiotics aren't an option. This is because they carry someserious risks. Common fluoroquinolones include:

• Ciprofloxacin (Cipro)
• Levofloxacin
• Moxifloxacin (Avelox)

Calcium citrate cansignificantly reducethe absorption of fluoroquinolones. This can make them less effective at treating your infection. Let your prescriber know if you're taking calcium citrate and need a fluoroquinolone antibiotic. They may pause your calcium supplement until your course of antibiotics is finished. Or they may have you take calcium citrateat least 2 hoursbefore or after your antibiotic.

5. Tetracycline antibiotics

Tetracycline antibioticsalso treat bacterial infections. Some are also prescribed for daily use totreat and prevent acne. Common tetracycline antibiotics include doxycycline (Doryx), minocycline (Minocin), and tetracycline.

Calcium can bind to tetracycline antibiotics. This makes it harder for your body to absorb them properly, which results in lower antibiotic levels in your body. As with fluoroquinolones, this interaction can leave your infection untreated.

Make sure your prescriber is aware you're taking a calcium citrate supplement for starting an antibiotic. They'll let you know if you should stop taking it or if you need to separate it from your antibiotic. In most cases, you should take a tetracycline antibiotic at least2 hours beforeor after taking calcium citrate.

6. Alendronate and other bisphosphonates

Bisphosphonatesare medications that can help you maintain your bone density. They're typically prescribed forosteoporosis. Common bisphosphonates include alendronate (Fosamax), risedronate (Actonel), and ibandronate (Boniva).

Calcium citrate can bind to bisphosphonate medications and decrease their absorption. When this happens, bisphosphonates might not work well enough to protect your bones. This could increase your risk of bone fractures.

In some cases, it's recommended that you take a calcium supplement if you're prescribed a bisphosphonate. But you shouldn't take them at the same time. Your prescriber may suggest skipping calcium on the day you take your bisphosphonate. But in general, separating the two medications byat least 2 hoursis fine. Your prescriber can give you specific directions based on your personal history.

7. Iron supplements

Iron supplementsare often prescribed to prevent or treatanemia(decreased red blood cells) caused by low iron levels. Iron supplements are available in both OTC and prescription forms. They may go bydifferent names, such as ferrous sulfate, ferrous gluconate, or ferric citrate.

Calcium citrate maymake it harderfor the body to absorb iron. This could prevent your iron supplement from working properly. It's unclear how serious of a risk this interaction is, but most experts recommend separating the two medications byat least 2 hoursto be on the safe side.

8. Dolutegravir

Dolutegravir (Tivicay, Dovato, Juluca) is an antiviralHIV medication. Calcium citrate can bind to dolutegravir and prevent your body from absorbing it. This could reduce your dolutegravir levels and make it less effective, which could in turn allow yourviral loadto go up.

You shouldn't take calcium citrate with dolutegravir unless your prescriber recommends it. If you need both medications,take dolutegravir2 hours before or 6 hours after calcium citrate.

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Calcium citrate (Citracal) is a type of calcium supplement. It's sold over the counter, but it can still interact with other medications. Calcium citrate can lower the levels of thyroid hormone medications, certain antibiotics, and dolutegravir if they're taken at the same time. Calcium citrate can also lower the absorption of iron supplements and bisphosphonates. If you need to take calcium citrate with these medications, it's best to separate the two by several hours. Your healthcare team can let you know how long is best based on your personal medical history.

Other calcium citrate interactions include thiazide diuretics and lithium. Your calcium levels may go too high if you take calcium citrate with either of these medications. So you shouldn't take calcium citrate with them unless your prescriber recommends it.

Always talk with your healthcare team before taking calcium citrate to make sure it's a safe and necessary supplement for you.

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