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Calcium Carbonate and Magnesium Carbonate - Uses, Mechanism of Action, Precautions, and Side Effects

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Calcium carbonate and magnesium carbonate are antacids that relieve heartburn, acid indigestion, and stomach upset.

Medically reviewed by

Dr. Muhammad Zohaib Siddiq

Published At March 7, 2023
Reviewed AtMarch 26, 2024

Overview:

Calcium carbonate is a salt used as an antacid. It is a base that neutralizes the hydrochloric acid in gastric secretions. An increase in the pH may inhibit the action of pepsin, an enzyme that breaks down proteins in food. Increased bicarbonate ions and prostaglandins may also lead to cytoprotective effects. It can also be used as a dietary supplement or to treat hypocalcemia.

Magnesium carbonate, also known as magnesite, is a common antacid used to treat heartburn and stomach upset caused by the overproduction of acids in the stomach.

How Do Calcium Carbonate and Magnesium Carbonate Work?

Calcium carbonate is a basic salt that neutralizes the hydrochloric acid present in the stomach. It also hinders the action of pepsin by increasing the pH. The cytoprotective effects of calcium carbonate occur through an increase in the bicarbonate ion and prostaglandins. On neutralization, hydrochloric acid leads to the formation of calcium chloride, carbon dioxide, and water. Around 90 % of the calcium chloride is converted to insoluble calcium salts such as calcium carbonate and phosphate.

Magnesium carbonate reacts with the hydrochloric acid in gastric secretion to form carbon dioxide and magnesium chloride, thus neutralizing excess acid in the stomach.

Uses of Calcium Carbonate and Magnesium Carbonate:

Calcium and magnesium carbonates are used as antacids to treat heartburn, indigestion, and stomach upset. Calcium carbonate can be used as a supplement or to treat hypocalcemia.

Dosage Restrictions:

1. Route of Administration -

  • Oral.

2. Dosage Strengths -

  • Suspension - 1250 mg.

  • Tablets - 1250 mg and 1500 mg.

  • Chewable Tablets - 400 mg, 500 mg, 750 mg, 1000 mg, 1177 mg.

3. Dosage Forms -

  • Tablets.

  • Chewable tablets.

  • Suspension.

Special Considerations:

Pregnancy -

No risk of congenital disabilities has been observed after using calcium carbonate and magnesium carbonate during pregnancy. Pregnant women should reduce the time the maximum dose is used, as per the doctor's advice. Pregnant women should avoid excess milk and dairy products to prevent calcium overload.

Lactation -

Calcium and magnesium are excreted into breast milk. The drugs are generally considered safe during lactation when used at recommended doses.

Fertility -

There is no known evidence suggesting that drugs adversely affect human fertility.

Warnings and Contraindications:

The drugs are contraindicated in:

  • Hypersensitivity to drugs.

  • Hypercalciuria.

  • Renal calculi.

  • Hypophosphatemia.

  • Hypercalcemia.

  • Suspected Digoxin toxicity.

Warnings and Precautions:

Precautions -

  • Hypercalciuria or increased calcium in the urine.

  • Caution should be exercised in individuals with impaired renal function.

  • Calcium-containing antacids should be carefully administered in patients with constipation, hemorrhoids, and sarcoidosis.

  • The medications should not be taken with large amounts of milk or dairy products.

For Patients:

What Are Heartburn and Indigestion?

Indigestion is also known as dyspepsia or an upset stomach. It is a discomfort in the upper part of the stomach. Indigestion causes abdominal pain and a feeling of fullness soon as one starts to eat. Indigestion can also occur as a symptom of various digestive diseases.

Heartburn is the condition that occurs when stomach acid regurgitates into the tube (esophagus) carrying the food from the mouth to the stomach. It may lead to a burning pain or discomfort in the upper or middle part of the chest, involving the neck and throat, that worsens while lying down.

Why Are Calcium Carbonate and Magnesium Carbonate Prescribed for Indigestion and Heartburn?

Calcium carbonate and magnesium carbonate belong to the medications known as antacids. Antacids are drugs that are used to treat certain conditions caused by the acid produced by the stomach. The stomach secretes hydrochloric acid, which helps in the process of digestion. The stomach, duodenum (the part of the small intestine connected to the stomach), and esophagus (food pipe) are protected from the acid by several protective mechanisms. However, in case of excess acid or inadequate protective mechanisms, the stomach lining and esophagus may get damaged by the acid, giving rise to inflammation and ulcerations. The inflammation gives rise to nausea, abdominal pain, and heartburn.

Antacids reduce acidity by neutralizing the excess acid and reducing the amount of acid getting into the esophagus or the duodenum. They also inhibit the activity of pepsin, a digestive enzyme that helps in protein digestion and is active only in an acidic medium.

Facts One Should Know About Calcium Carbonate and Magnesium Carbonate:

How Should One Take Calcium Carbonate and Magnesium Carbonate?

  • One should shake the oral suspension well before intake.

  • The chewable tablets should be chewed thoroughly and not swallowed as a whole.

  • Drink a glass of water after taking the medications.

  • It can be taken with or without food or as soon as the symptoms arise.

  • Do not exceed the recommended dosage.

  • Follow the directions mentioned in the prescription.

  • Do not take calcium carbonate for more than two weeks unless advised by the doctor.

What Should One Discuss With The Doctor Before Beginning Calcium Carbonate and Magnesium Carbonate?

  • The doctor should be informed if one is allergic to calcium carbonate or magnesium carbonate.

  • The doctor should be informed about specific prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products if one takes them.

  • The doctor should be informed if one has kidney disease, high blood pressure, is already taking calcium, has the stomach or intestinal ulcers, or has kidney stones.

  • The doctor should be told if one is taking Digoxin, Etidronate, Phenytoin, or Tetracycline.

  • Do not take calcium carbonate within one to two hours of other medicines. Calcium may decrease the effectiveness of other medicines.

  • The doctor should be informed if one plans to become pregnant or is breastfeeding.

Are Calcium Carbonate and Magnesium Carbonate Safe?

Calcium carbonate and magnesium carbonate are safe for most people but do not suit everyone.

Are Calcium Carbonate and Magnesium Carbonate Effective?

Both calcium and magnesium carbonate is effective in their prescribed doses. However, an overdose can prove to be fatal.

What Side Effects Can One Expect With Calcium Carbonate and Magnesium Carbonate?

Calcium carbonate can cause the following side effects:

  • Stomach upset.

  • Vomiting.

  • Stomach pain.

  • Belching.

  • Constipation.

  • Dry mouth.

  • Increased urination.

  • Loss of appetite.

  • Metallic taste in the mouth.

Magnesium carbonate can cause the following side effects:

  • Stomach upset.

  • Diarrhea.

  • Allergic reactions:

  1. Rash.

  2. Itching.

  3. Swelling.

  4. Trouble breathing.

Can One Stop Taking Calcium Carbonate and Magnesium Carbonate Without The Doctor's Approval?

Do not stop taking the medications without the doctor's consent. The medications should be taken as prescribed by the doctor.

Are There Any Dietary Restrictions to Consider When Taking Calcium Carbonate and Magnesium Carbonate?

  • Take the medications with or without food.

  • Avoid foods that might cause indigestion or heartburn, such as fried food, junk food, etc.

How Should One Store Calcium Carbonate and Magnesium Carbonate?

  • The medications should be kept in the container they came in, tightly closed, and out of reach of children.

  • It should be stored at room temperature, away from excess heat and moisture.

How Should One Dispose of Calcium Carbonate and Magnesium Carbonate?

  • Unused medications should be disposed of in ways to ensure that pets, children, and other people cannot take them.

  • One should not flush the medications in the toilet.

  • The best way to dispose of the medication is through a medicine take-back program by talking to a pharmacist or contacting the local garbage or recycling department about the medicine take-back programs.

What To Do in Case of Overdose?

In case of an overdose, poison control should be immediately contacted. Likewise, emergency services should be immediately contacted if the individual collapses, has a seizure, has trouble breathing, or is unconscious.

For Doctors:

Indications-

Calcium carbonate and magnesium carbonate are used in the following:

  • Indigestion.

  • Heartburn.

  • Stomach upset.

  • Additionally, calcium carbonate can be used as a nutritional supplement in treating hypocalcemia and constipation.

What Is the Pharmacology of Anastrozole?

Description -

  • Calcium Carbonate: Calcium carbonate, or CaCO3, is a resonance-stabilized inorganic salt used as a dietary supplement, an antacid, and a phosphate binder. Calcium carbonate is one of the most abundant compounds present in the earth's crust.

  • Magnesium Carbonate: Magnesium carbonate is a magnesium salt with the chemical formula CMgO3. It plays a role as an antacid. Magnesium carbonate, also known as magnesite, is commonly used for heartburn and upset stomach caused by the excess acid in the stomach.

Components-

Active Ingredients:

  • Calcium carbonate.

  • Magnesium carbonate.

Clinical Pharmacology:

Mechanism of Action -

Calcium Carbonate:

Calcium carbonate neutralizes the acid secreted in the stomach by acting as a buffer in the stomach's acidic environment. After entering the stomach, it dissociates into ionized calcium (Ca2+) and a carbonate anion (CO32-). The carbonate anion then binds to the free protons in the stomach, thus increasing the pH by reducing the concentration of the hydrogen ions. As the pH in the stomach increases, pepsin, bile acids, and the toxins of Helicobacter pylori get inhibited.

The inhibition of pepsin and bile acid helps to reduce the damage by promoting the healing of ulcers in the mucosal lining of the stomach, duodenum, and esophagus caused by GERD. There is doubt regarding the ulcer-healing property of calcium carbonate due to its acid-neutralizing mechanism because it can cause acid rebound by increasing the plasma gastrin levels and has been found to increase the prostaglandins PGE2 and PGF2 after long-term use. Calcium carbonate also enhances gastrointestinal motility, which initiates peristalsis. The free calcium stimulates movement in the esophagus to move the acid into the stomach, thus decreasing heartburn symptoms.

Magnesium Carbonate -

Magnesium carbonate is a magnesium salt that reacts with hydrochloric acid in the stomach to form carbon dioxide and magnesium chloride, thereby neutralizing the excess acid production in the stomach.

Pharmacodynamics-

Calcium Carbonate:

Antacids like calcium carbonate work by restoring the acid-base balance, reducing the pepsin activity, and increasing the secretions of bicarbonate and prostaglandin. As a nutritional supplement, calcium carbonate directly increases calcium stores within the body.

Magnesium Carbonate:

Magnesium carbonate acts as an antacid by neutralizing the excess acid in the stomach.

Pharmacokinetic Changes -

Calcium carbonate and magnesium carbonate react with the stomach acid, forming water and soluble mineral salts. Calcium and magnesium are absorbed from these salts. The rate of absorption is dependent on the patient and the dose. Around ten percent calcium and 15 to 20 % magnesium is absorbed.

The calcium and magnesium absorbed are usually excreted by the kidneys in healthy individuals. However, in the case of impaired renal function, serum concentrations of calcium and magnesium may be increased. Due to the effect of digestive juices outside the stomach, the soluble salts are converted to insoluble salts in the intestine and excreted out with the feces.

A. Distribution-

  • Binding to Plasma Proteins -

Calcium is a cofactor of various enzymes.

30 % of magnesium is bound to different proteins.

B. Metabolism-

Both calcium and magnesium are not metabolized in the typical pharmacokinetic way.

C. Excretion-

  • Recovery of Calcium Carbonate -

    • Feces.
    • Urine.
  • Recovery of Magnesium Carbonate -
    • Urine.

D. Elimination-

Calcium carbonate is usually eliminated in the feces as unabsorbed calcium carbonate, in the urine controlled by the parathyroid hormone, Vitamin D, and as carbon dioxide from the lungs.

Magnesium carbonate is primarily eliminated in the urine.

Special Considerations:

Calcium can pass through the placenta and into breast milk. Therefore, calcium carbonate is safe for pregnant patients with GERD, aspiration prophylaxis before labor, and nursing.

If one has diabetes, kidney disease, addiction to alcohol, liver disease, phenylketonuria (PKU), or any other condition, magnesium carbonate should be taken only after consultation with the doctor. Magnesium carbonate should be taken during pregnancy only after the doctor's consent.

There is no information regarding magnesium carbonate passing in human milk.

Drug Interactions-

  • Calcium Carbonate:

  1. Captopril - Calcium carbonate can cause a reduction in Captopril absorption, resulting in decreased serum concentration and efficiency.

  2. Cefuroxime - The serum concentration of Cefuroxime is reduced when combined with calcium carbonate.

  3. Benzthiazide - Benzthiazide might reduce the elimination of calcium carbonate resulting in an increased serum level.

  • Magnesium Carbonate:

  1. Aceclofenac - Aceclofenac might reduce the excretion of magnesium carbonate resulting in an increased serum level.

  2. Acetazolamide - Acetazolamide might increase the severity of adverse effects when combined with magnesium carbonate.

  3. Benzatropine - The efficacy of magnesium carbonate can be decreased when combined with Benzatropine.

What Have Clinical Trials Shown With Regard to Calcium Carbonate and Magnesium Carbonate?

The Onset of Acid-neutralizing Action of a Calcium/Magnesium Carbonate-based Antacid Using an Artificial Stomach Model: An in Vitro Evaluation:

The simulator of the human intestinal microbial ecosystem apparatus (SHIME) was used in the study, comprising five reactors simulating different parts of the human gastrointestinal tract. Calcium carbonara, magnesium carbonate, and the placebo were given two tablets per incubation over six independent, two-hour stomach incubations each. The primary objective was to evaluate the time required to achieve pH 3.0, 3.5, 4.0, and 4.5, as and the maximum pH achieved. A secondary objective was to assess the activity of pepsin over the entire two-hour gastric incubation.

Results-

After administering the drug containing calcium carbonate, and magnesium carbonate, the stomach pH reached 3.0 within 40 seconds. The pH of 5.24 was maintained for almost ten minutes. Whereas the placebo pH was 1.28 during the complete gastric simulation. The antacids reduced the activity of pepsin during the period of increased pH. With a placebo, the lower pH resulted in consistently high loads of digested peptides, identifying the high cumulative and instantaneous pepsin activity. Thus, the study confirms the higher efficacy and fast onset of acid-neutralizing action of both drugs, which begin to work within seconds.

Patient Counseling Information:

Administration Instructions-

1. Calcium Carbonate:

  • Calcium carbonate is available in tablet, chewable, oral suspension, or powder form.

  • The tablets should be swallowed with a full glass of water.

  • The suspension should be shaken well before use.

  • Dosing depends on the condition and the patient's age. For adults, the dosage should be at most seven grams in a day.

  • If the individual misses a regular dose, they should take it on remembering, unless it is close to the next dose.

  • After a particular age, the absorption of calcium carbonate can be affected by the dose, pH of the stomach, size of the patient, estrogen levels, vitamin D levels, and genetic polymorphisms. In addition, calcium carbonate absorption decreases if an individual has a mucosal lining disorder or achlorhydria.

  • The patients should limit their intake of oxalate-rich foods (soy, green, leafy vegetables, animal protein) to avoid reduced absorption through the calcium-oxalate formation.

2. Magnesium Carbonate:

  • Magnesium carbonate should be taken orally.

  • It is best to take the medication with food to treat an upset stomach and diarrhea.

  • Take each dose with a full glass of water.

  • Swallow extended-release capsules and delayed-release tablets or capsules whole.

  • Do not crush or chew the extended-release or delayed-release capsules or tablets.

  • Do not split extended-release tablets.

  • Swallow the whole without crushing or chewing.

  • Thoroughly chew the chewable tablets before swallowing.

Complications or Side Effects -

1. Calcium Carbonate: Due to the short-term use of calcium carbonate as an antacid and as a supplement, most side effects are minor. However, if large doses are taken for a longer time, the individual can experience the following side effects:

  • Irregular heart rhythms.

  • Coma.

  • Bone pain.

  • Confusion.

  • Muscle twitching.

  • Abdominal pain.

  • Pancreatitis.

  • Acute renal failure.

  • Kidney stones.

  • Headache.

  • Gallbladder stones.

  • Milk-alkali Syndrome - Milk-alkali syndrome results from hypercalciuria and alkaluria, leading to pancreatitis, kidney stone formation, and acute renal failure. The side effects include:

  • Acid rebound.

  • High calcium levels.

  • Low phosphate levels.

  • Vomiting.

  • Nausea.

  • Constipation.

  • Gas.

  • Loss of appetite.

  • Irritability.

  • Dry mouth.

2. Magnesium Carbonate:

  • Stomach upset.

  • Diarrhea.

  • Dizziness.

  • Allergic Reactions:

  1. Rash.

  2. Itching.

  3. Swelling.

  4. Trouble breathing.

Frequently Asked Questions

1.

How Do Magnesium Carbonate and Calcium Carbonate Differ?

Magnesium carbonate and calcium carbonate differ in terms of their chemical composition and properties. While both compounds are carbonates, magnesium carbonate has the chemical formula MgCO3, whereas CaCO3 represents calcium carbonate. Additionally, magnesium carbonate tends to be more soluble in water compared to calcium carbonate. Moreover, their respective applications and uses may also vary due to these differences in chemical properties.

2.

What Occurs When Calcium Carbonate Reacts with Magnesium Carbonate?

When calcium carbonate reacts with magnesium carbonate, a chemical reaction takes place. The specific products of this reaction would depend on the conditions and stoichiometry of the reaction. It could potentially result in the formation of mixed carbonates or double salts containing both calcium and magnesium ions. The reaction between calcium carbonate and magnesium carbonate may involve the exchange of ions, leading to the formation of new compounds. Further details regarding the reaction products can be determined by conducting specific experiments under controlled conditions.

3.

What Are the Uses of Calcium Carbonate and Magnesium Carbonate?

Calcium carbonate and magnesium carbonate have various uses in different industries. Calcium carbonate is commonly used as a dietary supplement, antacid for treating heartburn, filler in the production of paper, paint, and plastics, as well as a component in cement and construction materials. Magnesium carbonate is used in the manufacturing of fireproof materials, as a drying agent in certain industries, and as a supplement to provide magnesium in the human diet. Both compounds have versatile applications in diverse fields due to their unique properties and beneficial effects.

4.

What Are the Formulas for Calcium Carbonate and Magnesium Carbonate?

The formula for calcium carbonate is CaCO3, indicating that it consists of one calcium ion bonded to one carbonate ion. On the other hand, the formula for magnesium carbonate is MgCO3, indicating the presence of one magnesium ion bonded to one carbonate ion. The difference lies in the type of metal cation (calcium or magnesium) bonded to the carbonate anion, which gives each compound its distinct chemical composition and properties.

5.

Can Calcium Carbonate and Magnesium Carbonate Be Taken Together?

In general, it is safe to take calcium carbonate and magnesium carbonate together, as they are commonly found in combination in certain supplements or medications. People need to consult with a healthcare professional or pharmacist to determine the appropriate dosage and interactions with other medications. Calcium carbonate and magnesium carbonate are often used together to provide a balanced intake of these essential minerals, as they both play important roles in maintaining bone health, muscle function, and overall mineral balance in the body.

6.

Does Magnesium Carbonate Act as a Water Softener?

Yes, magnesium carbonate can act as a water softener to some extent. When dissolved in water, magnesium carbonate reacts with the dissolved calcium and magnesium ions, forming insoluble precipitates that can be removed through filtration or settling. This process helps reduce the hardness of water. However, it is worth noting that magnesium carbonate's effectiveness as a water softener may vary depending on the specific water composition and the desired level of water softness.

7.

Why Is Calcium Carbonate More Stable Than Magnesium Carbonate?

Calcium carbonate (CaCO3) is more stable than magnesium carbonate (MgCO3) due to differences in the chemical properties of calcium and magnesium ions. The stability of a compound is influenced by the strength of the chemical bonds holding its constituents together. In the case of CaCO3, the calcium ion forms stronger bonds with the carbonate ion compared to the magnesium ion in MgCO3. This stronger bond formation in calcium carbonate contributes to its increased stability, making it less prone to decomposition or chemical reactions compared to magnesium carbonate.

8.

Why Do Doctors Prescribe Calcium Carbonate?

Doctors prescribe calcium carbonate for various reasons. One of the primary uses is as a dietary supplement to address calcium deficiencies, particularly for individuals at risk of osteoporosis or other bone-related conditions. Calcium carbonate is also commonly prescribed as an antacid to relieve symptoms of heartburn, indigestion, and acid reflux by neutralizing stomach acid. Additionally, it may be recommended to patients with certain medical conditions that require calcium supplementation, such as chronic kidney disease or hypoparathyroidism. Calcium carbonate is a readily available and cost-effective form of calcium, making it a preferred choice in many clinical settings.

9.

Why Do Farmers Utilize Magnesium Carbonate?

Farmers utilize magnesium carbonate for agricultural purposes. It is commonly used as a soil amendment to address magnesium deficiencies in the soil. By applying magnesium carbonate to the soil, farmers can improve the magnesium content, enhance nutrient uptake by plants, and promote healthy growth. Additionally, magnesium carbonate can help regulate soil pH levels and improve soil structure, contributing to optimal conditions for plant growth and productivity.

10.

What Was the Previous Name for Calcium Carbonate?

The old name for calcium carbonate is precipitated chalk. Chalk is a term used to describe a soft, white, porous form of limestone primarily composed of calcium carbonate. Historically, this material was referred to as precipitated chalk due to its formation through the precipitation of calcium carbonate from water solutions. Over time, the term "precipitated chalk" has been replaced by the more commonly used name "calcium carbonate" in scientific and industrial contexts.

11.

Is Magnesium Carbonate Classified as a Salt or an Acid?

Magnesium carbonate is classified as a salt rather than an acid. Salts are formed by the reaction between an acid and a base, resulting in the neutralization of their respective properties. Magnesium carbonate is derived from the reaction between magnesium hydroxide (a base) and carbonic acid. The resulting compound, magnesium carbonate (MgCO3), does not exhibit the typical characteristics of an acid, such as releasing hydrogen ions (H+) in water. Instead, it dissociates into magnesium ions and carbonate ions, making it a salt compound.

12.

What Are the Drawbacks of Magnesium Carbonate?

One disadvantage of magnesium carbonate is its relatively low solubility in water. This limited solubility can restrict its effectiveness in certain applications, such as in water treatment or as a supplement for rapid magnesium absorption. Additionally, excessive intake of magnesium carbonate supplements may cause digestive discomfort or diarrhea in some individuals. Follow recommended dosage guidelines and consult a healthcare professional before taking magnesium carbonate or any other dietary supplement to avoid potential drawbacks or adverse effects.

13.

What Substances Should Not Be Combined with Calcium Carbonate?

Calcium carbonate should not be mixed with certain substances to avoid potential interactions or reduced effectiveness. Avoid combining calcium carbonate with iron supplements, as they can interfere with each other's absorption in the body. Additionally, certain medications, such as antibiotics like tetracycline or quinolones, can form complexes with calcium carbonate, reducing their absorption and effectiveness. It is advisable to separate the intake of calcium carbonate from these medications by a few hours. Consult with a healthcare professional or pharmacist for specific guidance on avoiding interactions with calcium carbonate based on your individual medications or health conditions.

14.

Is It Safe to Consume Magnesium Carbonate on a Daily Basis?

Taking magnesium carbonate on a daily basis is generally considered safe for most individuals when consumed in appropriate doses. However, one should follow the recommended dosage guidelines and consult with a healthcare professional before starting any new supplement regimen. Daily intake of magnesium carbonate can help supplement magnesium levels in the body, which is essential for various bodily functions, including nerve and muscle function, bone health, and energy production.

15.

Is MgCO3 Stronger Than CaCO3?

In terms of strength, calcium carbonate (CaCO3) is generally considered stronger than magnesium carbonate (MgCO3). This difference in strength can be attributed to the chemical properties and bonding of the respective compounds. Calcium carbonate forms stronger chemical bonds between the calcium ion and the carbonate ion, resulting in a more stable structure. On the other hand, magnesium carbonate has weaker bonds between the magnesium ion and the carbonate ion. This difference in bond strength contributes to the overall strength and stability of the compounds, with calcium carbonate being comparatively stronger than magnesium carbonate.
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Dr. Muhammad Zohaib Siddiq
Dr. Muhammad Zohaib Siddiq

Cardiology

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