Xtracal M 

Presentation: Film-coated tablets containing Calcium Carbonate BP equivalent to 600 mg elemental Calcium, Vitamin D3 BP (as Cholecalciferol) 200 IU, Magnesium Oxide BP equivalent to 40 mg Magnesium, Manganese Sulfate Monohydrate BP equivalent to 1.8 mg Manganese, Cupric Oxide equivalent to 1 mg Copper, Boron Citrate equivalent to 250 mcgBoron, and Zinc Oxide BP equivalent to 7.5 mg Zinc. Available in strips of [Specify number, e.g., 30] tablets, manufactured by Pharmasia Limited in Bangladesh.

Indications: Xtracal-M is indicated for:

• Prevention and treatment of osteoporosis.
• To maintain strong bone growth. 
• For proper functioning of the heart, muscles, and nerves. 
• As a nutritional supplement. 
• For bone development andregeneration.
• During pregnancy and lactation.
• Deficiency states of Calcium, Vitamin D3, Magnesium, Zinc, Copper, Manganese & Boron.

Dosage and Administration: The usual adult dosage is one tablet daily or as directed by a physician. The tablet should be swallowed whole with water. It can be taken with or without food. Follow the physician's instructions for the duration of use. If calcium and iron supplements are both required, they should be taken at different times, allowing a minimum period of four hours before taking calcium.

Side Effects:The use of calcium supplements has rarely given rise to mild gastro-intestinal disturbances such as constipation, flatulence, nausea, gastricpain, and diarrhea. Following the administration of Vitamin D3 supplements, occasional skin rash has been reported.

Precautions:

• Contraindicated in patients with hypercalcaemia resulting from myeloma, bone metastasis, or other malignant bone disease, sarcoidosis, primary hyperparathyroidism, and Vitamin D3 overdosage, severe renalfailure, and hypersensitivity to any of the tablet ingredients.
• The risk of hypercalcemia should be considered in patients taking thiazide diuretics since these drugs can reduce urinary calcium excretion.Hypocalcaemia must be avoided in digitalized patients. 
• The effects of digitalis and other cardiac glycosides may be attenuated with the oral administration of calcium combined with Vitamin D3.Strict medical supervision is needed, and if necessary, monitoring of ECG and calciumlevels.
• Calcium salts may reduce the absorption of thyroxin, bisphosphonates, sodium fluoride, quinolone or tetracycline antibiotics, or iron. It is advisable to allow a minimumperiod of four hours before takingcalcium.
• In patients with a history of renal stones, urinary calcium excretion should be measured to exclude hypercalciuria. With long-term treatment, it is advisable to monitor serum and urinary calcium levels and kidney function,and reduce or stop treatment temporarily if urinary calcium exceeds7.5 mmol/24 hours.
• During pregnancy and lactation, treatment should always be under the direction of a physician.

Storage: Store in a cool and dry place, protected from light and moisture. Keep out of reach of children.

Important Note: This information is for general knowledge and informational purposes only, and does not substitute professional medical advice. Always consult your doctor or pharmacist for specific instructions and guidance regarding your medication. They can assess your individual medical condition and provide the most appropriate advice.