It may be reasonable for patients to supplement their diet with calcium, as calcium deficiency is a common finding and our typical diet does not adequately keep pace with daily calcium loss (Thys-Jacobs et al. 1998). Many women supplement with calcium to improve symptoms associated with premenstrual syndrome and premature bone breakdown (McCarron and Hatton 1996).

Calcium may interfere with a host of commonly used drugs. The pain practitioner must be aware of patients with cardiac problems who may be taking calcium channel blockers or ^-blockers. The effects of calcium channel blockers may be affected by calcium supplementation, as calcium has been shown to antagonize the effects of verapamil (Bar-Or 1981). In fact, calcium has recently been used in the successful management of calcium channel blocker overdose (Durward 2003). Calcium supplementation may also decrease levels of ^-blockers, leading to a greater chronotropic and inotropic presentation than one would expect (Kirch etal. 1981).

Thiazide diuretics have been shown to increase serum calcium concentrations, possibly leading to hypercalcemia due to increased reabsorption of calcium in the kidneys. Dysrhythmias may occur in patients taking digitalis and calcium together. The antibiotic effect of tetracyclines and quinolone and pharmacological blood levels of bisphosphonates and levothyroxine may be decreased with calcium supplementation. These medications should not be taken within 2 h of calcium intake (Hendler and Rorvik 2001, Minerals 2000).

N. Vadivelu et al. (eds.), Essentials of Pain Management,

DOI 10.1007/978-0-387-87579-8_10, © Springer Science+Business Media, LLC 2011

Calcium supplementation may also affect the choice of anesthesia used in operative procedures. Recent data suggest that the use of propofol may have a protective effect on erythrocytes in patients with elevated levels of calcium (Zhang and Yao 2001). Documenting the use of calcium by patients preoperatively may prevent many of these drug interactions.

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