Still, hypervitaminosis D is a rare cause of hypercalcemia. Simultaneous treatment with calcium gluconate and cardiac glycosides is not recommended as toxic effects of the glycoside and potential for cardiac arrhythmias are markedly increased when these two drugs are co-administered. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. The daily dose of calcium should be based on the amount of . It was noted that, in patients with preascitic cirrhosis patients, a dose of 2 g calcium gluconate (~ 20 mL of FK USA's calcium gluconate injection, USP 10%) infusion over Calcium supplements are various forms of calcium used to treat or prevent low calcium blood levels ( hypocalcemia) in many species. Many drugs can interact with calcium gluconate, especially: This list is not complete and many other drugs may interact with calcium gluconate. Vitamin D3 is usually included in supplements because it aids in the absorption of the calcium, allowing for the body to increase stores. The positive charge of these calcium ions alters the electrical state of the sodium-channel protein, thus altering the voltage level required to open the channel. Administer by intravenous, subcutaneous or intraperitoneal injection using proper aseptic techniques. o [pig guinea] Label dosage: .3mg/kg SQ once for 3-4day effect (Barnard 2009) Extralabel dosage: .2mg/kg PO once, then .1mg/kg PO q24h in food for 3-4days Bats: .1mg/kg PO q24h (Bechert et al. Bicarbonate administration increases extracellular pH which translocates potassium into cells in exchange for hydrogen ions. This occurs in roughly 10 percent of cats undergoing thyroidectomy, but it is largely dependent upon the skill of the surgeon performing the procedure. Behavioral changes such as aggression, whining, salivation, pacing, hypersensitivity to stimuli, and disorientation are common. This calcium preparation must be given slowly and the veterinarian should monitor for cardiac arrhythmia. Dosage may be repeated after several hours if required, or as recommended by your veterinarian. Diagnosing and managing canine dystocia (Proceedings) July 31, 2008. In my experience, the first clinical sign of post-thyroidectomy hypocalcemia is anorexia. Most breeders do fine with Tums. over 4-6h. All reptiles: Highly cytotoxic and nephrotoxic - give with SC/IC fluids. Small dogs will need around 600 to 800 mg of oral calcium. Clinical signs of hypocalcemia include tetany, ataxia, facial twitches, seizures, arrhythmia, facial pruritus, PU/PD, anorexia, vomiting, diarrhea, and posterior lenticular cataracts. The daily requirements are 1-4 g for dogs and 0.5-1 g for cats. The toxic effects resolve in 114 days. Ionized calcium is the physiologically available fraction of calcium; it is affected by protein concentration, acid-base status (alkalosis favors protein binding of serum calcium and will decrease blood concentrations of the biologically important ionized calcium, thus exacerbating hypocalcemia), and other electrolyte imbalances. Diastase malt . Correction:This paper has been updated to correct the calcitriol dose units, which should have been mcg/kg/day (ng/kg/day), not mg/kg/day. 6 Treatment should be slowed or stopped if further bradycardia or other arrhythmias develop. In primary hypoparathyroidism, the parathyroid glands are destroyed by immune-mediated mechanisms, rendering the response to hypocalcemia impossible. Animalytix assumes no liability, and each user assumes full risk, responsibility, and liability, related to its use of the Animalytix service and data. Hypocalcemia is less common than hypercalcemia, and is often actually pseudohypocalcemia associated with hypoalbuminemia. Calcium chloride, 27%, contains 27.2 mg of elemental calcium/mL. If tetany recurs during the same lactation, the litter should be removed from the bitch or queen and either hand-raised (<4 weeks old) or weaned (>4 weeks old). Mild to moderate elevations Mild to moderate elevations exist when the serum potassium concentration is between 5.5mmol/L and 6.5mmol/L. In patients with acute symptomatic hypocalcemia, intravenous (IV) calcium gluconate is the preferred therapy, whereas chronic hypocalcemia is treated with oral calcium and vitamin D supplements. If your product contains calcium citrate, then it may be taken with or without food. Infants and Children: 200 to 500 mg/kg/day as a continuous infusion or in 4 divided doses Resistant: 10 mg/kg IM/PO q 24h. British Small Animal Veterinary Association, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester, GL2 2AB, United Kingdom. Thus, hemodialysis is an effective treatment for both the acute and prolonged management of hyperkalemia. About Us. Calcium D-gluconate Calcium hexagluconate Calglucol Calglucon D-Gluconic acid, calcium salt (2:1) (9CI) Dragocal Ebucin . Alternatively, regular insulin can be given at 0.25-1.0 units/kg IV in combination with intravenous glucose at 1-2 g/unit of administered insulin. Kidney function can also be evaluated by blood tests like complete blood count (to look for anemia) as well as urinalysis to verify the urine concentration. Regular diet, and. Predialysis serum potassium concentrations between 6 and 10 mmol/L are seen in approximately 75% of dogs maintained on chronic intermittent hemodialysis for longer than 2 weeks. These include Toy Poodle, German Shepherd, Miniature Schnauzer, Labrador Retriever, and Scottish Terrier. Half the dextrose should be given as a bolus and the remainder administered i.v. The physical examination findings in animals with primary hyperparathyroidism are usually normal. I prefer to withdraw treatment gradually at 2-week intervals beginning with the vitamin D therapy. Calcium borogluconate 23% (w/v) (equivalent to 19.14 mg/mL calcium) INDICATION: As an aid in the treatment of hypocalcemic conditions, such as milk fever, in cattle, horses, sheep, swine, dogs and cats. Calcium is a mineral that is found naturally in foods. In hypercalcemia of any cause, treatment of hypercalcemia is needed if the product of calcium x phosphorus exceeds 75. followed by 2-3 g of dextrose/unit of insulin (for urinary tract obstruction but not hypoadrenocorticism). They will be able to tell you if you need to worry or what actions may need to be taken. Usual Adult Dose for Exchange Transfusion: 300 mg (3 mL) IV one time with each 100 mL of citrated blood at a rate not to exceed 0.5 to 2 mL/min. Calcium gluconate is the calcium salt of gluconic acid, an intravenous medication used to treat conditions arising from calcium deficiencies such as hypocalcemic tetany, hypocalcemia related to hypoparathyrodism, and hypocalcemia due to rapid growth or pregnancy. Muscle relaxation should be immediate. https://doi.org/10.1016/j.cvsm.2018.02.010. Dogs need calcium for all the same processes that humans do. Small dogs that weigh between 5 to 20 pounds a day should get 250 to 500 mg per day. Calcium complexes tetracycline antibiotics, rendering them inactive. The cardiac effects lead progressively to bradycardia, atrial standstill, and cardiac arrest as the hyperkalemia worsens. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This imbalance in calcium metabolism occurs because calcium mobilization from bone into the serum pool is insufficient to compensate for the efflux of calcium via the mammary glands during lactation. Muscle relaxation should be immediate. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. Hypocalcemia (dose depends on clinical condition and serum calcium level): Calcium Gluconate Injection is supplied in single-dose vials and pharmacy bulk packages [see Dosage and Administration (2.6)]. If conventional therapy fails to provide an immediate or lasting resolution for the hyperkalemia, peritoneal or hemodialysis is indicated as alternative therapies. The joint supplement can come as a pill . Oral calcium supplementation is easier. Acute Toxicity Data and References. SeeCalcium Acetate forcontraindications, . . Pregnant and lactating dogs use high amounts of calcium to maintain the growing fetuses and produce enough milk to sustain the litter. It must be noted that every animal is different, and the return of normal parathyroid gland function is impossible to predict. Cats and dogs In a study previously reviewed by the Committee, five cats and three dogs received a daily dose of 1 g gluconic acid (10% solution) by stomach intubation for 14 days. (CPR) a single dose of 10ml (10% w/v) should be considered, according to the algorithm recommended by the European Resuscitation Council & the Resuscitation Council (UK). Treatment and Prevention of Eclampsia in Small Animals. It is employed to treat hypocalcemia and conditions in which the physiological effects of increasing the plasma calcium level are likely to be beneficial to the animal. Calcium can make it harder for your body to absorb certain medicines. 11 to 24 years: 1200 mg/day In the past, vitamin D-containing rodenticides were used and were a more common cause of hypervitaminosis D, but those products are no longer marketed. Complicating things even more, iron, phosphorus and calcium can lower the absorption of manganese. Copyright 1996-2023 Cerner Multum, Inc. Pros. The end result, however, is that calcium is usually normal in dogs and cats with renal failure, and it does not require treatment. Recommended daily allowance (RDA): (Dosage is in terms of elemental calcium): The aim of longterm treatment is to maintain the serum calcium concentration at mildly low to low-normal concentrations (89.5 mg/dL). The paresis observed in cattle, rather than the tetany evident in dogs, is probably results from a combination of factors. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. First pregnancy or subsequent ones. . If the signs of toxicity are relatively mild, blood tests are within normal ranges, and your dog appears stable, he may be sent home with instructions for you to monitor him for changes in behavior or health condition. Oral: 400 mg/day 10%). In: Hall JE, ed. Merck & Co., Inc., Rahway, NJ, USA(known as MSD outside of the US and Canada) is dedicated to using leading-edge science to save and improve lives around the world. Version: 6.01. Calcium gluconate 2,000 mg per 100 mL (20 mg/mL) single-dose bag. Options for the acute management of hyperkalemia are to antagonize the increased resting membrane potential in cardiac myocytes, redistribute potassium from the extracellular to the intracellular fluid compartments, and to eliminate the potassium load from the body. The treatment of hypocalcemia will be reviewed here. Cons. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use. Along with vitamin D, calcium supplementation must be given. Check the label on your brand of this medicine to see if it should be taken with or without food. Vitamin D is commonly available in two forms (dihydrotachysterol (DHT) and calcitriol). Warm solution to body temperature prior to use, and inject slowly. Administer by intravenous, subcutaneous or intraperitoneal injection using proper aseptic techniques. Follow all directions on the product . Urinalysis is critical to the work-up of the disease. For this reason, calcium must be monitored frequently, and owners should be made aware of the clinical signs of hypocalcemia. IV: 100 to 200 mg/kg/dose over 5 to 10 minutes; may repeat after 6 hours or follow with an infusion with a maximum dose of 500 mg/kg/day Some cats require post-operative supplementation for up to 6 months, but eventually normal parathyroid gland function returns. Hyperkalemia is a more prevalent and serious feature of acute uremia in cats with the increasing prevalence of acute ureteral obstruction over the past 10 years. Find custom compounded calcium gluconate medication for animals and articles with calcium gluconate information from Wedgewood Pharmacy, a leading veterinary pharmacy. Serum calcium concentrations of <8 mg/dL indicate the need to increase the dosage of parenteral calcium, whereas concentrations of>9 mg/dL suggest that it be decreased. Because calcium carbonate contains 40% elemental calcium, one 750 tablet contains 300 mg of calcium, so a cat would need approximately 3 tablets daily for calcium supplementation. The Veterinary Manual was first published in 1955 as a service to the community. PetPlace may be compensated when you click on or make a purchase using the links in this article. It may be administered on an emergency basis at a dosage of 0.5 to 1.5 mL/kg, diluted and given over several minutes, or it is added to . 60 to 100 mg/kg/dose; may repeat in 10 minutes if necessary. Dose expressed in mg of calcium gluconate: Here are some final tips for choosing and taking calcium supplements as found in the Harvard Special Health Report Osteoporosis: A guide to prevention and treatment: Avoid products made from unrefined oyster shell, bone meal, dolomite, or coral, as they may contain lead or other toxic metals. Summary. The factors which decide the required calcium are: Size. 3 DOSAGE FORMS AND STRENGTHS. Calcium gluconate 10% solution versus calcium chloride, may be recommended due to a perception that the former is of somewhat lesser (but not without) risk for tissue injury if inadvertent extravasation occurs. INDICATION: As an aid in the treatment of hypocalcemic conditions, such as milk fever, in cattle, horses, sheep, swine, dogs and cats. Calcium gluconate works best if you take it with food. If labor stalls for more than 2 hours, consult your veterinarian. See the Terms of Use for further details. This dose may be repeated as necessary in severe cases of hypermagnesemia (where discontinuation of exogenous magnesium is inadequate) to temporarily reverse many of the toxic effects of magnesium in the central nervous system. With hypocalcemia, sodium channels become activated (opened) by very little increase in membrane potential from their normal, negative level. o [ canine influenza] This protocol effectively supports serum calcium concentrations while waiting for oral vitamin D and calcium treatment to have effect. There are usually no signs due to hypercalcemia itself. . Renal hydroxylation of vitamin D, however, is often impaired in renal disease, leading to relative vitamin D deficiency. At the time of surgery, all four parathyroid glands must be inspected, although solitary gland involvement is by far the most common finding. over 20-30 min or Soluble insulin: 0.5 IU/kg i.v. In one survey (253 whelpings, 1,671 pups born), a high frequency . The trusted provider of veterinary information since 1955, Last review/revision Jul 2022 | Modified Oct 2022. high levels of calcium in your blood-- nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, confusion, lack of energy, or feeling tired. In more acute situations, the injectable variety is preferable. Calcitriol has a rapid onset of action (14 days) and a short half-life (<1 day). Carbon . Calcium gluconate. Ideally, serum calcium concentrations should be maintained at>8 mg/dL. All rights reserved. Not all possible drug interactions are listed here. Thus, the severity of clinical signs may not correlate with total calcium concentration. Get emergency medical help if you have signs of an allergic reaction to calcium gluconate: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Novocal. Objectives: Intravenous (IV) calcium salts are routinely recommended as a cardio-protective therapy in the emergency treatment of severe hyperkalemia. The bitch may remain nonresponsive after correction of hypocalcemia if cerebral edema has developed. Once the animal is stable, the dose of calcium gluconate needed for initial control of tetany may be diluted in an equal volume of normal (0.9%) saline and given subcutaneously every 8 hours to control clinical signs. For example, a 5 kg dog needs 250 mg of calcium per day. Calcium gluconate. The link you have selected will take you to a third-party website. 7 to 12 months: 270 mg/day Oxygen Recovery Mask Small Dog $ 62.90 Inc. GST Add to cart. Breed. Most cases of vitamin D toxicity are iatrogenic, and occur following parathyroidectomy. This dose may be repeated as necessary in cases of extreme hyperkalemia cardiotoxicity when P waves are absent, the QRS complexes are widened, and when continuous ECG monitoring is available. Amlodipine for dogs and cats: Uses, Dosage & Side Effects.
The average age of dogs with hypoparathyroidism is 6 years, and there is a female sex predilection. It is associated with varying degrees of hyponatremia and metabolic acidosis, and its prevalence is associated with the duration of dialytic support, degree of azotemia, ultrafiltration requirements, and the intensity of dialysis. This includes prescription and over-the-counter medicines, vitamins, and herbal products. L. Ari Jutkowitz, VMD, DACVECC. An enlarged parathyroid gland is usually not palpable in dogs, but can be palpated about half of the time in cats with the disease. Sodium bicarbonate is contraindicated in animals with metabolic alkalosis and potentially is risky in overhydrated animals. The infusion should be halted temporarily if S-T segment elevation, Q-T interval shortening, progressive bradycardia, or hypotension is observed. How does calcium benefit pregnant dogs and cats? The resin exchanges sodium for potassium secreted into the intestinal lumen to promote increased intestinal potassium clearance. Calcium gluconate may act as an irritant to the skin, eye or respiratory systems. The number one ruleout for hypercalcemia in dogs is lymphoma. Carcinoma of the parathyroid gland is also possible, but it is uncommon and is usually not invasive. Dosage IV Dose; Sodium Bicarbonate: prolonged arrest > 10 minutes: 1-2 mg/kg: 10% Calcium Chloride: The duration of calcium and vitamin D supplementation is difficult to predict. Ether . Thus, for 10% calcium gluconate the dosage is 0.51.5 mL/kg per hour, IV; and for 27% calcium chloride the dosage is 0.220.66 mL/kg per hour, IV. Use intravenously in horses. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use calcium gluconate only for the indication prescribed. Calcium gluconate . The first elelctrolyte abnormality in renal failure is usually hyperphosphatemia due to decreased renal blood flow, and calcium concentrations can drop by mass action. All rights reserved. It is important to base the dosage of calcium on a calculation of elemental (available) calcium because different products vary in the amount of calcium available. Intravenous administration is recommended for treatment of acute conditions. Class of drug. Max. A pretreatment total serum calcium concentration of <7 mg/dL in dogs or < 6 mg/dL in cats confirms the diagnosis; noting that reference values vary between laboratories. Mild hypocalcemia may contribute to ineffective myometrial contractions and slow the progression of labor without causing other clinical signs. Other causes of hypercalcemia of malignancy include apocrine gland adenocarcinoma of the anal sac, and any tumor that has osteolytic activity. Powder for oral suspension is available as a 346.7 mg elemental calcium/15mL. Dose is 0.5-1.25 mg/kg IM as needed. Doses may be repeated every 1 to 3 days as needed and tolerated to normalize the serum calcium level. Treatment of hypercalcemia associated with Addison's disease is not necessary. Other dogs will experience a mild stomach upset. Other causes of irritability and hyperthermia, such as metritis Metritis in Small Animals Metritis is postpartem infection of the uterus. Treatment and prevention of hyperkalemia in adults. Vitamin D becomes toxic at doses of .1mg/kg or more, so he would have had to eat . A presumptive diagnosis is based on signalment and clinical signs; confirmation requires measurement of serum calcium concentration. Calcium supplements poisoning can result in effects as serious as kidney failure. Hypocalcemic tetany or convulsions are indications for the immediate IV administration of 10% calcium gluconate (1-1.5 mL/kg), which should be slowly infused throughout a 10-min period. The initial recommended dose is 10 to 20 ml of 10% calcium chloride (30 to 60 ml for calcium gluconate) with repeat boluses every 10 to 20 minutes for 3 or 4 additional doses if clinical response is inadequate. Because glucocorticoids promote renal excretion of calcium, lack of glucocorticoids could also be associated with increased resorption. Adverse effects resulting from too rapid administration of calcium include bradycardia, shortening of the QT interval, and premature ventricular complexes. Deficiency of PTH results in an inability to adequately read more . Furthermore, it has a long half-life, so should vitamin D toxicity occur, it takes longer to subside. Dosing seems totally crazy when you first start: Calcium gluconate is available in 500 975 mg calcium gluconate (45-90 mg of elemental calcium) tablets. Dosage may be repeated after several hours if required, or as recommended by your veterinarian. It is best not to let puppies or kittens nurse for 1224 hours after the bitch or queen is treated for hypocalcemia. Calcium chloride contains about 3 times more elemental calcium than an equal volume of calcium gluconate: 1 g of calcium chloride has 270 mg (13.5 mEq) of elemental calcium, whereas 1 g of calcium gluconate has 90 mg (4.5 mEq). In addition, calcium is involved in the proper conduction of nervous impulses and regulates the secretory activity of exocrine glands. intravenous/Dog : The pathogenesis of hypercalcemia in hypoadrenocorticism is not completely understood either, but total calcium is probably elevated due to hemoconcentration. After the acute crisis, elemental calcium at 2550 mg/kg per day orally in three or four divided doses is given for the remainder of lactation. Dosage and Administration Dosing: Adult. Duodenal substance . Dystocia refers to abnormal or difficult birth. In some cases, however, signs of hypercalcemia are present, and include polyuria/polydipsia (this is the most common sign), constipation, vomiting, anorexia, neurological signs, muscle wasting, fatigue, and, if calcium containing uroliths are present due to longstanding hypercalciuria, lower urinary tract signs can be present. Dogs up to 20 lb, 2 mL initial dose; 1 mL per dose thereafter. Watch for the development of any signs but we should not see any. 10-50 mL. When should you use calcium? (Calcium chloride cannot be given subcutaneously.) A total serum calcium concentration < 7 mg/dL is confirmatory. Divide subcutaneous injections over several sites. Ionised calcium less than 0.65mmol/L (<0.75mmol/L if symptomatic) Hyperkalaemia Contraindications Contraindicated in patients with ventricular fibrillation or hypercalcaemia Dose Note: Prescribe calcium salt in full (i.e. For example, a 50-pound (23 kg) dog would need 2.5 grams of calcium phosphate per day. Daily maintenance calcium: Hypocalcemic animals should, therefore, receive parenteral calcium support during the initial posttetany period. Use to remove results with certain terms When expressed at the sinus node and on myocardial cells these perturbations cause classic electrocardiographic abnormalities associated with the severity of hyperkalemia. Contains magnesium which helps with calcium absorption. Giant breed dogs: 6 to 10 grams orally per day. Therapeutic effects begin within 10 minutes and may persist for 1 to 2 hours. Cardiac arrest in the presence of hyperkalemia or hypocalcemia, magnesium toxicity, or calcium antagonist toxicity: Small dogs can receive 500 mg, medium sized dogs 750 to 1000 mg and larger dogs 2000 mg. As a calcium supplement, common dosage ranges include: Cats: 1250 mg to 2 grams per day. Cerebral edema, hyperthermia, and hypoglycemia should be treated, if present. Give an additional dose if labor stalls more than an hour. Heavy panting may produce a respiratory alkalosis. Protect yourself and your pet. Calcium gluconate: hypocalcemia: 94-140 mg/kg slow IV. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Giant breeds will need 2000 mg. Calcium should only be offered after labor has begun. The level of toxicity will depend on the age and size of the dog (in comparison to the amount ingested), as well as the state of the kidneys at time of exposure. It is environmentally sustainable. Fluid therapy via intravenous could be needed; this may also include medications to promote a bowel movement, increase urine production, ease nausea, and stabilize blood calcium levels. Eclampsia is an acute, life-threatening condition that usually occurs at peak lactation, 23 weeks after whelping. Please confirm that you are a health care professional. Calcium is an essential building block for bones, and the balance of dietary calcium and phosphorous is especially important for young, growing animals. While it does occur, primary hyperparathyroidism is rare in cats. Calcium Supplements Poisoning Average Cost, From 57 quotes ranging from $500 - $2,000. To get that amount from beef muscle meat you'd have to give your dog 10,000g - that's 22 lbs. Dogs over 20 lb, 1 mL per 10 lb initial dose; 1 - 3 mL per dose thereafter. Assuming it was ONE chew that was eaten, there should be no risk. A healthcare provider will give you this injection. Preventive steps to consider in the bitch include feeding a high-quality, nutritionally balanced, and appropriate diet during pregnancy and lactation; providing food and water ad lib during lactation; and supplementing feeding of the puppies with milk replacer early in lactation and with solid food after 34 weeks of age. 1 to 3 years: 500 mg/day The serum chemistry profile, besides hypercalcemia, shows a normal or low serum phosphorus concentration. Note: One gram of calcium gluconate salt is equal to 93 mg of elemental calcium. Guided by the severity of neurologic signs, Administration of IV calcium gluconate with appropriate monitoring. Follow all directions on your medicine label and package. Rapid administration and high concentrations may cause heart blockage (Allen et al., 1993). Small-breed bitches with large litters are most often affected. Blood markers, electrolyte levels, and kidney and liver function will be monitored because all must be normal before your pet can be released from the hospital. Calcium gluconate injection is given as an infusion into a vein. Diagnosis is often based on signalment, history, clinical signs, and response to treatment. Approval was partially successful, following selected items could not be processed due to error, http://instance.metastore.ingenta.com/content/formulary/backmatter/canine-and-felineemergencydosesfordogsandcats, Asystole or pulseless electrical activity, Raised intracranial pressure (impending herniation), BSAVA Small Animal Formulary Part A: Canine and Feline. Data sources include IBM Watson Micromedex (updated 5 Feb 2023), Cerner Multum (updated 22 Feb 2023), ASHP (updated 12 Feb 2023) and others. Treatment options are: IV crystalloids, which correct volume and dehydration deficits. Exchange resins may be effective to control mild hyperkalemia, but have little efficacy or indications in the management of potassium associated cardiotoxicity. Many organ . Alternatively, 515 mg of elemental calcium/kg per hour can be continued intravenously. Your dose may need to be adjusted as you make changes to your diet. Available for Android and iOS devices. The acceptability of these preparations is low due to persistent side effects including nausea, constipation, gastrointestinal ulceration and necrosis.