Trade Names:Fortical- Nasal Spray 200 units/activation (0.09 mL/dose)
Trade Names:Miacalcin- Injection 200 units/mL- Nasal Spray 200 units/activation (0.09 mL/dose)Apo-Calcitonin (Canada)Caltine (Canada)Miacalcin NS (Canada)Sandoz Calcitonin NS (Canada)
Decreases rate of bone turnover, presumably by regulating bone metabolism (blocking bone resorption). In conjunction with parathyroid hormone, endogenous calcitonin regulates serum calcium.
T max is 16 to 25 min.Nasal
Rapidly absorbed. T max is 31 to 39 min. Bioavailability is approximately 3%.
Calcitonin does not cross the placenta.
Rapidly metabolized to inactive fragments, primarily by the kidneys but also in the blood and peripheral tissues.
A small amount is excreted in the urine. The t ½ is 43 min.
5 to 8 days (hypocalcemic effect after chronic dosing).
Treatment of postmenopausal osteoporosis in women more than 5 yr of age postmenopause who cannot tolerate estrogens.Injection only
Treatment of moderate to severe Paget disease of bone; early treatment of hypercalcemic emergencies.
Subcutaneous / IM 100 units every other day with supplemental calcium and adequate vitamin D. Nasal 200 units/day (1 spray) with supplemental calcium and vitamin D, alternating nostrils.Paget DiseaseAdults Initial dose
Subcutaneous / IM 100 units/day.Maintenance dose
Subcutaneous / IM 50 units/day or every other day is usually sufficient.HypercalcemiaAdults Starting dose
Subcutaneous / IM 4 units/kg every 12 h. Titrate gradually on basis of response to max dose of 8 units/kg every 6 h.
Refrigerate injection (36° to 46°F). Refrigerate new, unassembled bottles of nasal spray. Protect from freezing. Store bottle in use at controlled room temperature (59° to 86°F) in upright position, for up to 35 days.
None well documented.
None well documented.
Angina pectoris, hypertension (1% to 3%).
Nasal spray: Fatigue, depression, dizziness, paresthesia (1% to 3%). Injectable: Poor appetite; abdominal pain.
Erythematous rash (1% to 3%).Injectable
Pruritus of ear lobes; skin rash.
Rhinitis (12%); abnormal lacrimation, conjunctivitis (1% to 3%).Injectable
Abdominal pain, constipation, diarrhea, dyspepsia, nausea (1% to 3%).Injectable
Nausea with or without vomiting (10%); salty taste.
Cystitis (1% to 3%).Injectable
Infection, lymphadenopathy (1% to 3%).
Inflammation at subcutaneous or IM site (10%).
Back pain (5%); arthralgia (4%); arthrosis, myalgia (1% to 3%).
Epistaxis (4%); bronchospasm, sinusitis, upper respiratory tract infection (1% to 3%).
Influenza-like symptoms (1% to 3%).Injectable
Death caused by anaphylaxis (1 case), feet edema, feverish sensation.
Monitor serum electrolytes and calcium.Injection
Monitor drug effect in Paget disease with periodic measurement of serum alkaline phosphatase and 24-h urinary hydroxyproline, and evaluation of symptoms. Evaluate urine sediment periodically in patients on chronic therapy.Nasal
Periodically measure lumbar vertebral bone density to document stabilization of bone loss or increase in bone density. Monitor for nasal ulcerations.
Category C .
Safety and efficacy not established.
Systemic allergic reactions, including anaphylaxis, may occur. Consider skin testing for patients with suspected sensitivity to calcitonin.
Circulating antibodies to calcitonin-salmon may occur after 2 to 18 mo of treatment. Treatment of Paget disease may or may not remain effective.
May occur with calcitonin. Although no cases have been reported, have parenteral calcium available during first several injections of calcitonin.
Incidence increased in Paget disease.
Copyright © 2009 Wolters Kluwer Health.