calcitonin

Calcitonin (Cibacalcin) is an hormonal agent indicated for patients with Paget’s disease.

Generic Names & Brand Names

calcitonin
(kal si toe’ nin)
calcitonin, human
Cibacalcin
calcitonin, salmon
Calcimar, Caltine (CAN), Miacalcin, Miacalcin Nasal Spray, Osteocalcin

Pregnancy Category C (human) 
Pregnancy Category B (salmon)

Drug classes

• Hormonal agent
• Calcium regulator

Therapeutic actions

The calcitonins are polypeptide hormones secreted by the thyroid; human calcitonin is a synthetic product classified as an orphan drug; salmon calcitonin appears to be a chemically identical polypeptide but with greater potency per milligram and longer duration; inhibits bone resorption; lowers elevated serum calcium in children and patients with Paget’s disease; increases the excretion of filtered phosphate, calcium, and sodium by the kidney.

Indications

• Human and salmon calcitonin: Paget’s disease
• Salmon calcitonin: Postmenopausal osteoporosis in conjunction with adequate calcium and vitamin D intake to prevent loss of bone mass
• Salmon calcitonin: Hypercalcemia, emergency treatment

Contraindications and cautions

• Contraindicated with allergy to salmon calcitonin or fish products, lactation.
• Use cautiously with renal insufficiency, osteoporosis, pernicious anemia.

Available forms

Injection (human)—1 mg/mL; injection (salmon)—200 IU/mL; nasal spray (salmon)—200 IU/actuation

Dosages

ADULTS

Calcitonin, human

• Paget’s disease: Starting dose of 0.5 mg/day subcutaneously; some patients may respond to 0.5 mg two to three times per week or 0.25 mg/day. Severe cases may require up to 1 mg/day for 6 mo. Discontinue therapy when symptoms are relieved.

Calcitonin, salmon

• Skin testing: 0.1 mL of a 10 IU/mL solution injected subcutaneously.
• Paget’s disease: Initial dose 100 IU/day IM or subcutaneously. For maintenance dose, 50 IU/day or every other day. Actual dose should be determined by patient response.
• Postmenopausal osteoporosis: 100 IU/day IM or subcutaneously, with supplemental calcium (calcium carbonate, 1.5 g/day) and vitamin D (400 units/day) or 200 IU intranasally daily.
• Hypercalcemia: Initial dose, 4 IU/kg q 12 hr IM or subcutaneously. If response is not satisfactory after 1–2 days, increase to 8 IU/kg q 12 hr; if response remains unsatisfactory after 2 more days, increase to 8 IU/kg q 6 hr.

PEDIATRIC PATIENTS

Safety and efficacy not established.

Pharmacokinetics

Route	Onset	Peak	Duration
IM, SC	15 min	16–25 min	8–24 hr
Nasal	Rapid	31–39 min	8–24 hr

Metabolism: Renal; T_1/2: 43 min (salmon), 1 hr (human)
Distribution: May enter breast milk
Excretion: Urine

Posted in: Pharmacology