calcitonin (human)
Cibacalcin
calcitonin (salmon)
Calcimar, Calsynar§, Miacalcin, Miacalcin Nasal Spray, Osteocalcin, Salmonine
Pregnancy Risk Category C
How supplied
calcitonin (human)
Injection: 0.5 mg/vial
calcitonin (salmon)
Injection: 100 IU/ml, 1-ml ampules; 200 IU/ml, 2-ml ampules
Nasal spray: 200 IU/activation in 2-ml bottle
Action
Decreases osteoclastic activity by inhibiting osteocytic osteolysis; decreases mineral release and matrix or collagen breakdown in bone.
Indications & dosage
Paget's disease of bone (osteitis deformans)--
Adults: initially, 100 IU of calcitonin (salmon) daily S.C. or I.M.; maintenance dose is 50 to 100 IU daily S.C. or I.M., every other day, or three times weekly. Or, calcitonin (human) 0.5 mg daily, reduced to 0.25 mg daily. Some patients may need up to 0.5 mg b.i.d.
Hypercalcemia--
Adults: 4 IU/kg of calcitonin (salmon) q 12 hours I.M. If response inadequate after 1 or 2 days, dosage increased to 8 IU/kg I.M. q 12 hours. If response remains unsatisfactory after 2 more days, dosage increased to maximum of 8 IU/kg I.M. q 6 hours.
Postmenopausal osteoporosis--
Adults: 100 IU of calcitonin (salmon) daily I.M. or S.C. Or, 200 IU (one activation) of calcitonin (salmon) daily intranasally, alternating nostrils daily. Patients should receive adequate vitamin D and calcium supplements (1.5 g calcium carbonate and 400 U of vitamin D daily).
Adverse reactions
CNS: headache, weakness, dizziness, paresthesia.
EENT: eye pain, nasal congestion.
GI: transient nausea, unusual taste, diarrhea, anorexia, vomiting, epigastric discomfort, abdominal pain.
GU: increased urinary frequency, nocturia.
Respiratory: chest pressure, shortness of breath.
Skin: facial flushing, rash, pruritus of ear lobes, inflammation at injection site.
Other: hypersensitivity reactions (anaphylaxis), edema of feet, chills, tender palms and soles.
Interactions
None significant.
Effects on diagnostic tests
In Paget's disease, maximum reductions of serum alkaline phosphatase and urinary hydroxyproline excretion may take 6 to 24 months of continuous treatment.
Contraindications
Contraindicated in patients with hypersensitivity to salmon calcitonin. Human calcitonin has no contraindications.
Nursing considerations
- Skin test is usually done before therapy.
- Systemic allergic reactions are possible because hormone is protein. Keep epinephrine nearby.
- Calcitonin (human) is especially indicated in patients who have developed resistance to calcitonin (salmon). Calcitonin (human) is associated with risk of diminishing efficacy caused by antibody formation or hypersensitivity reactions. The two calcitonins aren't interchangeable.
- Administer at bedtime, when possible, to minimize nausea and vomiting.
- I.M. route is preferred if volume of dose to be administered exceeds 2 ml.
- Use freshly reconstituted solution within 2 hours.
- Observe patient for signs of hypocalcemic tetany during therapy (muscle twitching, tetanic spasms, and seizures when hypocalcemia is severe).
- Monitor serum calcium level closely. Watch for symptoms of hypercalcemia relapse: bone pain, renal calculi, polyuria, anorexia, nausea, vomiting, thirst, constipation, lethargy, bradycardia, muscle hypotonicity, pathologic fracture, psychosis, and coma.
- Periodic examinations of urine sediment are recommended.
- Monitor periodic serum alkaline phosphatase and 24-hour urine hydroxyproline levels to evaluate drug effect, as ordered.
- In patients with good initial clinical response to calcitonin who suffer relapse, expect to evaluate for antibody response to the hormone protein.
- If symptoms have been relieved after 6 months, treatment may be discontinued until symptoms or radiologic signs recur.
- Store calcitonin (human) at room temperature (77° F [25° C]) and protect from light; refrigerate calcitonin (salmon) at 36° to 46° F (2° to 8° C).
- Alert:
Don't confuse calcitonin with calcifediol or calcitriol.
Patient teaching
- When drug is administered for postmenopausal osteoporosis, remind patient to take adequate calcium and vitamin D supplements.
- Show home care patient and family member how to administer drug. Tell them to administer drug at bedtime if only one dose is needed daily. If nasal spray is prescribed, tell patient to alternate nostrils daily.
- Inform patient that facial flushing and warmth occur in 20% to 30% of all patients within minutes of injection and usually last about 1 hour. Reassure patient that this is a transient effect.
- Tell patient to report signs and symptoms of hypercalcemia promptly. Inform patient that, if calcitonin loses its hypocalcemic activity, other drugs or increased dosages won't help.
- Advise patient to notify doctor immediately if signs of an allergic response occur.
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING