Adult Dosing

Paget's bone disease (osteitis deformans)

• Initial: 100 units IM/SC qd
• Maintenance dose: 50 IU per day or every other day IM/SC

Hypercalcemia

• 4 IU/kg IM/SC q12 hrs
• Titrate: Increase to 8 IU/kg IM/SC q12 hrs if the response is unsatisfactory after one or two days of therapy; if response is unsatisfactory even after 2 more days, may increase the dose to 8 IU/kg q6 hrs

Postmenopausal osteoporosis

• 100 units IM/SC every other day, along with adequate calcium and vitamin D

Osteogenesis imperfecta [Not FDA approved]

• 2 U/kg IM/SC 3 times/wk with daily PO calcium supplementation

Pediatric Dosing

• Safety and effectiveness in pediatric patients have not been established

[Outline]

• Adult Dosing
• Pediatric Dosing

• Treatment of symptomatic Paget's disease of the bone
• Early treatment of hypercalcemic emergencies
• Postmenopausal osteoporosis

• Hypersensitivity to any of the ingredients of the product

• N/A

Renal Dose Adjustment

• Renal impairment: Dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Hypocalcemic tetany may occur with calcitonin therapy. Parenteral calcium administration should be indicated during initial several administrations of calcitonin
• IM injections preferred when injection volume is >2 mL; multiple injection sites to be used
• Supplement with calcium (at least 1 g/day) and vitamin D (400 IU/day); ensure an adequate diet
• Skin testing should be considered prior to treatment for patients with suspected sensitivity to calcitonin
• Systemic allergic reaction may occur. Serious allergic-type reactions such as swelling of the tongue or throat, bronchospasm, anaphylactic shock, including death very rarely, have been reported; provide appropriate emergency treatment in such situation
• Hypocalcemic tetany may occur with calcitonin therapy. Parenteral administration of calcium should be indicated during initial several administrations of calcitonin
• Perform periodic examinations of urine sediment in case of chronic therapy
• Perform frequent monitoring of serum alkaline phosphatase and 24-hour urinary hydroxyproline in Paget's disease
• Due to the possible association between malignancy and calcitonin-salmon use, the need for continued therapy should be re-evaluated on a periodic basis

Cautions: Use cautiously in:

• Prior bisphosphonate use
• Elderly patients

Pregnancy Category:C

Breastfeeding: Safety undetermined; use with caution.

• GI: Nausea, vomiting, abdominal pain, diarrhea, salty taste
• LOCAL: Inflammatory reactions at the injection site
• DERM: Flushing of face/hands, skin rashes, pruritus of the ear lobes
• EENT: Pain in the eyes, visual disturbance
• MUSC: Back pain, arthralgia, musculoskeletal pain
• METABOLIC: Poor appetite, hypocalcemic tetany
• CNS: Dizziness, headache
• CV: Hypertension
• RESP: Bronchospasm
• GU: Nocturia, polyuria
• IMMU: Hypersensitivity, anaphylactic/anaphylactoid reactions, anaphylactic shock
• MISC: Influenza-like symptoms, angioedema, edema of feet, fatigue, feverish sensation, osteogenic sarcoma

• Hormone; directly acts on bone, kidney, and GI tract. Inhibits bone removal by osteoclasts; also reduces mineral release and collagen breakdown in bone and promotes renal excretion of calcium
• Bioavailability is approximately 66% and 71% after IM and SC administration respectively
• Metabolism: Predominantly kidney, blood, peripheral tissues
• Excreted in urine (0.1% unchanged)
• Half-life:
• IM Route: 58 min
• SC Route: 59-64 min

US Trade Name(s)

• Miacalcin

US Availability

Miacalcin

• INJ: 200 IU/mL (2 mL vial)

Canadian Trade Name(s)

• Calcimar
• Caltine

Canadian Availability

calcitonin-salmon (generic)

• INJ: 200 IU/mL (2 mL vial)

Calcimar

• INJ: 200 IU/mL

Caltine

• 100 IU/mL (1 mL amp)

UK Trade Name(s)

• Miacalcic

UK Availability

Miacalcic

• INJ: 50 IU/mL (1 mL amp)
• INJ: 100 IU/mL (1 mL amp)
• INJ: 200 IU/mL (2 mL vial)

Australian Trade Name(s)

• Miacalcic

Australian Availability

Miacalcic

• INJ: 50 IU/mL (1 mL amp)
• INJ: 100 IU/mL (1 mL amp)

[Outline]

Endocrine/Metabolic

Hypocalcemics

Hormones

Pricing data from www.DrugStore.com in U.S.A.

• Miacalcin 200 UNIT/ML SOLN [Vial] (NOVARTIS)
  2 ml = $70.99
  6 ml = $194.97

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.