Adult Dosing
Secondary hyperparathyroidism associated with CKD
- 0.04-0.1 mcg/kg IV thrice weekly during dialysis
- Increase 2-4 mcg q2-4 wks based on iPTH levels
- Max: 0.24 mcg/kg
Pediatric Dosing
Secondary hyperparathyroidism associated with CKD
- Child >5 yrs: 0.04-0.1 mcg/kg IV thrice weekly during dialysis
- Increase 2-4 mcg q2-4 wks based on iPTH levels
- Max: 0.24 mcg/kg
[Outline]
See Supplemental Patient Information
- Acute overdose may lead to hypercalcemia and may require emergency attention
- Monitor Ca, PO4, Ca x PO4 product twice weekly, then qmo; iPTH q3mo and during treatment adjustment
- Immediately reduce or interrupt therapy in patients with clinically significant hypercalcemia, provide a low calcium diet, withdraw calcium supplements, monitor fluid/electrolyte imbalances including ECG (if receiving digitalis), hemodialysis/peritoneal dialysis against a Ca free dialysate. Monitor serum Ca until normocalcemia ensues
- Hypercalcemia of any cause potentiates digitalis toxicity. Take precaution while prescribing digitalis compounds concomitantly with paricalcitol
- Excessive administration of vitamin D compounds, including paricalcitol, can cause over suppression of PTH, hypercalcemia, hypercalciuria, hyperphosphatemia, and adynamic bone disease
- Cardiac arrhythmias and seizures may be exacerbated by hypercalcemia
- Avoid high intake of calcium and phosphate concomitantly with vitamin D compounds
- If patient is on a calcium-phosphate binder, decrease/withhold drug or switch to non-calcium-phosphate binder
Cautions: Use cautiously in
- Cardiac disorders
- Arrhythmias
- Concurrent thiazide diuretics
- Concurrent magnesium containing drugs
- Concurrent calcium containing drugs
- Geriatric patients (safety not established)
Supplemental Patient Information
- The patient should be instructed that, to ensure effectiveness of paricalcitol therapy, it is important to adhere to a dietary regimen of calcium supplementation and phosphorus restriction
Pregnancy Category:C
Breastfeeding: Paricalcitol is excreted in breast milk of lactating rats. Manufacturer advises discontinuation of nursing or discontinuation of drug, taking into account the importance of the drug to the mother.
