Adult Dosing
Renal failure, dialysis patients
- Start 1-2 mcg IV 3 times/wk during dialysis
- May be increased by 0.5 - 1 mcg/dose q2-4 wks
- Usual range: 0.5-4 mcg IV 3x/wk
- Refer table for dose adjustments according to PTH levels
| PTH Levels | Calcitriol Injection Dose |
|---|
| same or increased | increase |
| Decreased by <30% | increase |
| Decreased by >30%, <60% | maintain |
| Decreased by >60% | decrease |
| One and one-half to three times the upper limit of normal | maintain |
- Discontinue if hypercalcemia or Ca x PO4 product > 70. restart at lower doses once parameters are appropriate
- Monitor serum calcium and phosphorus levels 2x/wk
- Inspect visually for particulate matter and discoloration prior to dose administration
- Discard unused portion
Pediatric Dosing
Renal failure, dialysis patients
13-18 yrs
- Start 0.5-1.5 mcg IV 3x/wk during dialysis
- May be increased by 0.25 mg increments based on iPTH levels, calcium and Ca × P
- Usual range: 1-1.4 mcg/wk IV divided 3x/wk
- Refer table for dose adjustments according to PTH levels
| PTH Levels | Calcitriol Injection Dose |
|---|
| same or increased | increase |
| Decreased by <30% | increase |
| Decreased by >30%, <60% | maintain |
| Decreased by >60% | decrease |
| One and one-half to three times the upper limit of normal | maintain |
- Discontinue if hypercalcemia or Ca x PO4 product > 70. restart at lower doses once parameters are appropriate
- Monitor serum calcium and phosphorus levels 2x/wk
- Inspect visually for particulate matter and discoloration prior to dose administration
- Discard unused portion
[Outline]
See Supplemental Patient Information
- Avoid use of vitamin D or its derivatives during therapy
- Use non-aluminum phosphate-binding compound to control serum phosphorus levels in patients undergoing dialysis
- Overdosage can be fatal, emergency situation may occur due to progressive hypercalcemia and vascular calcification, nephrocalcinosis and other soft-tissue calcification can occur due to chronic hypercalcemia
- Do not exceed serum calcium times phosphate (Ca × P) product >70
- Perform radiographical evaluation of suspected anatomical regions
- Monitor calcium and phosphate 2x/wk during dose titration
- Discontinue treatment on occurrence of hypercalcemia
- Monitor serum levels of calcium, phosphorus, magnesium, alkaline phosphatase and 24-hr urinary calcium and phosphorus periodically
- Monitor serum calcium and phosphorus 2x/wk
- Reduce dose or discontinue therapy if PTH levels falls below recommended target range (1.5 to 3 times the upper limit of normal) as adynamic bone disease may occur
- Do not withdraw abruptly, titrate to maintenance dose
Cautions: Use cautiously in
- Patients on digitalis
- Cardiac arrhythmias
- If surgery
- Prolonged immobilization
- Geriatrics
Supplemental Patient Information
- Adherence to instructions about diet and calcium supplementation to be included
- Avoidance of the use of unapproved non-prescription drugs, including magnesium-containing antacids
Pregnancy Category:C
Breastfeeding: A dose adjustments in nursing mother does not affect breastfed infant. Requirements of calcitriol and calcium are usually reduced during lactation in women with hypoparathyroidism. Administration of a minimum of 400 IU of vitamin D daily to all infants, children and adolescents is recommended by the American Academy of Pediatrics. This information is based on LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 02 November 2010).Manufacturer advices discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother because of the potential for possible serious adverse reactions in nursing infants
