• Adjunctive treatment (with calcium and vitamin D) in the management of hypocalcemia associated with hypoparathyroidism in patients who cannot be managed by calcium and active forms of Vitamin D alone.

Contraindicated in:

• Hypersensitivity
• Paget's disease of the bone, unexplained ↑ alkaline phosphatase, children/young adults with open epiphyses, hereditary disorders predisposing to osteosarcoma, prior history of external beam/implant radiation therapy of the skeleton (may ↑ risk osteosarcoma).

Use Cautiously in:

• Concurrent use of digoxin
• Severe hepatic or renal impairment
• Geri: Initiate treatment at lower dose, consider age-related ↓ in renal, hepatic and cardiac function, concurrent disease states and drug therapies
• OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant
• Pedi: Safety and effectiveness not established in children.

CV: hypertension.

F and E: hypercalcemia, hypocalcemia.

GI: diarrhea, nausea, vomiting, upper abdominal pain.

GU: hypercalciuria.

MS: arthralgia, extremity pain, neck pain, OSTEOSARCOMA.

Neuro: headache, hypoaesthesia, paresthesia , SEIZURES.
Misc: (INCLUDING ANAPHYLAXIS AND ANGIOEDEMA)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• Hypercalcemia ↑ risk of digoxin toxicity; careful monitoring is recommended during concurrent use.
• Concurrent doses of calcium supplements and active vitamin D supplements will require adjustment during treatment.
• Concurrent use with alendronate↓ calcium sparing effects and disrupts normalization of calcium; concurrent use is not recommended.

• Lyophilized powder for injection: 25 mcg; 50 mcg; 75 mcg; 100 mcg;

• SC (Adults): 50 mcg once daily, frequent monitoring and adjustment may be necessary.

Natpara

• ↑ serum calcium by ↑ renal tubular reabsorption, ↑ GI absorption of calcium (via activation of Vitamin D), and ↑ bone turnover (releases calcium).

• Normalization of serum calcium.

Therapeutic Classification: electrolyte modifiers

Pharmacologic Classification: hormones

Absorption: Well absorbed (53%) following SUBQ administration.

Distribution: Unknown.

Metabolism/Excretion: Mostly metabolized by the liver, with some renal clearance.

Half-life: 2.8–3 hr.

(↑ calcium)

• Instruct patient and caregiver in correct technique for SUBQ injection, use and disposal of equipment. Administer missed dose as soon as possible and take additional calcium supplementation if signs and symptoms of hypocalcemia occur. Advise patient to read Medication Guide before starting and with each Rx refill in case of changes.
• Explain potential for developing hypocalcemia or hypercalcemia during dose adjustment. Instruct patient on signs and symptoms and advise to notify health care professional if signs and symptoms occur.
• Inform patient of risk of osteosarcoma. Instruct patients to promptly notify health care professional if persistent localized pain or soft tissue masses tender to palpation occur; may signal osteosarcoma.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Advise female patient to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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