calcitonin (salmon)

Derm: facial flushing, rash

EENT: nasal onlyrhinitis, epistaxis, nasal irritation

GI: IM, SUBQnausea, vomiting

GU: IM, SUBQurinary frequency

Local: injection site reactions

MS: nasalarthralgia, back pain

Neuro: nasal onlyheadaches

Misc: MALIGNANCY, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Previous bisphosphonate therapy, including alendronate, risedronate, ibandronate, or pamidronate, may ↓ response to calcitonin.
May ↓ lithium levels.

Availability ⬆ ⬇

(Generic available)

Injection: 200 units/mL
Nasal spray: 200 units/actuation

Route/Dosage ⬆ ⬇

Postmenopausal osteoporosis

IM SC (Adults ): 100 units every other day.
(Adults ): 1 spray (200 units)/day in alternating nostrils.

Paget’s disease

IM SC (Adults ): 100 units/day initially, after titration, maintenance dose is usually 50 units/day or every other day.

Hypercalcemia

IM SC (Adults ): 4 units/kg every 12 hr; if adequate response not achieved, may ↑ dose after 1–2 days to 8 units/kg every 12 hr, and if necessary after 2 more days may be ↑ to 8 units/kg every 6 hr.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Inhibits osteoclastic bone resorption and promotes renal excretion of calcium.

Therapeutic effects:

Decreased rate of bone turnover.
Lowering of serum calcium.

Classifications ⬆ ⬇

Therapeutic Classification: hypocalcemics

Pharmacologic Classification: hormones

Pharmacokinetics ⬆ ⬇

Absorption: Completely absorbed from IM and SUBQ sites. Rapidly absorbed from nasal mucosa; absorption is 3% compared with parenteral administration.

Distribution: Unknown.

Metabolism/Excretion: Rapidly metabolized in kidneys, blood, and tissues.

Half-Life: 40–90 min.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
IM, SUBQ‡	unknown	2 hr	6–8 hr
Intranasal‡	rapid	31–39 min	unknown

‡Effects on serum calcium; effects on serum alkaline phosphates and urinary hydroxyproline in Paget's disease may require 6–24 mo of continuous treatment.

‡Serum levels of administered calcitonin.

Patient/Family Teaching ⬆ ⬇

Advise patient to take calcitonin as directed. If dose is missed and medication is scheduled for twice a day, take only if possible within 2 hr of correct time. If scheduled for daily dose, take only if remembered that day. If scheduled for every other day, take when remembered and restart alternate day schedule. If taking 1 dose 3 times weekly (Mon, Wed, Fri), take missed dose the next day and set each injection back 1 day; resume regular schedule the following week. Do not double doses.
- Instruct patient in the proper method of self-injection and care and disposal of equipment.
- Caution patient to notify health care professional and seek emergency help immediately if sign and symptoms of serious hypersensitivity reaction occur.
- Advise patient to report signs of hypercalcemic relapse (deep bone or flank pain, renal calculi, anorexia, nausea, vomiting, thirst, lethargy) or allergic response promptly.
- Reassure patient that flushing and warmth following injection are transient and usually last about 1 hr.
- Explain that nausea following injection tends to decrease even with continued therapy.
- Instruct patient to follow low-calcium diet if recommended by health care professional (see Food Sources for Specific Nutrients). Women with postmenopausal osteoporosis or patients with Paget's disease should adhere to a diet high in calcium (1000 mg elemental calcium/day) and vitamin D (400 IU/day).
- Inform patient of increased risk of malignancy.
Osteoporosis: Advise patients receiving calcitonin for the treatment of osteoporosis that exercise has been found to arrest and reverse bone loss. Encourage patient to discuss any exercise limitations with health care professional before beginning program.
Intranasal: Instruct patient on correct use of nasal spray. Demonstrate procedure for use. Before first use, activate pump by holding upright and depressing white side arms down toward bottle 5 times until a full spray is emitted. Following activation, place nozzle firmly in nostril with head in an upright position and depress the pump toward the bottle. The pump should NOT be primed before each daily use. Discard bottle 30 days after first use.
- Advise patient to notify health care professional if significant nasal irritation occurs.

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇