CALCITONIN calcitonin (salmon), Calcimar,Miacalcin

 Indications

IM, Subcut: Treatment of Paget’s disease of bone. Adjunctive

therapy for hypercalcemia. IM, Subcut, Intranasal:

Management of postmenopausal osteoporosis.

Action

Inhibits osteoclastic bone resorption and promotes renal

excretion of calcium. Therapeutic Effects: Decreased

rate of bone turnover. Lowering of serum calcium.

Pharmacokinetics

Absorption: Completely absorbed from IM and subcut

sites. Rapidly absorbed from nasal mucosa; absorption

is 3% compared with parenteral administration.

Distribution: Unknown.

Metabolism and Excretion: Rapidly metabolized

in kidneys, blood, and tissues.

Half-life: 40–90 min.

TIME/ACTION PROFILE

ROUTE ONSET PEAK DURATION

IM, subcut† 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.

Contraindications/Precautions

Contraindicated in: Hypersensitivity to calcitonin,

salmon protein or gelatin diluent (in some products);

OB, Lactation: Use not recommended.

Use Cautiously in: Pedi: Safety not established.

Adverse Reactions/Side Effects

CNS: nasal only—headaches. EENT: nasal only—

rhinitis, epistaxis, nasal irritation. GI: IM, subcut—

nausea, vomiting. GU: IM, subcut—urinary frequency.

Derm: rash. Local: injection site reactions.

MS: nasal—arthralgia, back pain. Misc: MALIGNANCY,

allergic reactions including ANAPHYLAXIS, facial

flushing, swelling.

Interactions

Drug-Drug: Previous bisphosphonate therapy, including

alendronate, risedronate, etidronate,

ibandronate, or pamidronate, maypresponse to

calcitonin. Mayplithium levels.

Route/Dosage

Postmenopausal osteoporosis

IM, Subcut (Adults): 100 units every other day.

Intranasal (Adults): 1 spray (200 units)/day in alternating

nostrils.

Paget’s disease

IM, Subcut (Adults): 100 units/day initially, after titration,

maintenance dose is usually 50 units/day or

every other day.

Hypercalcemia

IM, Subcut (Adults): 4 units/kg every 12 hr; if adequate

response not achieved, mayqdose after 1–2

days to 8 units/kg every 12 hr, and if necessary after 2

more days may beqto 8 units/kg every 6 hr.

Availability (generic available)

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