No

Antidote

Calcitonin (salmon): Treatment of Paget's disease of bone and as adjunctive therapy for hypercalcemia; also used in postmenopausal osteoporosis and osteogenesis imperfecta

Calcitonin (human): Treatment of Paget's disease of bone

C

Hypersensitivity to salmon protein or gelatin diluent

A skin test should be performed prior to initiating therapy of calcitonin salmon; have epinephrine immediately available for a possible hypersensitivity reaction

>10%:

Cardiovascular: Facial flushing

Gastrointestinal: Nausea, diarrhea, anorexia

Local: Edema at injection site

1% to 10%: Genitourinary: Polyuria

<1%: Edema, chills, headache, dizziness, rash, urticaria, paresthesia, weakness, shortness of breath, nasal congestion

Symptoms of overdose include nausea, vomiting, hypocalcemia, hypocalcemic tetany

Plicamycin may enhance hypocalcemic effect

Salmon calcitonin: Injection: Store under refrigeration at 2°C to 6°C/36°F to 43°F; stable for up to 2 weeks at room temperature; NS has been recommended for the dilution to prepare a skin test

Salmon calcitonin: Nasal: Store unopened bottle under refrigeration at 2°C to 8°C; Once the pump has been activated, store at room temperature

Human calcitonin: Store at <25°C/77°F and protect from light

Structurally similar to human calcitonin; it directly inhibits osteoclastic bone resorption; promotes the renal excretion of calcium, phosphate, sodium, magnesium and potassium by decreasing tubular reabsorption; increases the jejunal secretion of water, sodium, potassium, and chloride

Hypercalcemia:

Onset of reduction in calcium: 2 hours

Duration of effect: 6-8 hours

Distribution: Does not cross into the placenta

Metabolism: Rapidly by the kidneys

Half-life: S.C.: 1.2 hours

Elimination: As inactive metabolites in urine

Children: Dosage not established

Adults:

Paget's disease:

Salmon calcitonin: I.M., S.C.: 100 units/day to start, 50 units/day or 50-100 units every 1-3 days maintenance dose

Human calcitonin: S.C.: Initial: 0.5 mg/day (maximum: 0.5 mg twice daily); maintenance: 0.5 mg 2-3 times/week or 0.25 mg/day

Hypercalcemia: Initial: Salmon calcitonin: I.M., S.C.: 4 units/kg every 12 hours; may increase up to 8 units/kg every 12 hours to a maximum of every 6 hours

Osteogenesis imperfecta: Salmon calcitonin: I.M., S.C.: 2 units/kg 3 times/week

Postmenopausal osteoporosis: Salmon calcitonin:

I.M., S.C.: 100 units/day

Intranasal: 200 units (1 spray)/day

Adequate vitamin D and calcium intake is essential for osteoporosis. Patients with Paget's disease and hypercalcemia should follow a low calcium diet as prescribed.

Serum electrolytes and calcium; alkaline phosphatase and 24-hour urine collection for hydroxyproline excretion (Paget's disease); serum calcium

Therapeutic: <19 pg/mL (SI: 19 ng/L) basal, depending on the assay

None reported

None reported

No information available to require special precautions

No effects or complications reported

When this drug is given subcutaneously or I.M. it will be necessary for you or a significant other to learn to prepare and give the injections (keep drug vials in a refrigerator - do not freeze). Report significant nasal irritation if using calcitonin nasal spray. Follow directions exactly. Increased warmth and flushing may be experienced with this drug and should only last about 1 hour after administration (taking drug in the evening may minimize these discomforts). Immediately report twitching, muscle spasm, dark colored urine, hives, significant skin rash, palpitations, or difficulty breathing. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to be pregnant. Consult prescriber if breast-feeding.

Skin test should be performed prior to administration of salmon calcitonin; refrigerate; I.M. administration is preferred if the volume to injection exceeds 2 mL

Injection:

Human (Cibacalcin®): 0.5 mg/vial

Salmon: 200 units/mL (2 mL)

Spray, nasal: Salmon (Miacalcin®): 200 units/activation (0.09 mL/dose) (2 mL glass bottle with pump)

Bauwens SF, "Osteomalacia and Osteoporosis," Pharmacotherapy: A Pathophysiologic Approach, 2nd ed, DiPiro JT, Talbert RL, Hayes PE, et al, eds, New York, NY, 1992, 1293-1312.

Bergqvist E, Sjoberg HE, Hjern B, et al, "Calcitonin in the Treatment of Hypercalcaemic Crisis," Acta Med Scand, 1972, 192(5):385-9.

Lyritis GP, Tsakalakos N, Magiasis B, et al, "Analgesic Effect of Salmon Calcitonin in Osteoporotic Vertebral Fractures: A Double-Blind, Placebo-Controlled Clinical Study," Calcif Tissue Int, 1991, 49(6):369-72.

Pontiroli AE, Pajetta E, Scaglia L, et al, "Analgesic Effect of Intranasal and Intramuscular Salmon Calcitonin in Postmenopausal Osteoporosis: A Double-Blind, Double-Placebo Study," Aging, 1994, 6(6):459-63.

Reginster JY, Deroisy R, Lecart MP, et al, "A Double-Blind, Placebo-Controlled, Dose-Finding Trial of Intermittent Nasal Salmon Calcitonin for Prevention of Postmenopausal Lumbar Spine Bone Loss," Am J Med, 1995, 98(5):452-8.

Reginster JY, "Calcitonin for Prevention and Treatment of Osteoporosis," Am J Med, 1993, 95(5A):44S-47S.

Stevenson JC, "Current Management of Malignant Hypercalcemia," Drugs, 1988, 36(2):229-30.