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(kal-sih- TOH-nin)
Pregnancy Category: C (Rx)
Calcitonin-salmon (Calcimar)
(kal-sih- TOH-nin)
Pregnancy Category: C Calcimar Caltine Miacalcin Osteocalcin Salmonine (Rx)

Classification: Calcium regulator

Action/Kinetics: Calcitonins are polypeptide hormones produced in mammals by the parafollicular cells of the thyroid gland. Calcitonin isolated from salmon has the same therapeutic effect as the human hormone, except for a greater potency per milligram and a somewhat longer duration of action. Calcitonin-human is a synthetic product that has the same sequence of amino acids as the naturally occurring calcitonin found in human beings. Ineffective when administered PO. Beneficial in Paget's disease of bone by reducing the rate of turnover of bone; the drug acts to both block initial bone resorption, decreasing alkaline phosphatase levels in the serum, and urinary hydroxyprolineexcretion. Its effectiveness in treating osteoporosis or hypercalcemia is due to decreased serum calcium levels from direct inhibition of bone resorption. Use of the nasal spray for osteoporosis results in significant increases in bone mass density within 6 months. Time to peak plasma levels, calcitonin-salmon: 16-25 min for the injection and 31-39 min for the spray. Duration, calcitonin-salmon: 6-8 hr for hypercalcemia. t 1/2: 60 min for calcitonin-human and 43 min for calcitonin-salmon. The onset of calcitonin-human in reducing serum alkaline phosphatase level and urinary hydroxyproline excretion in Paget's disease may take 6-24 months. Metabolized to inactive compounds in the kidneys, blood, and peripheral tissues.

Uses: Injection: Prevention of progressive loss of bone mass in postmenopausal osteoporosis in women who are more than 5 years past menopause and who have low bone mass compared with women before menopause. Also, for women who cannot or will not take estrogens. Moderate to severe Paget's disease characterized by polyostotic involvement with elevated serum alkaline phosphatase and urinary hydroxyproline excretion. With other therapies for early treatment of hypercalcemic emergencies. NOTE: Calcitonin human is now an orphan drug. Nasal: Postmenopausal osteoporosis (see above for injection).

Contraindications: Allergy to calcitonin-salmon or its gelatin diluent.

Special Concerns: Use with caution during lactation. Safe use in children not established.

Side Effects: Side effects listed are for calcitonin-salmon. GI: N&V, anorexia, epigastric discomfort, salty taste, flatulence, increased appetite, gastritis, diarrhea, dry mouth, abdominal pain, dyspepsia, constipation. CNS: Dizziness, paresthesia, insomnia, anxiety, vertigo, migraine, neuralgia, agitation, depression (rare). CV: Hypertension, tachycardia, palpitation, bundle branch block, MI, CVA, thrombophlebitis angina pectoris (rare). Respiratory: Sinusitis, URTI, pharyngitis, bronchitis, pneumonia, coughing, dyspnea, taste perversion, parosmia, bronchospasm. Musculoskeletal: Arthrosis, arthritis, polymyalgia rheumatica, stiffness, myalgia. Dermatologic: Inflammatory reactions at the injection site, flushing of face or hands, pruritus of ear lobes, edema of feet, skin rash, skin ulceration, eczema, alopecia, increased sweating. Endocrine: Goiter, hyperthyroidism. Ophthalmic: Abnormal lacrimation, conjunctivitis, eye pain, blurred vision, vitreous floater. Otic: Tinnitus, hearing loss, earache. Hematologic: Lymphadenopathy, anemia, infection. Metabolic: Mild tetanic symptoms, asymptomatic mild hypercalcemia, cholelithiasis, thirst, hepatitis, weight increase. Miscellaneous: Flu-like symptoms, fatigue, nocturia, feverish sensation. Use of the nasal spray may cause rhinitis, nasal irritation, redness, nasal sores, back pain, arthralgia, epistaxis, and headache.

Laboratory Test Alterations: Reduction of alkaline phosphatase and 24-hr urinary excretion of hydroxyproline are indicative of successful therapy. Monitor urine for casts (indicative of kidney damage).

Overdose Management: Symptoms: N&V.

How Supplied: Calcitonin-salmon: Injection: 200 IU/mL; Nasal Spray: 200 IU/inh

Calcitonin-Human ?SC Paget's disease.
Adults, initial: 0.5 mg/day; then, depending on severity of disease, dosage may range from 0.5 mg 2-3 times/week to 0.25 mg/day.
Calcitonin-Salmon ?IM, SC Paget's disease.
Adults, initial: 100 IU/day; maintenance, usual: 50 IU/day, every other day, or 3 times/week.
Adults, initial: 4 IU/kg q 12 hr; then, increase the dose, if necessary after 1 or 2 days (i.e., if unsatisfactory response), to 8 IU/kg q 12 hr up to a maximum of 8 IU/kg q 6 hr. If the volume to be injected exceeds 2 mL by the SC route, the dose should be given IM with multiple sites used.
Postmenopausal osteoporosis.
Adults: 100 IU/day given with calcium carbonate (1.5 g/day) and vitamin D (400 units/day).
?Nasal Spray
Adults: 200 IU/day, alternating nostrils daily given with calcium carbonate (1.5 g/day) and vitamin D (400 units/day).

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