Cibacalcin

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Contents 1 Introduction 2 Indications 3 Contraindications 4 Dosage 5 Pharmacokinetics 6 Adverse-effects 7 Mechanism-of-action 8 More General Terms 9 References

Introduction

• Salmon calicitonin: Tradenames: Calcimar, Miacalcin. Human calcitonin: Tradename: Cibacalcin.

Indications

• hypercalcemia: start 200 IU every 12 hours; max 400 IU every 6 hours
• Paget's disease 50-100 IU SC/ IM QD
• postmenopausal osteoporosis (see mechanism of action)

• 50-100 IU SC/ IM QD
• give with adequate doses of Ca+2 & vitamin D
• 200 IU/day (nasal metered dose)

Contraindications

• Pregnancy category: C 'salmon calcitonin'
• Safety in lactation: ? 'salmon calcitonin'

Dosage

• Skin test:

• 1 unit/0.1 mL SC inner aspect of arm (dilution required)
• observe injection site for 15 minutes for wheal or significant erythema

• Injection:

• 0.5 mg SC or IM QD
• volumes > 2 mL require IM injection

• Injection: 200 units/ mL SC: tuberculin syringe 1 mL, 26 g, 3/8 inch IM: total volume > 2 mL, syringe 2.5-3 mL, 22 g needle, 1.5 inch
• Nasal metered dose:

• 200 IU/day
• alternate nostrils

• 200 IU/actuation. 2 mL, 14 doses.

Pharmacokinetics

• 1/2 life 1 hour in plasma
• duration of action is 8-24 hours after IM or SC injection
• elimination plasma

Adverse-effects

• common (> 10%)

• nausea/vomiting
• anorexia
• diarrhea
• flushing of face
• swelling at site of injection

• less common (1-10%)

• frequency of urination
• with nasal administration

• headache
• nasal symptoms

• dryness, nasal crusts, redness, sore nares

• uncommon (< 1%)

• skin rash, urticaria, chills, stuffy nose, weakness, paresthesias of hands & feet, swelling, nasal congestion, dizziness, shortness of breath

• other

• salty metallic taste
• hypersensitivity reaction

Mechanism-of-action

• inhibits osteoclastic bone resorption

• effect is largely on trabecular bone, not cortical bone
• decreases risk of vertebral fractures, not hip fractures

• lowers serum Ca+2 concentrations
• calcitonin also has analgesic properties
• salmon calcitonin is more potent & has a longer duration of action than human calcitonin

More General Terms

• calcitonin; PDN-21 (CALCA, CALC1)
• endocrine agent
• analgesic (antalgic)

References

1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
4. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
5. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001

Cibacalcin (calcitonin, Calcimar, Miacalcin)