salmon calcitonin (Cibacalcin, Calcimar, Miacalcin)
Jump to navigation
Jump to search
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)
- FDA recommends against use of salmon calcitonin for treatment of postmenopausal osteoporosis[6][7]
Contraindications
Pregnancy category: C 'salmon calcitonin'
Safety in lactation: ? 'salmon calcitonin'
Dosage
- 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/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%)
- less common (1-10%)
- 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
- increased risk of cancer[6][7]
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
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 6.0 6.1 6.2 Physician's First Watch. March 7, 2013 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
FDA Advisory committee background document. March 5, 2013 http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM341779.pdf - ↑ 7.0 7.1 7.2 Overman RA, Borse M, Gourlay ML. Salmon calcitonin use and associated cancer risk. Ann Pharmacother. 2013 Dec;47(12):1675-84. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24259626