Hyperparathyroidism Drug Summary

Drug	Dosage	Remarks
Alfacalcitriol (alfacalcidol, alpha-D3,  1α-hydroxyvit D3)	Initial dose: 1 mcg IV bolus over 30 seconds Maintenance dose:   0.25-1 mcg IV 24 hourly	Adverse Reactions CV effects (arrhythmia, hypertension); Dermatologic effect (pruritus); Metabolic effects (decreased libido, hypercalcemia, hyperphosphatemia, hypercholesterolemia, polydipsia, weight loss); GI effects (anorexia, constipation, dysgeusia, nausea/vomiting, pancreatitis, xerostomia); GU effect (nocturia); CNS effects (headache, hyperthermia, drowsiness); Hepatic effect (increased LFTs); Ophthalmologic effects (conjunctivitis, corneal calcification, photophobia); Respiratory effect (rhinorrhea) Special Instructions Should be taken with food Regular serum calcium monitoring while on treatment
Calcitriol	Normal or slightly reduced serum Ca: 0.25 mcg PO every other day May be increased by 0.25 mcg/day at 2–4-week intervals Secondary hyperparathyroidism in chronic kidney disease patient: 0.25 mcg PO 24 hourly May be increased to 0.5 mcg/day Secondary hyperparathyroidism in dialysis patient: 1-2 mcg PO every other day May be increased by 0.5-1 mcg at 2–4-week intervals	Adverse Reactions Dermatologic effect (skin rash); Metabolic effect (polydipsia); GI effects (abdominal pain, nausea); GU effect (urinary tract infection); CNS effect (headache) Special Instructions May be taken with or without food Monitor plasma calcium while on treatment Control plasma phosphate concentration while on treatment
Paricalcitol	Intact parathyroid hormone (iPTH) level ≤500 pg/mL: 1 mcg PO/IV 24 hourly or 2 mcg PO/IV 3x weekly iPTH level >500 pg/mL: 2 mcg PO/IV 24 hourly or 4 mcg PO/IV 3x weekly	Adverse Reactions Abdominal discomfort, acne, anorexia, breast tenderness, diarrhea, GI disorders, hypercalcemia, hypocalcemia, rash Special Instructions May be taken with or without food Monitor serum calcium levels

Drug	Dosage	Remarks
Cinacalcet	Primary hyperparathyroidism: Titrate every 2-4 weeks through sequential doses of 30 mg PO 12 hourly, 60 mg PO 12 hourly and 90 mg PO 6-8 hourly as necessary to normalize serum calcium levels Secondary hyperparathyroidism in patients with chronic kidney disease on dialysis: May titrate dose in increments of 30 mg every 2-4 weeks up to 180 mg PO 24 hourly	Adverse Reactions CV effect (hypotension); Metabolic effects (hypocalcemia, hypercalcemia, dehydration, hypoparathyroidism); GI effects (abdominal pain, diarrhea, nausea/vomiting, anorexia, constipation); CNS effects (headache, paresthesia, depression, fatigue); Musculoskeletal effects (bone fracture, muscle spasm, weakness, myalgia); Respiratory effects (upper respiratory tract infection, cough, dyspnea) Special Instructions Should be taken with food or shortly after meals Carefully monitor for hypocalcemia

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated. 
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.