calcitonin

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calcitonin

 [kal″sĭ-to´nin]
a polypeptide hormone secreted by the parafollicular or C cells of the thyroid gland; it is involved in plasma calcium homeostasis and acts to decrease the rate of bone resorption. Preparations of calcitonin are called either calcitonin-human or calcitonin-salmon; the former is a synthetic polypeptide with the same sequence as that occurring naturally in humans, and the latter is either derived from salmon or is a synthetic polypeptide of the same sequence as that found in salmon. They are used in the treatment of severe hypercalcemia, paget's disease of bone, and postmenopausal osteoporosis. Called also thyrocalcitonin.

calcitonin (salmon)

APO-Calcitonin, Calcimar, Caltine, Fortical, Miacalcic (UK), Miacalcin, Miacalcin Nasal Spray, Sandoz Calcitonin

Pharmacologic class: Hormone (calcium-lowering)

Therapeutic class: Hypocalcemic

Pregnancy risk category C

Action

Directly affects bone, kidney, and GI tract. Decreases osteoclastic osteolysis in bone; also reduces mineral release and collagen breakdown in bone and promotes renal excretion of calcium. In pain relief, acts through prostaglandin inhibition, pain threshold modification, or beta-endorphin stimulation.

Availability

Injection: 0.5 mg/ml (human), 1 mg/ml (human), 200 international units/ml in 2-ml vials (salmon)

Nasal spray (salmon): 200 international units/actuation, metered nasal spray in 3.7 ml-bottle

Indications and dosages

Postmenopausal osteoporosis

Adults:Calcitonin (salmon)-100 international units/day I.M. or subcutaneously, or 200 international units/day intranasally with concurrent supplemental calcium and vitamin D

Paget's disease of bone (osteitis deformans)

Adults:Calcitonin (salmon)-Initially, 100 international units/day I.M. or subcutaneously; after titration, maintenance dosage is 50 to 100 international units daily or every other day (three times weekly). Calcitonin (human)-0.5 mg I.M. or subcutaneously daily, reduced to 0.25 mg daily.

Hypercalcemia

Adults:Calcitonin (salmon)-4 international units/kg I.M. or subcutaneously q 12 hours; after 1 or 2 days, may increase to 8 international units/kg q 12 hours; after 2 more days, may increase further, if needed, to 8 international units q 6 hours.

Contraindications

• Hypersensitivity to drug or salmon
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• renal insufficiency, pernicious anemia
• children.

Administration

Before salmon calcitonin therapy begins, perform skin test, if prescribed. Don't give drug if patient has positive reaction. Have epinephrine available.
• Bring nasal spray to room temperature before using.
• Give intranasal dose as one spray in one nostril daily; alternate nostrils every day.
• To minimize adverse effects, give at bedtime.
• Rotate injection sites to decrease inflammatory reactions.

Adverse reactions

CNS: headache, weakness, dizziness, paresthesia

CV: chest pain

EENT: epistaxis, nasal irritation, rhinitis

GI: nausea, vomiting, diarrhea, epigastric pain or discomfort

GU: urinary frequency

Musculoskeletal: arthralgia, back pain

Respiratory: dyspnea

Skin: rash

Other: altered taste, allergic reactions including facial flushing, swelling, and anaphylaxis

Interactions

Drug-drug.Previous use of bisphosphonates (alendronate, etidronate, pamidronate, risedronate): decreased response to calcitonin

Patient monitoring

• Monitor for adverse reactions during first few days of therapy.
• Assess alkaline phosphatase level and 24-hour urinary excretion of hydroxyproline.
• Check urine for casts.
• Monitor serum electrolyte and calcium levels.

Patient teaching

• Instruct patient to take drug before bedtime to lessen GI upset. Tell him to call prescriber if he can't maintain his usual diet because of GI upset.
• Inform patient using nasal spray that runny nose, sneezing, and nasal irritation may occur during first several days as he adjusts to spray.
• Instruct patient to bring nasal spray to room temperature before using.
• Advise patient to blow nose before using spray, to take intranasal dose as one spray in one nostril daily, and to alternate nostrils with each dose.
• Tell patient to discard unrefrigerated bottles of calcitonin (salmon) nasal spray after 30 days.
• Encourage patient to consume a diet rich in calcium and vitamin D.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs mentioned above.

cal·ci·to·nin

(kal'si-tō'nin),
A peptide hormone, of which eight forms in five species are known; composed of 32 amino acids and produced by the parathyroid, thyroid, and thymus glands; its action is opposite to that of parathyroid hormone in that calcitonin increases deposition of calcium and phosphate in bone and lowers the level of calcium in the blood; its level in the blood is increased by glucagon and by Ca2+ and thus opposes postprandial hypercalcemia.
Synonym(s): thyrocalcitonin
[calci- + G. tonos, stretching, + -in]

calcitonin

/cal·ci·to·nin/ (-to´nin) a polypeptide hormone secreted by C cells of the thyroid gland, and sometimes of the thymus and parathyroids, which lowers calcium and phosphate concentration in plasma and inhibits bone resorption. Preparations (c.-human, c.-salmon) are used in the treatment of osteitis deformans, postmenopausal osteoporosis, and hypercalcemia.

calcitonin

(kăl′sĭ-tō′nĭn)
n.
A peptide hormone, secreted by the thyroid gland in humans or produced synthetically, that lowers plasma calcium and phosphate levels without augmenting calcium accretion and is used therapeutically to treat diseases such as osteoporosis. Also called thyrocalcitonin.

calcitonin

[kal′sitō′nin]
Etymology: L, calx + Gk, tonos, tone
a hormone produced in parafollicular cells of the thyroid that participates in regulating the blood level of calcium and stimulates bone mineralization. A synthetic preparation of the hormone is used in the treatment of certain bone disorders. Calcitonin acts to reduce the blood level of calcium and to inhibit bone resorption, whereas parathyroid hormone acts to increase blood calcium level and bone resorption. Vitamin D also contributes to the regulation of calcium homeostasis. Also called salmon calcitonin, thyrocalcitonin.

CALCA

A gene on chromosome 11p15.2 that encodes peptide hormones calcitonin, calcitonin gene-related peptide and katacalcin, by tissue-specific alternative RNA splicing of gene transcripts and cleavage of inactive precursor peptides. Calcitonin regulates calcium and phosphorus metabolism; calcitonin gene-related peptide is a vasodilator; katacalcin is a calcium-lowering peptide.

calcitonin

Thyrocalcitonin Physiology A 32 residue polypeptide–plasma levels 100 pg/mL hormone produced by the parafollicular or 'C'–ultimobranchial cells of the thyroid; calcitonin is rapidly secreted in response to ↑ plasma Ca2+, pentagastrin, glucagon, β-adrenergics, and alcohol; it is produced by several neoplasms, especially, medullary CA of thyroid–MCT, which may also be associated with other endocrine tumors ↑ in MCT, small cell of the lung, breast CA. See C cells.

cal·ci·to·nin

(kal'si-tō'nin)
A peptide hormone, of which eight forms are known; produced by the parathyroid, thyroid, and thymus glands; its action is opposite to that of parathyroid hormone in that calcitonin increases deposition of calcium and phosphate in bone and lowers the level of calcium in the blood.
[calci- + G. tonos, stretching, + -in]

calcitonin

Salcatonin or calcitonin (salmon), a hormone secreted by the THYROID gland, independently of the thyroid hormones, and concerned with the control of calcium levels in the blood. It acts on bone to interfere with the release of calcium. It is less important in calcium balance than the parathyroid glands. Used as a drug under the brand name Miacalcic.

calcitonin

a polypeptide hormone secreted by both the THYROID and PARATHYROID glands that lowers the calcium content of the blood.

Calcitonin

A hormone produced by the parafollicular cells (C cells) of the thyroid. The main function of the hormone is to regulate calcium levels in body serum.

calcitonin

; thyrocalcitonin hormone (secreted by parafollicular cells of thyroid) reducing plasma calcium (by increasing urinary calcium excretion and reducing osteoclastic bone resorption); used to treat Paget's disease

calcitonin (kal·si·tōˑ·nin),

n hormone originating in the thyroid's parafollicular cells; plays a role in calcium blood level regulation and serves to stimulate bone mineralization.

cal·ci·to·nin

(kal-si-tō'nin)
A peptide hormone formed in parathyroid, thyroid, and thymus glands; increases deposition of calcium and phosphate in bone and lowers blood levels of calcium.
[calci- + G. tonos, stretching, + -in]

calcitonin (kal´sitō´nin),

n brand names: Calcitonin, Calcimar, Miacalcin;
drug class: synthetic polypeptide calcitonins;
action: inhibits bone resorption, reduces osteoclast function, reduces serum calcium levels in hypercalcemia;
uses: Paget's disease, postmenopausal osteoporosis, hypercalcemia.

calcitonin

a polypeptide hormone secreted by the parafollicular or C cells of the thyroid gland, which is involved in plasma calcium homeostasis. It acts to decrease the rate of bone resorption. Called also thyrocalcitonin.

calcitonin gene-related peptides
potent vasodilators widely distributed in periadventitial nerves of blood vessels, sinoatrial and atrioventricular nodes, sensory neurons and the central nervous system generally.
calcitonin-secreting cells
parafollicular cells of the thyroid gland.
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