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Pharmacologic class: Hormone (calcium-lowering)
Therapeutic class: Hypocalcemic
Pregnancy risk category C
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.
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.
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.
• Hypersensitivity to drug or salmon
• Pregnancy or breastfeeding
Use cautiously in:
• renal insufficiency, pernicious anemia
☞ 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.
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
Other: altered taste, allergic reactions including facial flushing, swelling, and anaphylaxis
Drug-drug. Previous use of bisphosphonates (alendronate, etidronate, pamidronate, risedronate): decreased response to calcitonin
• 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.
• 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.