Cinacalcet

Drugs affecting Bone Metabolism · Calcimimetic agent

Indications

Secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy, as part of a regimen including phosphate binders and/or vitamin D. Reduction of hypercalcaemia in patients with parathyroid carcinoma or primary hyperparathyroidism for whom parathyroidectomy would be indicated on the basis of serum calcium levels but is not clinically appropriate or is contraindicated.

Dosage

Adults: Secondary hyperparathyroidism: Initially 30 mg once daily. Titrate every 2-4 wk according to target parathyroid levels. Max 180 mg once daily. Parathyroid carcinoma and primary hyperparathyroidism: Initially 30 mg twice daily. Titrate every 2-4 wk to 60 mg twice daily, then 90 mg twice daily, then 90 mg three or four times daily as necessary to reduce serum calcium to or below ULN; max 90 mg four times daily. Children: Not recommended.

Adverse Effects

Nausea, anorexia, dizziness, paraesthesia, rash, myalgia, asthaenia, hypocalcaemia, reduced testosterone levels.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Hypocalcaemia. Precautions: Moderate to severe hepatic impairment, impaired cardiac function, epilepsy. In hyperparathyroidism, monitor parathyroid levels 1-4 weeks after initiation or dose adjustment and 1-3 monthly during maintenance. Monitor serum calcium within 1 week of initiation or dose adjustment and regularly during maintenance. Changes in smoking habits.

Interactions

Strong inhibitors or inducers of CYP3A4 and/or CYP1A2. Drugs predominantly metabolized by CYP2D6.

Advice to Patient

Take with meals or immediately after meals. Do not chew or crush, swallow whole. Contact prescriber if there is cramping, muscle pain, seizures, and tetany.

Pharmacokinetics

Absorption: Increased bioavailability and peak plasma conc with food. Bioavailability: Absolute: Approx. 25% (fasted state). Metabolism: Hepatic. Rapidly and extensively metabolized. Half-life elimination: Initial: Approx. 6 hrs. Terminal: 30-40 hrs. Time to peak, plasma: Approx. 2-6 hrs. Excretion: Mainly via urine (approx. 80%). Faeces (approx. 15%).

Brands with this active ingredient

• Censipar
• Mycalcet
• Sincalcet

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.