Medications and Drugs
Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD
GENERIC NAME: calcitonin-salmon
BRAND NAME: Miacalcin, Fortical (Calcimar brand no longer available)
DRUG CLASS: Calcitonin-salmon is a man-made version of the hormone,
calcitonin, that is found in salmon. Calcitonin is used for treating
postmenopausal (after menopause) osteoporosis (bone loss),
Paget's disease of
bone, and hypercalcemia (high blood calcium levels). In humans, calcitonin is
produced by the thyroid gland. It acts primarily on bone, but the mechanism of
its action is not well understood. Bone is in a constant state of remodeling,
whereby old bone is removed by cells called osteoclasts, and new bone is laid
down by cells called osteoblasts. Calcitonin inhibits bone removal by
osteoclasts, and promotes bone formation by osteoblasts.
After menopause, the
rate of bone loss accelerates. In women with osteoporosis, calcitonin has been
shown to increase bone density and strength.
Paget's disease is a bone disease
characterized by a disorderly and accelerated remodeling of the bone, leading to
bones that are weak and painful. Calcitonin reduces the turnover of bone and
pain in patients with Paget's disease. The FDA approved calcitonin intranasal
spray in March 1991.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Injection: 200 units/ml. Intranasal spray: 200
units/activation (0.09 ml/puff)
STORAGE: Calcitonin should be stored in a refrigerator between 2-8 C
(36-46 F). It should be protected from freezing. Bottles of intranasal spray
that are being used may be stored at room temperature between 15-30 C (59-86 F)
for 30 days.
PRESCRIBED FOR: Injectable calcitonin is used to treat osteoporosis
and Paget's disease. Injectable calcitonin also is used to treat seriously
elevated blood calcium levels. The nasal spray is used only for osteoporosis in
women who are at least 5 years postmenopausal.
DOSING: Injectable calcitonin is injected under the skin or into the
muscle. The nasal spray is administered into the nostril. To achieve optimal
results, patients with osteoporosis should simultaneously receive adequate
amounts of calcium and vitamin D.
The recommended regimens for Paget's disease and post menopausal osteoporosis
are 100 units per day injected into muscle or under the skin or 1 spray (200
units) per day administered in alternate nostrils. Increased blood calcium
(hypercalcemia) is treated with 4-8 units/kg of injectable calcitonin every 6-12
hours
DRUG INTERACTIONS: Calcitonin is not associated with significant drug
interactions.
PREGNANCY: There are no adequate studies of calcitonin in
pregnant
women.
NURSING MOTHERS: There are no adequate studies of calcitonin in
nursing mothers.
SIDE EFFECTS: Side effects from calcitonin are uncommon and usually
are mild. Injectable calcitonin can cause nausea with or without
vomiting in 10%
of patients. Nausea can occur with initial treatment and tends to disappear with
continued use. Injectable calcitonin also can cause local redness of the skin at
the site of injection. Flushing and skin rash are also seen. The nasal spray can
cause runny nose (rhinorrhea),
nose-bleeding, bone pain and
headaches. The
nausea that can occur with injectable calcitonin is unlikely to occur with the
nasal spray. In rare instances, the nasal spray can cause an upset stomach.
Reference: FDA Prescribing Information
Last Editorial Review: 3/12/2009
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