Calcitriol is indicated in the management of secondary hyperparathyroidism and resultant metabolic bone disease in patients with moderate to severe chronic renal failure (Ccr 15 to 55 mL/min) not yet on dialysis.
Calcitriol is one of the most important active metabolites of vitamin D3. It is normally formed in the kidneys from its precursor, 25-hydroxycholecalciferol. Calcitriol promotes intestinal absorption of calcium and regulates bone mineralization. The key role of Calcitriol is the regulation of calcium homeostasis, which includes stimulation effects on osteoblastic activity in the skeleton.
ORAL Hyperparathyroidism in renal failure: Adult: 0.25 mcg daily or every other day. May increase by 0.25 mcg daily at intervals of 4-8 wk. Child: 0.25-2 mcg daily w/ haemodialysis. Hypoparathyroidism/ pseudohypoparat hyroidism: Adult: 0.5-2 mcg once daily. Child: 1-5 yr: 0.25-0.75 mcg once daily; >6 yr: 0.5-2 mcg once daily. Vitamin D-resistant rickets (familial hypophosphataemia): Adult: 0.015-0.02 mcg/kg once daily. Maintenance: 0.03- 0.06 mcg/kg once daily. Max: 2 mcg once daily. Child: 0.015-0.02 mcg/kg once daily. Maintenance: 0.03-0.06 mcg/kg once daily. Max: 2 mcg once daily. Hypocalcaemia in premature infants: Child: 1 mg once daily for 5 days. INTRAVENOUS Hyperparathyroidism in dialysis patients: Adult: 0.5-4 mcg 3 times/wk, increased if needed in steps of 0.25-0.5 mcg at intervals of 2-4 wk; max. 8 mcg 3 times/wk. Child: 1 mcg once daily. Hyperparathyroidism in renal failure: Adult: 0.5 mcg daily 3 times/wk if undergoing haemodialysis. If necessary, dose can be increased by 0.25-0.5 mcg at intervals of 2-4 wk. Maintenance:0.5-3 mcg 3 times/wk. Hypocalcaemic tetany in premature infants: Child: 0.05 mcg/kg once daily for 5-12 days.
Concomitant treatment with a thiazide diuretics increases the risk of hypercalcemia. Calcitriol dosage must be determined with care in patients undergoing treatment with digitalis as hypercalcemia in such patients may precipitate cardiac arrhythmias. Magnesium containing drugs (e.g.,antacids) may cause hypermagnesemia.
Hypercalcaemia; evidence of vit D toxicity. Pregnancy (dose exceeding RDA). Lactation. Idiopathic hypercalcaemia. Pediatric doses must be individualised & monitored under close medical supervision. Coronary disease, renal function impairment & arteriosclerosis, esp in the elderly. Hypoparathyroidism.
Weakness; headache; somnolence; nausea; vomiting; dry mouth; constipation; muscle pain; bone pain; metallic taste; polyuria; polydipsia; anorexia; irritability; wt loss; nocturia; mild acidosis; reversible azotemia; generalized vascular calcification; neph rocalcinosis; conjunctivitis (calcific); pancreatitis; photophobia; rhinorrhoea; pruritus; hyperthermia; decreased libido; elevated BUN; albuminuria; hypercholesterolaemia; elevated AST & ALT; ectopic calcification; hypertension; cardiac arrhythmias.
This drug should not be used during pregnancy unless the benefit outweighs the risk to the fetus. Use is not recommended and a decision should be made to discontinue breastfeeding or discontinue the drug, taking into account the importance of the drug to the mother.
Administration of Calcitriol injection to patients in excess of their requirements can cause hypercalcemia, hypercalciuria and hyperphosphatemia. General treatment of hypercalcemia (greater than 1 mg/dL) consists of immediate discontinuation of Calcitriol injection therapy, institution of a low calcium diet and withdrawal of calcium supplements.
keep in a dry place away from light and heat. Keep out of the reach of children.
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