Names and pronunciation
Miacalcin
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Drug reference
Miacalcin
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Func. class.: Parathyroid agent (calcium regulator)
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Chem. class.: Polypeptide hormone
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Do not confuse: Calcitonin/calcitriol/calcifediol/calcium
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ACTION: Decreases bone resorption, blood calcium levels; increases deposits of calcium in bones; opposes parathyroid hormone
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USES: Paget’s disease, postmeno- pausal osteoporosis, hypercalcemia
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CONTRAINDICATIONS: Hyper- sensitivity to this product, fish Precautions: Pregnancy, breastfeeding, children, hypotension, hypocalcemia, secondary malignancy
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SIDE EFFECTS CNS: Headache (nasal) EENT: Eye pain (nasal) GI: Nausea, diarrhea, vomiting, anorexia, (IM/SUBCUT) GU: Nocturia, frequency INTEG: Rash, flushing, reaction at injec- tion site MS: Backache, myalgia, arthralgia RESP: Dyspnea, flulike symptoms, bron- chospasm SYST: Anaphylaxis, infection
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INTERACTIONS Decrease: lithium effect; monitor lithium level Decrease: effect of nasal spray— bisphosphonates (Paget’s disease); mon- itor for adequate effect
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DOSAGE AND ROUTES Postmenopausal osteoporosis • Adult: SUBCUT/IM 100 units every other day; INTRANASAL 200 units (1 spray) daily, alternating nostrils daily Paget’s disease • Adult: SUBCUT/IM 100 units/day; maintenance 50 units daily, every other day, or 3× per wk Hypercalcemia • Adult: SUBCUT/IM 4 units/kg q12hr, increase to 8 units/kg q12hr if response is unsatisfactory, may increase to 8 units/kg q6hr if needed after 2 more days
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Available forms: Injection 200 units/ mL; nasal spray 200 units/actuation
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Administer: • Store at <77°F (25°C); protect from light SUBCUT route • Rotate injection sites; use within 2 hr of reconstitution; give at bedtime to min- imize nausea, vomiting IM route • After test dose of 10 units/mL, 0.1 mL in- tradermally; watch for 15 min; give only with EPINEPHrine, emergency meds available • IM inject slowly into deep muscle mass; rotate sites; preferred route if volume is >2 mL; use within 2 hr of reconstitution Nasal route • Prime pump before first dose • Use at bedtime; alternate nostrils daily, prime to get full spray before first dose, store in refrigerator • Allow to come to room temperature before using • Discard after 30 days
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Assess: • Anaphylaxis, hypersensitivity reaction (rash, fever, inability to breathe); emer- gency equipment should be nearby • GI symptoms, polyuria, flushing, head swelling, tingling, headache; may indi- cate hypercalcemia • Nutritional status; diet for sources of vitamin D (milk, some seafood), calcium (dairy products, dark green vegetables), phosphates • Postmenopausal osteoporosis: vitamin D (50-135 international units/dL), alkaline phosphatase baseline, q3-6mo; monitor urine hydroxyproline with Paget’s disease, biochemical markers of bone formation/ absorption, radiologic evidence of fracture; bone density • Toxicity (can occur rapidly), in- C creased drug level; have parenteral cal- cium on hand if calcium level drops too low; check for tetany (irritability, pares- thesia, nervousness, muscle twitching, seizures, tetanic spasms)
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Evaluate: • Therapeutic response: calcium levels 9-10 mg/dL, decreasing symptoms of Paget’s disease
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: SUBCUT route/IM route • About the method of injection if patient will be responsible for self-medication; to rotate sites, not to inject into broken, irritated skin; provide written instruc- tions • To report difficulty swallowing, any changes in side effects to prescriber im- mediately • To report immediately signs/symp- toms of hypocalcemia: tetany, seizures • Pregnancy/breastfeeding: to advise prescriber if pregnancy is planned or suspected or if breastfeeding • Postmenopausal osteoporosis: to take vitamin D and calcium differential; that nausea, vomiting, and facial flushing occur often Nasal route • To use alternating nostrils; to use after allowing to warm to room temperature; to prime to get full spray; to discard after 30 days
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PHARMACOKINETICS IM/SUBCUT: Onset 15 min, peak 2 hr, duration 6-8 hr, metabolized by kidneys, excreted as inactive metabolites via kidneys
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• Adult: SUBCUT/IM 100 units every other day; INTRANASAL 200 units (1 spray) daily, alternating nostrils daily Paget’s disease
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• Adult: SUBCUT/IM 100 units/day; maintenance 50 units daily, every other day, or 3× per wk Hypercalcemia
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• Adult: SUBCUT/IM 4 units/kg q12hr, increase to 8 units/kg q12hr if response is unsatisfactory, may increase to 8 units/kg q6hr if needed after 2 more days
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