Names and pronunciation
(kal-sih-try′ole) Rocaltrol, Vectical
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Drug reference
(kal-sih-try′ole) Rocaltrol, Vectical
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Func. class.: Parathyroid agent (calcium regulator)
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Chem. class.: Vitamin D hormone
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Do not confuse: calcitriol/Calciferol/calcitonin/calcium
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ACTION: Increases intestinal absorp- tion of calcium; provides calcium for bones; increases renal tubular reabsorp- tion of phosphate
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USES: Hypocalcemia with chronic renal disease, hyperparathyroidism, pseudohypoparathyroidism, psoriasis, renal osteodystrophy
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CONTRAINDICATIONS: Hyper- sensitivity, hyperphosphatemia, hypercal- cemia, vitamin D toxicity Precautions: Pregnancy, breastfeeding, renal calculi, CV disease
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SIDE EFFECTS CNS: Drowsiness, headache, vertigo CV: Hypertension, dysrhythmias, edema EENT: Blurred vision, photophobia, rhinorrhea ENDO: Hypercalcemia GI: Nausea, vomiting, jaundice, anorexia, dry mouth, constipation, cramps, metal- lic taste, pancreatitis GU: Polyuria MS: Myalgia, arthralgia, weakness SYST: Anaphylaxis INTEG: Pain at injection site, rash, pruritus
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INTERACTIONS Increase: hypercalcemia—thiazide diuret- ics, calcium supplements Increase: cardiac dysrhythmias—cardiac glycosides, verapamil; use cautiously Increase: hypermagnesemia—magnesium antacids/supplements, avoid using together Increase: toxicity—other vitamin D prod- ucts, avoid using together Increase: metabolism of vitamin D— phenytoin Decrease: absorption of calcitriol— cholestyramine, mineral oil, fat-soluble vitamins; avoid concurrent use Drug/Food • Large amounts of high-calcium foods may cause hypercalcemia Drug/Lab Test Increase: AST/ALT, BUN, creatinine False increase: Cholesterol Interference: Alkaline phosphatase, electrolytes
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TREATMENT OF OVERDOSE: Discontinue treatment, diuretics, hemodialysis
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DOSAGE AND ROUTES Hypocalcemia in long-term dialysis • Adult: PO 0.25 mcg/day • Adult and child ≥13 yr IV 0.5 mcg (0.01 mcg/kg) 3× per wk, may increase by 0.25-0.5 mcg/dose q2-4wk • Child 1-5 yr: PO 0.25-2 mcg/day; IV 0.01-0.05 mcg/kg 3× per wk Hypoparathyroidism • Adult and child ≥6 yr: PO 0.25 mcg/ day, may increase q2-4wk, maintenance 0.5-2 mcg/day • Child <1 yr: PO 0.04-0.08 mcg/kg/day Management of secondary parathyroidism with bone disease in predialysis (CCr 15-55 mL/min) • Adult/child ≥3 yr: PO 0.25 mcg/day, may increase to 0.5 mcg/day Mild-moderate plaque psoriasis • Adult: Topical: apply to affected areas bid, max 200 g
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Available forms: Capsules 0.25, 0.5 mcg; injection 1 mcg/mL; oral solution 1 mcg/mL; topical 3 mcg/g
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Administer: PO route • Do not break, crush, chew capsules • Give without regard to meals • Store protected from light, heat, moisture Topical route • Rub into skin IV route • Hypocalcemia: Give by direct IV over 1 min through catheter at hemodialysis conclusion
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Assess: • Vitamin D deficiency: Baseline and periodically • May increase calcium; should be kept at 9-10 mg/dL, vitamin D 50-135 units/dL, phosphate 70 mg/dL; toxic reactions may occur rapidly • Serum calcium, phosphate 2× per wk during beginning treatment; serum cal- cium magnesium, alkaline phosphatase and intact PTH ≤ monthly • Hypercalcemia: dry mouth, metallic taste, polyuria, bone pain, muscle weakness, head- ache, fatigue, change in level of conscious- ness, dysrhythmias, increased respirations, anorexia, nausea, vomiting, cramps, consti- pation; hypocalcemia: paresthesia, twitch- ing, Chvostek’s sign, Trousseau’s sign • Nutritional status, diet for sources of vita- min D (milk, some seafood); calcium (dairy products, dark green vegetables), phos- phates (dairy products) must be avoided • Restrict sodium, potassium if required; restriction of fluids if required for chronic renal failure • Height, weight in children, baseline and periodically if on long-term high-dose therapy
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Evaluate: • Therapeutic response: calcium 9-10 mg/dL; decreasing symptoms of hypocal- cemia, hypoparathyroidism
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About symptoms of hypercalcemia: renal stones, nausea, vomiting, anorexia, lethargy, thirst, bone or flank pain, confusion • To follow prescribed diet, to avoid products with sodium: cured meats, dairy products, cold cuts, olives, beets, pickles, soups, meat tenderizers with chronic renal failure; products with po- tassium: oranges, bananas, dried fruit, peas, dark green leafy vegetables, milk, melons, beans • To avoid OTC products that contain calcium, potassium, sodium with chronic renal failure, to take as prescribed, not to double or skip doses • To monitor weight weekly; to maintain fluid intake • To continue with exams and lab work • To avoid large doses of vitamins or supplements • Pregnancy/breastfeeding: identify if pregnancy is planned or suspected or if breastfeeding; do not breastfeed
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PHARMACOKINETICS IV: Onset immediate, duration 3-5 days TOPICAL: Onset, peak, duration unknown PO: Absorbed readily from GI tract, peak 10-12 hr, duration 3-5 days, half-life 5-8 hr, undergoes hepatic recycling, excreted in bile
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• Adult: PO 0.25 mcg/day
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• Adult and child ≥6 yr: PO 0.25 mcg/ day, may increase q2-4wk, maintenance 0.5-2 mcg/day
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• Adult/child ≥3 yr: PO 0.25 mcg/day, may increase to 0.5 mcg/day Mild-moderate plaque psoriasis
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• Adult: Topical: apply to affected areas bid, max 200 g
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