Drug Action
Cinacalcet reduces parathyroid hormone which leads to a decrease in serum calcium concentrations.
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Drug reference
Cinacalcet reduces parathyroid hormone which leads to a decrease in serum calcium concentrations.
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Secondary hyperparathyroidism [in patients with end- stage renal disease on dialysis] (under expert supervision) ▶BY MOUTH ▶Adult: Initially 30 mg once daily, dose to be adjusted every 2–4 weeks according to response; maximum 180 mg per day Hypercalcaemia in parathyroid carcinoma | Primary hyperparathyroidism [in patients where parathyroidectomy is inappropriate] ▶BY MOUTH ▶Adult: Initially 30 mg twice daily (max. per dose 90 mg 4 times a day), dose to be adjusted every 2–4 weeks according to response
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Hypocalcaemia
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Conditions that may worsen with a decrease in serum-calcium concentrations. switching from etelcalcetide CAUTIONS, FURTHER INFORMATION ▶Conditions that may worsen with a decrease in serum-calcium Blood and nutrition concentrations Manufacturer advises caution with use in patients with conditions that may worsen with a decrease in serum-calcium concentrations, including predisposition to QT-interval prolongation, history of seizures, and history of impaired cardiac function—serum-calcium concentration should be closely monitored. ▶Switching from etelcalcetide Manufacturer advises that in patients who have discontinued etelcalcetide, do not initiate cinacalcet until at least three subsequent haemodialysis sessions are completed, and serum-calcium concentration is confirmed within normal range.
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NICE decisions ▶Cinacalcet for the treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy (January 2007) NICE TA117 Cinacalcet (Mimpara ®) is not recommended for the routine treatment of secondary hyperparathyroidism in patients with end-stage renal disease on maintenance dialysis therapy. www.nice.org.uk/guidance/ta117 Cinacalcet (Mimpara ®) is recommended for the treatment of refractory secondary hyperparathyroidism in patients with end-stage renal disease (including those with calciphylaxis) only in those: Blood and nutrition . who have ’very uncontrolled’ plasma concentration of intact parathyroid hormone (defined as greater than 85 picomol/litre) refractory to standard therapy, and a normal or high adjusted serum calcium concentration, and . in whom surgical parathyroidectomy is contra-indicated, in that the risks of surgery outweigh the benefits. Response to treatment should be monitored regularly and treatment should be continued only if a reduction in the plasma concentration of intact parathyroid hormone of 30% or greater is seen within 4 months of treatment. www.nice.org.uk/guidance/ta117
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→Appendix 1: cinacalcet
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▶Common or very common Appetite decreased. asthenia. back pain. constipation. cough. diarrhoea. dizziness. dyspnoea. electrolyte imbalance. gastrointestinal discomfort. headache. hypersensitivity. hypotension. muscle complaints. nausea. paraesthesia. rash. seizure. upper respiratory tract infection. vomiting ▶Frequency not known Heart failure aggravated. QT interval prolongation. ventricular arrhythmia
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Manufacturer advises use only if potential benefit outweighs risk—no information available.
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Manufacturer advises avoid—present in milk in animal studies.
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Manufacturer advises caution in moderate to severe impairment.
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▶When used for Secondary hyperparathyroidism Manufacturer advises measure serum-calcium concentration before initiation of treatment and within 1 week after starting treatment or adjusting dose, then monthly thereafter. Measure parathyroid hormone concentration 1–4 weeks after starting treatment or adjusting dose, then every 1–3 months. ▶When used for Primary hyperparathyroidism and parathyroid carcinoma Manufacturer advises measure serum-calcium concentration before initiation of treatment and within 1 week after starting treatment or adjusting dose, then every 2–3 months.
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Manufacturer advises capsules containing granules should be opened and the granules sprinkled on to a small amount of soft food (apple sauce or yogurt) or liquid, then administered immediately. Capsules should not be swallowed whole. For administration advice via nasogastric or gastrostomy tube—consult product literature.
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There can be variation in the licensing of different medicines containing the same drug. Granules CAUTIONARY AND ADVISORY LABELS 21 ▶Mimpara (Amgen Ltd) Cinacalcet (as Cinacalcet hydrochloride) 1 mg Mimpara 1mg granules in capsules for opening | 30 capsule P £161.16 (Hospital only) Cinacalcet (as Cinacalcet hydrochloride) 2.5 mg Mimpara 2.5mg granules in capsules for opening | 30 capsule P £161.16 (Hospital only) Cinacalcet (as Cinacalcet hydrochloride) 5 mg Mimpara 5mg granules in capsules for opening | 30 capsule P £161.16 (Hospital only) Tablet CAUTIONARY AND ADVISORY LABELS 21 ▶Cinacalcet (Non-proprietary) Cinacalcet (as Cinacalcet hydrochloride) 30 mg Cinacalcet 30mg tablets | 28 tablet P £125.74–£125.75 DT = £125.75 Cinacalcet (as Cinacalcet hydrochloride) 60 mg Cinacalcet 60mg tablets | 28 tablet P £231.96–£231.97 DT = £231.97 Cinacalcet (as Cinacalcet hydrochloride) 90 mg Cinacalcet 90mg tablets | 28 tablet P £347.95–£347.96 DT = £347.96 ▶Mimpara (Amgen Ltd) Cinacalcet (as Cinacalcet hydrochloride) 30 mg Mimpara 30mg tablets | 28 tablet P £125.75 DT = £125.75 Cinacalcet (as Cinacalcet hydrochloride) 60 mg Mimpara 60mg tablets | 28 tablet P £231.97 DT = £231.97 Cinacalcet (as Cinacalcet hydrochloride) 90 mg Mimpara 90mg tablets | 28 tablet P £347.96 DT = £347.96
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Manufacturer advises patients and their carers should be counselled on the symptoms of hypocalcaemia and importance of serum- calcium monitoring. Driving and skilled tasks Manufacturer advises patients and carers should be counselled on the effects on driving and performance of skilled tasks—increased risk of dizziness and seizures.
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Initially 30 mg once daily, dose to be adjusted
First-line fragment. Read the complete Indications and Dose section above.
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Initially 30 mg twice daily (max. per dose 90 mg
First-line fragment. Read the complete Indications and Dose section above.
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