Cinacalcet
Mechanism :
Increases the sensitivity of the calcium-sensing receptor on the parathyroid gland
Indication :
- Hyperparathyroidism, primary and secondary
- Parathyroid carcinoma
Contraindications :
Serum calcium less than the lower limit of normal range.
Dosing :
Safety and efficacy not established in pediatric population.
Adults:
Initial dose: 30 mg PO OD. May increase at 2-4 week intervals by 30 mg.
Max dose: 180 mg daily.
Adverse Effect :
Diarrhea, nausea, vomiting, myalgia, dizziness, hypertension, anorexia, asthenia, seizures.
Interaction :
CYP2D6 Substrates: CYP2D6 Inhibitors may decrease the metabolism of CYP2D6 Substrates.
CYP3A4 Inhibitors: May decrease the metabolism of CYP3A4 Substrates.
Etelcalcetide: Cinacalcet may enhance the hypocalcemic effect of Etelcalcetide.
Tricyclic Antidepressants: Cinacalcet may increase the serum concentration of Tricyclic Antidepressants.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Not dialysed. Dose as in normal renal function |
| HD | Not dialysed. Dose as in normal renal function |
| HDF/High flux | Unlikely to be dialysed. Dose as normal renal function |
| CAV/VVHD | Not dialysed. Dose as in normal renal function |
Hepatic Dose :
Moderate to severe hepatic impairment: Reduction in dose may be required. Parathyroid hormone and serum calcium concentrations should be closely monitored.