Drug reference

Calcitonin

Calcitonin (salmon) — calcium-regulating hormone · Bone Metabolism

START

Hypercalcaemia 4 IU/kg SC/IM q12h (rapid adjunct to fluids/bisphosphonate); osteoporosis 200 IU intranasal daily

TYPICAL MAX

Hypercalcaemia up to 8 IU/kg q6h; osteoporosis 200 IU/day intranasal

STOP IF

Anaphylaxis/severe hypersensitivity, symptomatic hypocalcaemia, severe nasal ulceration

WATCH

Serum calcium, hypersensitivity (consider skin test if at risk), nasal mucosa (spray), limit long-term duration

CDSCO approvedSchedule HATC H05BA01

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 2h · calcium-lowering onset
PEAK: 8h · peak hypocalcaemic effect
t½: 1h · SC/IM t½
DURATION: 7h · effect duration

EXCRETION

Rapid renal/peripheral degradation; metabolites renal

route + CYP

INTERACTIONS

—

none in our sources

PREGNANCY

Use only if clearly needed — does not cross placenta well; limited data

FDA category + note

Available in India

27 branded formulations. Look up specific brands in the Drugs workspace.

Mechanism

Binds osteoclast calcitonin receptors inhibiting bone resorption and increasing renal calcium excretion → lowers serum calcium; salmon calcitonin is more potent/longer-acting than human; also analgesic effect in acute vertebral fracture.

Indications

Hypercalcaemia (acute adjunct, rapid onset)Paget disease of bone (when bisphosphonates unsuitable)Postmenopausal osteoporosis (≥5 years post-menopause, alternatives unsuitable — limited duration due to malignancy signal)Acute pain of vertebral osteoporotic fracture (short-term)

Dosing

Adult: Hypercalcaemia: 4 IU/kg SC/IM every 12 h, up to 8 IU/kg q6–12 h. Paget: 50–100 IU SC/IM daily/alternate days. Osteoporosis: 200 IU intranasal once daily (alternate nostrils) or 100 IU SC/IM alternate days — limit duration.
Pediatric: Not routinely (specialist).
Renal adjustment: No specific adjustment.
Hepatic adjustment: No specific adjustment.
Geriatric: No specific adjustment; nasal route common.
Max dose: Hypercalcaemia up to 8 IU/kg q6h; osteoporosis 200 IU/day intranasal

Pharmacokinetics

Onset

Calcium fall within ~2 h (hypercalcaemia)

Peak effect

Hypocalcaemic peak ~6–10 h; rapid escape (tachyphylaxis)

Duration

6–8 h (effect wanes with continued use)

Half-life

SC/IM ~1 h; nasal ~18–43 min

Bioavailability

Nasal ~3% (relative to IM)

Protein binding

~30–40%

Metabolism

Rapid (kidney, blood, peripheral tissues)

Excretion

Renal (metabolites)

Contraindications

Hypocalcaemia
Hypersensitivity to salmon calcitonin
Long-term use limited by possible increased malignancy risk

Side effects

Common

Nausea/vomiting (esp. injection)Flushing of face/handsInjection-site or nasal irritation/rhinitisDiarrhoea

Serious

Hypocalcaemia/tetany
Serious hypersensitivity/anaphylaxis (foreign protein — test dose if at risk)
Possible increased malignancy with long-term use
Severe nasal mucosal ulceration (nasal spray)

Pregnancy & lactation

Pregnancy

Use only if clearly needed — does not cross placenta well; limited data

Lactation

May inhibit lactation; limited data — caution

Drug interactions

Lithium

Moderate

Database

Calcitonin may reduce lithium levels

Monitor lithium concentration