Drug reference

Cinacalcet

Bisphosphonate · Treatment of hypercalcaemia and hyperparathyroidism

BisphosphonateTreatment of hypercalcaemia and hyperparathyroidism

CDSCO approved

EXCRETION

—

not curated

INTERACTIONS

12 major

SEVERE in our sources

PREGNANCY

Manufacturer advises use only if potential benefit outweighs risk; no information available.

FDA category + note

Top interactionssee all 12 →

AtomoxetineSevereDatabaseDDInter
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Mechanism

Cinacalcet reduces parathyroid hormone which leads to a decrease in serum calcium concentrations.

Indications

Secondary hyperparathyroidism (in patients with end-stage renal disease on dialysis)Hypercalcaemia in parathyroid carcinomaPrimary hyperparathyroidism (in patients where parathyroidectomy is inappropriate)Primary hyperparathyroidism if surgery has been unsuccessful, is unsuitable, or has been declined; and they have an elevated albumin-adjusted serum calcium level with or without symptoms of hypercalcaemia (unlicensed indication)secondary hyperparathyroidism in adults with chronic kidney disease (CKD) on dialysishypercalcemia in adults with parathyroid carcinomahypercalcemia in adults with primary hyperparathyroidism who are not candidates for surgical parathyroidectomySecondary hyperparathyroidism due to renal diseaseParathyroid tumourParathyroid carcinomaEctopic PTH-producing tumorsOncogenic osteomalacia (by reducing PTH-mediated phosphaturia)

Dosing

Adult: For Secondary hyperparathyroidism (in patients with end-stage renal disease on dialysis): Initially 30 mg once daily by mouth, dose to be adjusted every 2–4 weeks according to response.…
Renal adjustment: Indicated for secondary hyperparathyroidism in patients with end-stage renal disease on dialysis (see adult dosing).
Hepatic adjustment: Caution advised in moderate to severe impairment.
Max dose: 180 mg per day for secondary hyperparathyroidism. 90 mg four times a day (360 mg per day) for hypercalcaemia in parathyroid carcinoma/primary hyperparathyroidism.

Pharmacokinetics

Onset

peak serum concentrations achieved 2 to 6 h after oral administration; maximal effects on serum PTH occur 2 to 4 h after administration

Half-life

30 to 40 h

Bioavailability

∼20%

Protein binding

volume of distribution of 1000 L

Metabolism

by multiple hepatic CYPs, including CYPs 3A4, 2D6, and 1A2

Excretion

biliary (15%) and renal (85%)

Contraindications

Hypocalcaemia
Conditions that may worsen with a decrease in serum-calcium concentrations
Switching from etelcalcetide (do not initiate cinacalcet until at least three subsequent haemodialysis sessions are completed, and serum-calcium concentration is confirmed within normal range)
initial serum calcium <8.4 mg/dL

Side effects

Common

Appetite decreasedAstheniaBack painConstipationCoughDiarrhoeaDizzinessDyspnoeaElectrolyte imbalanceGastrointestinal discomfortHeadacheHypersensitivityHypotensionMuscle complaintsNauseaParaesthesiaRashSeizureUpper respiratory tract infectionVomiting

Serious