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Calcitonin (Salmon)
Calcitonin (Salmon) is a synthetic form of the hormone calcitonin, which is derived from salmon. It is used to treat conditions related to bone loss, such as osteoporosis in postmenopausal women, Paget's disease of bone, and hypercalcemia (high blood calcium levels). Calcitonin helps regulate calcium levels in the body and works by inhibiting the activity of osteoclasts, the cells responsible for breaking down bone. This leads to decreased bone resorption and helps maintain bone strength.
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Comprehensive Drug Guide
How Does Calcitonin (Salmon) Work?
Calcitonin (Salmon) works by directly inhibiting osteoclast activity in bones, which reduces bone resorption and helps maintain or increase bone density. It also lowers blood calcium levels by increasing the excretion of calcium, phosphate, and sodium through the kidneys. This dual action helps in the treatment of conditions associated with bone loss and hypercalcemia.
What is Calcitonin (Salmon) Used For?
- Postmenopausal Osteoporosis: To treat osteoporosis in women who are at least 5 years postmenopausal, particularly those who cannot tolerate other osteoporosis treatments.
- Paget’s Disease of Bone: To treat Paget’s disease, a chronic condition that causes bones to become enlarged and deformed.
- Hypercalcemia: To treat hypercalcemia, particularly when it is caused by cancer or other conditions that lead to excessive bone resorption.
Common Dosages
- Administration:
- Nasal Spray: The spray should be administered in a different nostril each day to reduce the risk of nasal irritation.
- Injection: The injection can be given either subcutaneously or intramuscularly, depending on the patient’s preference or the healthcare provider’s recommendation. The site of injection should be rotated to avoid irritation.
- Duration of Use: Calcitonin is generally used for long-term management of osteoporosis or other bone disorders, though its use may be limited due to the availability of more effective treatments for osteoporosis. For hypercalcemia, the treatment duration depends on the underlying cause and response to therapy.
Typical Dosing
FDA Approved Indications
The typical dosage of Calcitonin (Salmon) varies depending on the condition being treated:
- For Postmenopausal Osteoporosis:
- Nasal Spray: 200 IU (international units) once daily, administered in one nostril, alternating nostrils daily.
- Injection: 100 IU every other day subcutaneously or intramuscularly.
- For Paget’s Disease:
- Injection: 100 IU daily or every other day subcutaneously or intramuscularly.
- For Hypercalcemia:
- Injection: 4 IU/kg every 12 hours subcutaneously or intramuscularly. In severe cases, the dose can be increased to 8 IU/kg every 12 hours.
Who Shouldn't Take Calcitonin (Salmon)?
Calcitonin (Salmon) is contraindicated in patients with:
- Known hypersensitivity to calcitonin (Salmon) or any of the components of the formulation.
- Allergy to salmon or fish products, due to the risk of cross-reactivity.
- The presence of significant nasal mucosal damage (when using the nasal spray), as this can increase the risk of nasal adverse effects.
Advice From The Pharmacist
Patients using Calcitonin (Salmon) should be advised to:
- Follow the prescribed dosing schedule carefully and use the medication exactly as directed by their healthcare provider.
- For the nasal spray, alternate nostrils daily to reduce the risk of irritation. If they experience nasal discomfort, bleeding, or persistent irritation, they should contact their healthcare provider.
- Store the nasal spray in the refrigerator before opening. After opening, it can be stored at room temperature for up to 35 days. Do not freeze the medication.
- If using the injectable form, rotate injection sites to avoid local irritation.
- Be aware of the potential for allergic reactions, especially if they have a known allergy to salmon or other fish products. Symptoms of an allergic reaction include rash, itching, swelling, and difficulty breathing, and they should seek immediate medical attention if these occur.
- Maintain adequate calcium and vitamin D intake as recommended by their healthcare provider to support bone health.
Side Effects of Calcitonin (Salmon)
Common Side Effects
- Nasal Spray: Nasal irritation, dryness, or crusting; nosebleeds; runny nose; or headaches.
- Injection: Injection site reactions such as redness, swelling, or pain; nausea; or flushing.
Uncommon/Severe Side Effects
Serious side effects can include:
- Allergic Reactions: Such as rash, itching, swelling, or difficulty breathing. Anaphylaxis, though rare, can occur.
- Hypocalcemia: Symptoms include muscle cramps, tingling, or numbness in the fingers and toes.
- Cancer Risk: Long-term use of calcitonin has been associated with an increased risk of cancer, although the absolute risk is small. Patients should discuss the risks and benefits of long-term therapy with their healthcare provider.
Risks and Warnings of Calcitonin (Salmon)
Cancer Risk: There is a potential increased risk of cancer with long-term use of calcitonin, particularly when used for the treatment of osteoporosis. The risks should be weighed against the benefits, and alternative treatments should be considered when appropriate.
Nasal Adverse Effects: Patients using the nasal spray should be monitored for nasal mucosal changes. If significant nasal irritation or ulceration occurs, treatment should be discontinued.
Hypocalcemia: Calcitonin can lower blood calcium levels, so patients should ensure adequate intake of calcium and vitamin D to reduce this risk.
Interactions with Calcitonin (Salmon)
Common Drug Interactions
Calcitonin (Salmon) may interact with other medications, including:
- Bisphosphonates: Concurrent use with bisphosphonates, which are also used to treat osteoporosis, may enhance the effects on calcium metabolism.
- Lithium: Calcitonin may reduce lithium levels in the blood, so monitoring may be necessary.
Patients should inform their healthcare provider of all medications and supplements they are taking to avoid potential interactions.
Alternatives to Calcitonin (Salmon)
Alternative treatments for osteoporosis and related conditions include:
- Bisphosphonates: Such as alendronate (Fosamax) or risedronate (Actonel), which are often the first-line treatment for osteoporosis.
- Selective Estrogen Receptor Modulators (SERMs): Such as raloxifene (Evista), which can help prevent bone loss in postmenopausal women.
- Parathyroid Hormone Analogues: Such as teriparatide (Forteo), which stimulates new bone formation.
- Denosumab: A monoclonal antibody that inhibits bone resorption, used in the treatment of osteoporosis.
The choice of treatment depends on the individual’s overall health, the severity of their condition, and their response to previous treatments.
