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Cinacalcet HCl
Cinacalcet HCl is a medication used to treat conditions related to excessive levels of parathyroid hormone (PTH), including secondary hyperparathyroidism in patients with chronic kidney disease (CKD) on dialysis and hypercalcemia in patients with parathyroid carcinoma. It belongs to the class of drugs called calcimimetics, which work by lowering the levels of PTH, calcium, and phosphorus in the body. Cinacalcet HCl helps manage the imbalance of these minerals, improving bone health and reducing cardiovascular risks associated with high calcium levels.
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Frequently Asked Questions
How long does it take for Cinacalcet HCl to start working?
Cinacalcet HCl usually starts to lower PTH and calcium levels within a few days of starting treatment. However, it may take several weeks to reach the target levels, depending on dosage adjustments.
Can I take calcium supplements while on Cinacalcet?
Yes, but only under the supervision of your healthcare provider. Calcium supplements may be necessary if your calcium levels drop too low while taking Cinacalcet.
What happens if I miss a dose of Cinacalcet HCl?
If you miss a dose, take it as soon as you remember, unless it’s almost time for your next dose. Do not take two doses at once. Contact your doctor for specific instructions.
Is Cinacalcet HCl safe during pregnancy?
There is limited information about the safety of Cinacalcet during pregnancy. It should be used only if clearly needed and under close medical supervision. Consult your doctor if you are pregnant or planning to become pregnant.
How often will I need blood tests while taking Cinacalcet HCl?
You will need regular blood tests to monitor your calcium, phosphorus, and PTH levels. The frequency of these tests depends on your doctor's recommendations and how well your body responds to treatment.
Comprehensive Drug Guide
How Does Cinacalcet HCl Work?
Cinacalcet HCl works by increasing the sensitivity of the calcium-sensing receptors on the parathyroid gland. This heightened sensitivity allows the gland to detect smaller amounts of calcium in the blood, leading to a decrease in PTH production. As PTH levels drop, calcium and phosphorus levels in the blood also decrease, helping to restore a healthier mineral balance and prevent complications such as bone disease and cardiovascular issues.
What is Cinacalcet HCl Used For?
Cinacalcet is primarily used to treat high levels of calcium in patients with parathyroid cancer and to treat hyperparathyroidism in patients with chronic kidney failure on dialysis.
Common Dosages
- Tablets: 30 mg, 60 mg, and 90 mg
Typical Dosing
- For secondary hyperparathyroidism in CKD: The starting dose is 30 mg once daily. The dose is gradually increased every 2 to 4 weeks based on blood levels of calcium and PTH.
- For hypercalcemia in parathyroid carcinoma: The starting dose is typically 30 mg twice daily, with dose adjustments based on calcium levels.
- For severe hypercalcemia in primary hyperparathyroidism: Initial dosing starts at 30 mg twice daily, with titration based on response.
Typical Dosing
FDA Approved Indications
- Secondary hyperparathyroidism in patients with chronic kidney disease on dialysis
- Hypercalcemia in patients with parathyroid carcinoma
- Severe hypercalcemia in patients with primary hyperparathyroidism who are unable to undergo parathyroidectomy
Who Shouldn't Take Cinacalcet HCl?
- Hypersensitivity or allergy to Cinacalcet or its components
- Hypocalcemia (low calcium levels), as Cinacalcet lowers calcium levels further
Advice From The Pharmacist
- Take Cinacalcet HCl with food or shortly after a meal to enhance absorption.
- Regular blood tests are necessary to monitor calcium, phosphorus, and PTH levels while on Cinacalcet.
- Notify your healthcare provider if you experience symptoms of low calcium, such as muscle cramps, tingling, or numbness.
- Avoid taking Cinacalcet HCl if you have low calcium levels. It can lead to dangerously low calcium levels, requiring medical attention.
Side Effects of Cinacalcet HCl
Common Side Effects
- Nausea
- Vomiting
- Diarrhea
- Muscle pain or weakness
Uncommon/Severe Side Effects
- Hypocalcemia (severely low calcium levels), leading to muscle cramps, spasms, or convulsions
- Severe allergic reactions (rash, swelling, difficulty breathing)
- Unusual fatigue or fainting
Risks and Warnings of Cinacalcet HCl
- Hypocalcemia: Cinacalcet can cause dangerously low levels of calcium in the blood. Regular monitoring of calcium levels is necessary, and dosage adjustments may be required.
- Seizures: Patients with a history of seizures may be at a higher risk of experiencing them while taking Cinacalcet HCl due to low calcium levels.
- Drug Interactions: Cinacalcet HCl can interact with certain medications that affect calcium levels, including certain antibiotics and antifungal drugs.
Interactions with Cinacalcet HCl
Common Drug Interactions
- Ketoconazole and Itraconazole: These antifungal medications may increase the levels of Cinacalcet in the body, requiring dose adjustments.
- Calcium Supplements: Taking calcium supplements along with Cinacalcet can help prevent hypocalcemia, but should be done under medical supervision.
- Seizure Medications: Cinacalcet may increase the risk of seizures in individuals taking certain anticonvulsant drugs, particularly when calcium levels are low.
Alternatives to Cinacalcet HCl
- Etelcalcetide: Another calcimimetic used for treating secondary hyperparathyroidism in CKD patients on dialysis.
- Parathyroidectomy: Surgical removal of the parathyroid glands for patients with severe primary hyperparathyroidism or parathyroid cancer.
- Vitamin D Analogues: Calcitriol and other vitamin D analogs help regulate calcium and phosphorus levels, particularly in CKD patients.
