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Zemplar
Zemplar (generic name: paricalcitol) is a synthetic form of vitamin D used to treat and prevent secondary hyperparathyroidism in patients with chronic kidney disease (CKD). Secondary hyperparathyroidism is a condition in which the parathyroid glands produce too much parathyroid hormone (PTH) due to low calcium levels, often caused by kidney failure. Zemplar helps regulate calcium and phosphate levels in the body by suppressing the overproduction of PTH, improving bone health and reducing complications associated with CKD.
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Frequently Asked Questions
How long does it take for Zemplar to work?
Zemplar starts to reduce PTH levels within a few weeks of starting treatment. Regular monitoring of calcium, phosphorus, and PTH levels is necessary to assess its effectiveness.
Can I take Zemplar with other medications?
Zemplar can interact with certain medications, such as calcium supplements or phosphate binders. Always inform your healthcare provider of all medications you are taking to avoid potential interactions.
What should I do if I miss a dose of Zemplar?
If you miss a dose, take it as soon as you remember unless it’s close to your next scheduled dose. Do not double up on doses to make up for the missed one.
Can I take Zemplar if I have high calcium levels?
No, Zemplar should not be used if you have hypercalcemia (high blood calcium levels). Your healthcare provider will monitor your calcium levels regularly to ensure they stay within a safe range.
Is Zemplar safe for long-term use?
Yes, Zemplar can be used long-term to manage secondary hyperparathyroidism in patients with CKD, but regular monitoring of calcium, phosphorus, and PTH levels is essential to avoid complications.
Comprehensive Drug Guide
How Does Zemplar Work?
Paricalcitol, the active ingredient in Zemplar, works by activating the vitamin D receptors in the parathyroid gland. This leads to the inhibition of parathyroid hormone (PTH) production. By reducing PTH levels, Zemplar helps control calcium and phosphate metabolism in patients with chronic kidney disease, reducing the risk of bone disease and other complications related to abnormal mineral metabolism.
Common Dosages
- Capsules: 1 mcg, 2 mcg, 4 mcg
- Injectable solution: 2 mcg/mL, 5 mcg/mL
Typical Dosing
- For CKD patients on dialysis, the typical dose of the injectable form is based on baseline PTH levels, given 3 times a week during dialysis sessions.
- For CKD patients not on dialysis, the starting dose of the oral form (capsules) is usually 1 mcg to 2 mcg once daily or 2 mcg to 4 mcg three times per week, adjusted based on PTH levels and response to treatment.
Typical Dosing
FDA Approved Indications
- Treatment and prevention of secondary hyperparathyroidism in patients with chronic kidney disease (CKD) who are undergoing dialysis (end-stage renal disease).
- Treatment of secondary hyperparathyroidism in CKD patients not yet on dialysis (CKD Stage 3 or 4).
Who Shouldn't Take Zemplar?
- Hypercalcemia (high blood calcium levels)
- Vitamin D toxicity
- Known hypersensitivity to paricalcitol or any components of the formulation
Advice From The Pharmacist
- Take Zemplar exactly as prescribed by your healthcare provider. Do not adjust the dose without consulting your healthcare provider, as improper dosing can lead to serious imbalances in calcium and phosphate levels.
- Monitor your calcium and phosphorus levels regularly, as directed by your healthcare provider, to ensure the medication is working properly and to avoid complications like hypercalcemia or hyperphosphatemia.
- If you miss a dose, take it as soon as you remember unless it is close to your next scheduled dose. Do not double up on doses to make up for a missed one.
- Avoid excessive use of vitamin D supplements or calcium supplements unless instructed by your healthcare provider, as this can increase the risk of high calcium levels.
Side Effects of Zemplar
Common Side Effects
- Nausea
- Diarrhea
- Headache
- Infection
- Dizziness
Uncommon/Severe Side Effects
- Hypercalcemia (high blood calcium levels), which can cause confusion, weakness, irregular heartbeat, or bone pain
- Hyperphosphatemia (high blood phosphate levels)
- Allergic reactions (rash, swelling, difficulty breathing)
Risks and Warnings of Zemplar
- Hypercalcemia: Zemplar can cause high levels of calcium in the blood, leading to confusion, irregular heartbeat, or kidney problems. Regular monitoring of calcium and phosphate levels is essential during treatment.
- Vitamin D toxicity: Excessive use of Zemplar or other vitamin D supplements can lead to vitamin D toxicity, which can cause severe hypercalcemia and related complications.
- Use in pregnancy: Zemplar should be used in pregnancy only if clearly needed, as the effects on the fetus are not fully known. Consult your healthcare provider if you are pregnant or planning to become pregnant.
Interactions with Zemplar
Common Drug Interactions
- Calcium supplements and vitamin D: Using calcium or vitamin D supplements alongside Zemplar may increase the risk of hypercalcemia.
- Phosphate binders: Patients taking phosphate binders should monitor their calcium and phosphate levels carefully to avoid imbalances.
- Digoxin: Hypercalcemia caused by Zemplar can increase the risk of digoxin toxicity, so close monitoring of calcium levels is necessary in patients taking both medications.
Alternatives to Zemplar
- Calcitriol (Rocaltrol): Another active form of vitamin D used to treat secondary hyperparathyroidism in CKD patients.
- Doxercalciferol (Hectorol): A vitamin D analog used to manage secondary hyperparathyroidism in patients with CKD.
- Cinacalcet (Sensipar): A calcimimetic agent that lowers PTH, calcium, and phosphorus levels in patients with secondary hyperparathyroidism.
