Calcitonin

Indications

Salmon Calcitonin is a hormone medicine used to prevent sudden bone loss after a period of immobility (such as after a fracture), to treat Paget's disease of bone (a condition where bone is broken down and rebuilt abnormally) when other medicines cannot be used, and to lower dangerously high blood calcium caused by cancer. In some countries a nasal spray is also used for osteoporosis pain and fracture prevention, but long-term use is now limited.

How It Works

Calcitonin is a natural hormone made by the thyroid gland; the salmon form is stronger and longer acting than human calcitonin. It slows down osteoclasts, the cells that break down bone. This reduces calcium release from bone into the blood, lowers blood calcium and can reduce bone pain.

Dosage and Administration

Given by injection under the skin or into a muscle, or into a vein in hospital for high calcium, by a doctor or nurse, or self-injected after training. A nasal spray form may be used as directed. The dose depends on the condition and is given as prescribed. Treatment is usually kept as short as possible. Taking it at bedtime may reduce nausea and flushing.

Interactions

• It may lower Lithium levels, so lithium doses may need adjusting.
• Use with bisphosphonates such as Zoledronic acid may lower calcium more.
• Heart medicines such as Digoxin and calcium channel blockers may need monitoring because of calcium changes.

Contraindications

• Allergy to salmon calcitonin or any ingredient.
• Low blood calcium (hypocalcaemia).

Side Effects

Common: nausea, vomiting, flushing of the face, dizziness, headache, a metallic taste, and pain or redness at the injection site. Nasal spray: runny or blocked nose, nosebleeds and nasal irritation. Long-term use has been linked to a small increase in cancer risk.

Get urgent medical help for swelling of the face or throat, difficulty breathing, or signs of low calcium such as tingling around the mouth or in the fingers, muscle cramps or spasms, or fits.

Pregnancy and Lactation

Not recommended in pregnancy. It may reduce milk production and should not be used while breastfeeding.

Precautions and Warnings

• Blood calcium may be checked during treatment.
• Because of the cancer risk with long-term use, it is given for the shortest time needed.
• A skin test may be done in people with many allergies.

Overdose

Overdose may cause nausea, vomiting, flushing, dizziness and low blood calcium. Seek medical help.

Therapeutic Class

Calcium-regulating hormone; bone resorption inhibitor.

Storage

Store in a refrigerator at 2 to 8°C, do not freeze, unless the pack says otherwise. An opened nasal spray may be kept at room temperature below 25°C for the time stated on the pack. Keep out of the reach of children.