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salmon calcitonin (Cibacalcin, Calcimar, Miacalcin)

Salmon calicitonin: Tradenames: Calcimar, Miacalcin. Human calcitonin: Tradename: Cibacalcin. Indications: 1) hypercalcemia: start 200 IU every 12 hours; max 400 IU every 6 hours 2) Paget's disease 50-100 IU SC/IM QD 3) postmenopausal osteoporosis (see mechanism of action) a) 50-100 IU SC/IM QD b) give with adequate doses of Ca+2 & vitamin D c) 200 IU/day (nasal metered dose) d) FDA recommends against use of salmon calcitonin for treatment of postmenopausal osteoporosis [6,7] Contraindications: Pregnancy category: C 'salmon calcitonin' Safety in lactation: ? 'salmon calcitonin' Dosage: Skin test: 1) 1 unit/0.1 mL SC inner aspect of arm (dilution required) 2) observe injection site for 15 minutes for wheal or significant erythema Injection: 1) 0.5 mg SC or IM QD 2) volumes > 2 mL require IM injection Injection: 200 units/mL SC: tuberculin syringe 1 mL, 26 g, 3/8 inch IM: total volume > 2 mL, syringe 2.5-3 mL, 22 g needle, 1.5 inch Nasal metered dose: 1) 200 IU/day 2) alternate nostrils 200 IU/actuation. 2 mL, 14 doses. Pharmacokinetics: 1) 1/2 life 1 hour in plasma 2) duration of action is 8-24 hours after IM or SC injection 3) elimination plasma Adverse effects: 1) common (> 10%) - nausea/vomiting - anorexia - diarrhea - flushing of face - swelling at site of injection 2) less common (1-10%) - frequency of urination - with nasal administration - headache - nasal symptoms - dryness, nasal crusts, redness, sore nares 3) uncommon (< 1%) - skin rash, urticaria, chills, stuffy nose, weakness, paresthesias of hands & feet, swelling, nasal congestion, dizziness, shortness of breath 4) other - salty metallic taste - hypersensitivity reaction - increased risk of cancer [6,7] Mechanism of action: 1) inhibits osteoclastic bone resorption a) effect is largely on trabecular bone, not cortical bone b) decreases risk of vertebral fractures, not hip fractures 2) lowers serum Ca+2 concentrations 3) calcitonin also has analgesic properties 4) salmon calcitonin is more potent & has a longer duration of action than human calcitonin

General

calcitonin; contains: katacalcin; calcitonin carboxyl-terminal peptide; CCP; PDN-21 (CALC, CALC1) endocrine agent analgesic (antalgic)

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  3. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  4. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  5. UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  6. Physician's First Watch. March 7, 2013 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - FDA Advisory committee background document. March 5, 2013 http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/ReproductiveHealthDrugsAdvisoryCommittee/UCM341779.pdf
  7. Overman RA, Borse M, Gourlay ML. Salmon calcitonin use and associated cancer risk. Ann Pharmacother. 2013 Dec;47(12):1675-84. Review. PMID: 24259626