calcitonin Nursing Considerations & Management

calcitonin

(kal si toe’ nin)

calcitonin, human

Cibacalcin

calcitonin, salmon

Calcimar, Caltine (CAN), Miacalcin, Miacalcin Nasal Spray, Osteocalcin

Pregnancy Category C (human) 

Pregnancy Category B (salmon)

Drug classes

• Hormonal agent
• Calcium regulator

Therapeutic actions

The calcitonins are polypeptide hormones secreted by the thyroid; human calcitonin is a synthetic product classified as an orphan drug; salmon calcitonin appears to be a chemically identical polypeptide but with greater potency per milligram and longer duration; inhibits bone resorption; lowers elevated serum calcium in children and patients with Paget’s disease; increases the excretion of filtered phosphate, calcium, and sodium by the kidney.

Indications

• Human and salmon calcitonin: Paget’s disease
• Salmon calcitonin: Postmenopausal osteoporosis in conjunction with adequate calcium and vitamin D intake to prevent loss of bone mass
• Salmon calcitonin: Hypercalcemia, emergency treatment

Contraindications and cautions

• Contraindicated with allergy to salmon calcitonin or fish products, lactation.
• Use cautiously with renal insufficiency, osteoporosis, pernicious anemia.

Available forms

Injection (human)—1 mg/mL; injection (salmon)—200 IU/mL; nasal spray (salmon)—200 IU/actuation

Dosages

ADULTS

Calcitonin, human

• Paget’s disease: Starting dose of 0.5 mg/day subcutaneously; some patients may respond to 0.5 mg two to three times per week or 0.25 mg/day. Severe cases may require up to 1 mg/day for 6 mo. Discontinue therapy when symptoms are relieved.

Calcitonin, salmon

• Skin testing: 0.1 mL of a 10 IU/mL solution injected subcutaneously.
• Paget’s disease: Initial dose 100 IU/day IM or subcutaneously. For maintenance dose, 50 IU/day or every other day. Actual dose should be determined by patient response.
• Postmenopausal osteoporosis: 100 IU/day IM or subcutaneously, with supplemental calcium (calcium carbonate, 1.5 g/day) and vitamin D (400 units/day) or 200 IU intranasally daily.
• Hypercalcemia: Initial dose, 4 IU/kg q 12 hr IM or subcutaneously. If response is not satisfactory after 1–2 days, increase to 8 IU/kg q 12 hr; if response remains unsatisfactory after 2 more days, increase to 8 IU/kg q 6 hr.

PEDIATRIC PATIENTS

Safety and efficacy not established.

Pharmacokinetics

Metabolism: Renal; T_1/2: 43 min (salmon), 1 hr (human)

Distribution: May enter breast milk

Excretion: Urine

Adverse effects

• Dermatologic: Flushing of face or hands, rash
• GI: Nausea, vomiting
• GU: Urinary frequency (calcitonin-human)
• Local: Local inflammatory reactions at injection site (salmon), nasal irritation (nasal spray)

Nursing considerations

Assessment

• History: Allergy to salmon calcitonin or fish products, lactation, osteoporosis, pernicious anemia, renal disease
• Physical: Skin lesions, color, T; muscle tone; urinalysis, serum calcium, serum alkaline phosphatase and urinary hydroxyproline excretion

Interventions

• WARNING: Give skin test to patients with any history of allergies; salmon calcitonin is a protein, and risk of allergy is significant. Prepare solution for skin test as follows: Withdraw 0.05 mL of the 200 IU/mLsolution or 0.1 mL of the 100 IU/mL solution into a tuberculin syringe. Fill to 1 mL with sodium chloride injection. Mix well. Discard 0.9 mL, and inject 0.1 mL (approximately 1 IU) subcutaneously into the inner aspect of the forearm. Observe after 15 min; the presence of a wheal or more than mild erythema indicates a positive response. Risk of allergy is less in patients being treated with human calcitonin.
• Use reconstituted human calcitonin within 6 hr.
• Ensure that parenteral calcium is readily available in case hypocalcemic tetany develops.
• Monitor serum alkaline phosphatase and urinary hydroxyproline excretion prior to therapy and during first 3 mo and q 3–6 mo during long-term therapy.
• WARNING: Inject doses of more than 2 mL IM, not subcutaneously; use multiple injection sites.
• Refrigerate nasal spray until activated, then store at room temperature.

Teaching points

• This drug is given IM or subcutaneously; you or a significant other must learn how to do this at home. Refrigerate the drug vials.
• For intranasal use, alternate nostrils daily; notify health care provider if significant nasal irritation occurs.
• You may experience these side effects: Nausea, vomiting (this passes); irritation at injection site (rotate sites); flushing of the face or hands, rash.
• Report twitching, muscle spasms; dark urine; hives, rash; difficulty breathing.