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Last updated: Lupus Nephritis…
on 26 Aug 2016

Cinacalcet



Indication
  • Treatment of secondary hyperparathyroidism (HPT) in patients with end-stage renal disease (ESRD) on maintenance dialysis therapy
  • Reduction of hypercalcaemia in patients with:
  • Parathyroid carcinoma
  • Primary HPT for whom parathyroidectomy would be indicated on the basis of serum calcium levels (as defined by relevant treatment guidelines), but in whom parathyroidectomy is not clinically appropriate or is contraindicated
Preparations
  • Tablets: 30mg, 60mg, 90mg
Contraindications
  • Hypersensitivity to the active substance or to any of its excipients
Cautions
  • Monitor calcium
  • Avoid initiating if patient has hypocalcaemia - since Cinacalcet lowers serum calcium. It is essential that calcium is monitored regularly
  • Caution in patients with moderate to severe hepatic impairment
Side-effects
  • Nausea and vomiting are the most common side effects
  • Other side effects include dizziness, paraesthesia, rash
Dose
  • Secondary hyperparathyroidism: initial dose: 30 mg daily, titrate every 2 to 4 weeks, to a maximum daily dose of 180 mg. The aim is to achieve a target parathyroid hormone (PTH) of between 15.9-31.8 pmol/l in dialysis patients
  • Monitor PTH 1 to 4 weeks after initiation or dose adjustment. Monitor PTH approximately every 1-3 months during maintenance
  • Monitor calcium levels weekly after initiation and dose titration; less frequently when stable
  • Increase in bioavailability when taken with food
Dose in renal impairment
  • No dose adjustments in renal impairment. Not dialysed
Interactions
  • Metabolism of Cinacalcet is increased by tobacco
  • Ketoconazole inhibits metabolism → increase in Cinacalcet levels
How to Prescribe View Details
Patient comment
  • Take with the evening meal. This makes the drug more effective and also reduces gastro-intestinal side effects
  • PTH levels should be taken at least 12 hours after a dose

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