Calcitriol

DEA Class; Rx

Common Brand Names; Calcijex, Rocaltrol, Vectical

• Vitamin D Analogs
• Antipsoriatics, Topical

Active form of vitamin D3 (cholecalciferol)
Used for secondary hyperparathyroidism, metabolic bone disease in chronic renal failure patients not receiving dialysis, hypoparathyroidism, familial hypophosphatemia, and vitamin D-dependent rickets
More than twice the vitamin D activity of calcifediol

Hypercalcemia or evidence of vitamin D toxicity

Hypersensitivity to calcitriol, other vitamin D analogues, or other ingredients

• Abdominal pain
• Apathy
• BUN and creatinine increased
• Cardiac arrhythmia
• Constipation
• Dry mouth
• Dehydration
• Growth suppression
• Headache
• Hyperthermia
• Hypercalcemia
• Hypercholesteremia
• Hypermagnesemia
• Hyperphosphatemia
• Hypertension
• Libido decreased
• Metallic taste
• Muscle or bone pain
• N/V
• Nocturia
• Pruritus
• Psychosis
• Somnolence
• Weakness

Other vitamin D compounds should be withheld during treatment in order to avoid the development of hypervitaminosis D; excessive vitamin D may suppress parathyroid hormone

If patients are “changed over” from ergocalciferol to calcitriol it may take many months for blood levels of ergocalciferol to return to pre-treatment values; overdosage of any form of vitamin D is dangerous; chronic hypercalcemia can lead to generalised vascular calcification, nephrocalcinosis and other soft-tissue calcification

Patients with hypophosphatemic rickets (familial hypophosphatemia) should pursue their oral phosphate therapy; however, the possible stimulation of intestinal phosphate absorption may modify the requirement for phosphate supplements; during the stabilisation phase of treatment, serum calcium levels should be checked at least twice weekly

Efficacy may be unpredictable in patients with malabsorption syndrome

Sudden increases in calcium consumption due to dietary change (eg, dairy products) or injudicious calcium supplements may precipitate hypercalcaemia; patients and relatives should receive instruction in dietary management, be informed about symptoms of hypercalcaemia, and be warned of consequences of not adhering to dietary recommendations

In patients with normal renal function, chronic hypercalcaemia may be associated with an increase in serum creatinine

Therapy raises serum inorganic phosphate levels; while this is a desirable effect in patients with hypophosphatemic states, caution must be taken in patients with renal failure

Calcitriol may increase plasma phosphate levels; while this effect is desirable in hypophosphatemic osteomalacia, it may cause ectopic calcification, especially in patients with renal failure; plasma phosphate levels should be kept normal in such patients by the oral administration of phosphate binding agents

Patients with normal renal function should avoid dehydration; adequate fluid intake should be maintained

Use caution in malabsorption syndrome, renal/hepatic impairment

Patients immobilized after surgical procedures are more at risk of developing hypercalcaemia, therefore more frequent monitoring is recommended

Special care should be taken when administering therapy to patients with renal dysfunction; more frequent monitoring in these patients is appropriate

In elderly patients suffering from ischemic heart disease, serum calcium levels should be carefully monitored; if hypercalcemia is observed, therapy should be suspended immediately; it should also be remembered that geriatric patients receive many other drugs and that their compliance may not be ideal

Pregnancy category: C

Lactation: Enters breast milk; not recommended

200 g ointment/week topically. Specific maximum dosage information for systemic use is not available; individualize dosage based on clinical parameters.

200 g ointment/week topically. Specific maximum dosage information for systemic use is not available; individualize dosage based on clinical parameters.

200 g ointment/week topically. Specific maximum dosage information for systemic use is not available; individualize dosage based on clinical parameters.

7 to 12 years: 200 g ointment/week topically. Specific maximum dosage information for systemic use is not available; individualize dosage based on clinical parameters.
2 to 6 years: 100 g ointment/week topically. Specific maximum dosage information for systemic use is not available; individualize dosage based on clinical parameters.

Safety and efficacy of the topical ointment have not been established. Specific maximum dosage information for systemic use is not available; individualize dosage based on clinical parameters.

Safety and efficacy have not been established; however, 0.25 mcg/day PO has been used off-label.

Calcitriol

capsule

• 0.25mcg

• 0.5mcg

oral solution

• 1mcg/mL

injectable solution

• 1mcg/mL

topical ointment

• 3mcg/g