Paricalcitol

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Paricalcitol Brand Name– Zemplar

What is Paricalcitol

Paricalcitol is a synthetic, biologically active analog of calcitriol. Intravenous paricalcitol is indicated for the treatment and prevention of secondary hyperparathyroidism associated with chronic kidney disease (CKD) stage 5 (chronic renal failure requiring dialysis).

Oral paricalcitol is indicated for the treatment and prevention of secondary hyperparathyroidism associated with CKD stage 3 and 4 and CKD stage 5 patients requiring dialysis.

Vitamin D is a fat-soluble vitamin, which is found in 2 forms, vitamin D3 or calcitriol, and vitamin D2. Both forms of vitamin D have effects on calcium absorption from the intestine and through bone resorption.

Paricalcitol is approximately 10-fold less active than calcitriol in promoting resorption of calcium and phosphorus from the bone and does not increase absorption from the GI tract.

Paricalcitol decreases parathyroid hormone (PTH) concentrations but has a lower incidence of hypercalcemia and hyperphosphatemia than calcitriol; the relative dosing of paricalcitol to calcitriol is 4:1.

Chronic renal failure patients with secondary hyperparathyroidism treated with intravenous paricalcitol for 12 weeks achieved more than a 50% decrease in PTH concentrations.

There was no significant change in serum calcium and phosphorus concentrations in the paricalcitol-treated patients compared to placebo.

Similarly, 91% of patients treated with oral paricalcitol for 24 weeks achieved 2 consecutive reductions in PTH concentrations of 30% or more relative to baseline; there was no significant difference in the incidence of hypercalcemia or hyperphosphatemia between paricalcitol- and placebo-treated patients.

Indications

  • hyperparathyroidism
  • renal osteodystrophy

For the prevention and treatment of secondary hyperparathyroidism and resultant metabolic bone disease (renal osteodystrophy†)

NOTE: Dosage adjustments should be determined based on serum calcium, serum phosphorous, and serum or plasma iPTH concentrations. Initially and following a dosage adjustment, serum calcium, serum phosphorous, and serum or plasma iPTH concentrations should be monitored at least every 2 weeks for 3 months, monthly for 3 months, and then every 3 months thereafter.

Side Effects

  1. abdominal pain
  2. acne vulgaris
  3. agitation
  4. alopecia
  5. anemia
  6. angioedema
  7. anxiety
  8. arrhythmia exacerbation
  9. arthralgia
  10. asthenia
  11. atrial flutter
  12. back pain
  13. bone fractures
  14. bowel ischemia
  15. cardiac arrest
  16. chest pain (unspecified)
  17. chills
  18. confusion
  19. conjunctivitis
  20. constipation
  21. cough
  22. dehydration
  23. delirium
  24. depression
  25. diarrhea
  26. dizziness
  27. dysgeusia
  28. dysphagia
  29. dyspnea
  30. edema
  31. elevated hepatic enzymes
  32. fatigue
  33. fever
  34. gastritis
  35. gastroesophageal reflux
  36. GI bleeding
  37. headache
  38. hirsutism
  39. hypercalcemia
  40. hypercalciuria
  41. hyperemia
  42. hyperkalemia
  43. hyperphosphatemia
  44. hypertension
  45. hypervitaminosis D
  46. hypocalcemia
  47. hypoesthesia
  48. hypoglycemia
  49. hypotension
  50. impotence (erectile dysfunction)
  51. infection
  52. influenza
  53. injection site reaction
  54. insomnia
  55. laryngeal edema
  56. lymphadenopathy
  57. malaise
  58. muscle cramps
  59. myalgia
  60. myoclonia
  61. nausea
  62. new primary malignancy
  63. night sweats
  64. ocular hypertension
  65. palpitations
  66. paresthesias
  67. peripheral edema
  68. pharyngitis
  69. prolonged bleeding time
  70. pruritus
  71. pulmonary edema
  72. rash
  73. renal failure (unspecified)
  74. restlessness
  75. rhinitis
  76. sinusitis
  77. skin ulcer
  78. syncope
  79. urinary urgency
  80. urticaria
  81. vertigo
  82. vomiting
  83. weight loss
  84. wheezing
  85. xerostomia

Monitoring Parameters

  • serum calcium
  • serum intact parathyroid hormone concentrations (iPTH)
  • serum phosphate

Contraindications

  • breast-feeding
  • hypercalcemia
  • hypervitaminosis D
  • pregnancy

Interactions

  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Aliskiren; Hydrochlorothiazide, HCTZ
  • Aluminum Hydroxide
  • Aluminum Hydroxide; Magnesium Carbonate
  • Aluminum Hydroxide; Magnesium Hydroxide
  • Aluminum Hydroxide; Magnesium Hydroxide; Simethicone
  • Aluminum Hydroxide; Magnesium Trisilicate
  • Amiloride; Hydrochlorothiazide, HCTZ
  • Amiodarone
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Amprenavir
  • Aprepitant, Fosaprepitant
  • Atazanavir
  • Atazanavir; Cobicistat
  • Atenolol; Chlorthalidone
  • Azilsartan; Chlorthalidone
  • Benazepril; Hydrochlorothiazide, HCTZ
  • Bendroflumethiazide; Nadolol
  • Bisoprolol; Hydrochlorothiazide, HCTZ
  • Boceprevir
  • Bosentan
  • Burosumab
  • Calcifediol
  • Calcitonin
  • Calcitriol
  • Calcium
  • Calcium Acetate
  • Calcium Carbonate
  • Calcium Carbonate; Magnesium Hydroxide
  • Calcium Carbonate; Risedronate
  • Calcium Carbonate; Simethicone
  • Calcium Chloride
  • Calcium Gluconate
  • Calcium; Vitamin D
  • Candesartan; Hydrochlorothiazide, HCTZ
  • Captopril; Hydrochlorothiazide, HCTZ
  • Carbamazepine
  • Ceritinib
  • Chloramphenicol
  • Chlorothiazide
  • Chlorthalidone
  • Chlorthalidone; Clonidine
  • Cholestyramine
  • Chromium
  • Clarithromycin
  • Cobicistat
  • Colestipol
  • Conivaptan
  • Danazol
  • Darunavir
  • Darunavir; Cobicistat
  • Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
  • Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
  • Delavirdine
  • Digoxin
  • Dihydrotachysterol
  • Diltiazem
  • Doxercalciferol
  • Dronedarone
  • Efavirenz
  • Efavirenz; Emtricitabine; Tenofovir
  • Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
  • Elbasvir; Grazoprevir
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
  • Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
  • Enalapril; Hydrochlorothiazide, HCTZ
  • Eprosartan; Hydrochlorothiazide, HCTZ
  • Erythromycin
  • Erythromycin; Sulfisoxazole
  • Fluconazole
  • Fluoxetine
  • Fluoxetine; Olanzapine
  • Fosamprenavir
  • Fosinopril; Hydrochlorothiazide, HCTZ
  • grapefruit juice
  • Hetastarch; Dextrose; Electrolytes
  • Hydantoins
  • Hydralazine; Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ
  • Hydrochlorothiazide, HCTZ; Irbesartan
  • Hydrochlorothiazide, HCTZ; Lisinopril
  • Hydrochlorothiazide, HCTZ; Losartan
  • Hydrochlorothiazide, HCTZ; Methyldopa
  • Hydrochlorothiazide, HCTZ; Metoprolol
  • Hydrochlorothiazide, HCTZ; Moexipril
  • Hydrochlorothiazide, HCTZ; Olmesartan
  • Hydrochlorothiazide, HCTZ; Propranolol
  • Hydrochlorothiazide, HCTZ; Quinapril
  • Hydrochlorothiazide, HCTZ; Spironolactone
  • Hydrochlorothiazide, HCTZ; Telmisartan
  • Hydrochlorothiazide, HCTZ; Triamterene
  • Hydrochlorothiazide, HCTZ; Valsartan
  • Ibritumomab Tiuxetan
  • Idelalisib
  • Imatinib
  • Indinavir
  • Iron Sucrose, Sucroferric Oxyhydroxide
  • Isavuconazonium
  • Itraconazole
  • Ketoconazole
  • Lesinurad
  • Lesinurad; Allopurinol
  • Letermovir
  • Lopinavir; Ritonavir
  • Lumacaftor; Ivacaftor
  • Magnesium
  • Magnesium Citrate
  • Magnesium Hydroxide
  • Magnesium Salts
  • Methyclothiazide
  • Metolazone
  • Mineral Oil
  • Mitotane
  • Nefazodone
  • Nelfinavir
  • Nevirapine
  • Nicardipine
  • Nilotinib
  • Ombitasvir; Paritaprevir; Ritonavir
  • Oritavancin
  • Orlistat
  • Pazopanib
  • Phosphorated Carbohydrate Solution
  • Phosphorus
  • Polycarbophil
  • Posaconazole
  • Potassium Phosphate
  • Potassium Phosphate; Sodium Phosphate
  • Protease inhibitors
  • Ranolazine
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifamycins
  • Ritonavir
  • Rufinamide
  • Saquinavir
  • Simeprevir
  • St. John’s Wort, Hypericum perforatum
  • Telaprevir
  • Telithromycin
  • Telotristat Ethyl
  • Thiazide diuretics
  • Tipranavir
  • Trandolapril; Verapamil
  • Tucatinib
  • Vemurafenib
  • Verapamil
  • Voriconazole
  • Zafirlukast
  • Zileuton

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