Calcitriol

Indications & Dose:

Renal osteodystrophy

• BY MOUTH

Adult: Initially 250 nanograms daily, adjusted in steps of 250 nanograms every 2–4 weeks if required; usual dose 0.5–1 microgram daily 

•  BY INJECTION

0.5 µg (0.01 uglkg)  three times weekly by IV, approximately every other day  at the end of hemodialysis..

Renal osteodystrophy (in patients with normal or only slightly reduced plasma-calcium concentration)

• BY MOUTH

Adult: Initially 250 nanograms once daily on alternate days, adjusted in steps of 250 nanograms every 2–4 weeks if required; usual dose 0.5–1 microgram daily

Established postmenopausal osteoporosis

• BY MOUTH

Adult: 250 nanograms twice daily, plasma-calcium concentration and creatinine to be monitored (consult product literature) 

Contraindications:

 Hypercalcaemia vit D toxicity. 

Side Effects:

1) Hypersensitivity: Rarely hypersensitivity reactions including anaphylaxis and local reddening at injection site have been reported.

2) Vitamin D toxicity Adverse effects of Bonky (Calcitriol injection) are, in general, similar to those encountered with excessive vitamin D intake. The early and late signs and symptoms of vitamin D intoxication associated with hypercalcemia include.

(1)Early: Weakness, headache, somnolence, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain and metallic taste.

(2) Late: Polyuria, polydipsia, anorexia, weight loss, nocturia, conjuctivitis (calcific), pancreatitis, photophobia, rhinorrhea, pruritus, hyperthermia,decreased libido, elevated BUN, albuminura, hypercholesterolemia, elevated AST and ALT, ectopic calcification, hypertension, cardiac arrhythmias and, rarely, overt psychosis.

3) Occasional mild pain on injection has been observed. 

Cautions:

Precautions:

Maintain adequate calcium intake. Pregnancy, Lactation. Monitor serum calcium, phosphorous levels regularly; discontinue if hypercalcaemia occurs.

PRECAUTIONS: When the optimal daily dosage of this drug has been determined, serum calcium concentrations should be checked every month. If the serum calcium concentrations rise by 1 mg/100 ml than normal (average 9-11 mg/100ml), immediately, the dosage of the drug should be substantially reduced or treatment should be stopped altogether until normocalcemia ensues. Withdrawal of calcium supplements may be useful in rapidly reestablishing normocalcemia. Careful consideration should also be given to lowering the dietary calcium intake. During the periods of hypercalcemia, serum calcium and phosphate levels must be measured daily. When normal levels have been attained, the treatment with the drug should be continued, at a daily dose of 0.25 µg lower than that previously used. 

Interaction:

Warnings:

Adverse Effects:

Lactations:

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: