Calcitonin

To make sure you are not allergic to calcitonin, your doctor may perform an allergy skin test before your first dose of this medicine.

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Calcitonin nasal comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Store unopened calcitonin nasal in the refrigerator but do not allow it to freeze.

Once you put the bottle and pump assembly together, you may keep the medicine at room temperature, away from light and heat. Store the bottle upright with the pump attached.

Before your first use of the assembled bottle and pump, you must prime the spray. Allow the medicine to reach room temperature before priming.

To prime calcitonin nasal, press the pump at least 5 times until a fine mist appears. Prime the spray only before your first use of the newly assembled bottle.

To use the nasal spray:

• Blow your nose gently. Keep your head upright and insert the tip of bottle into one nostril. Hold the nasal spray upright with your first and second fingers on each side of the pump and your thumb on the bottom of the bottle.
• Pump the spray unit firmly to spray the medicine into your nostril. You do not need to sniff or inhale deeply.
• Do not blow your nose for at least a few minutes after using the nasal spray.
• If the spray gets in your eyes or mouth or on your skin, rinse with water.

Calcitonin nasal is usually given as one spray per day into only one of your nostrils. Use the other nostril the next day and continue alternating back and forth for each daily dose.

Calcitonin nasal spray delivers a fine mist into the nose. Even if you do not feel the spray while using it, the medication is still being absorbed by your nasal passages.

Each bottle contains 30 doses of calcitonin nasal. Throw away the medicine after 30 uses, even if there is still medicine left in the bottle.

To be sure this medication is not causing harmful side effects to the inside of your nose, your doctor may want to check your nasal passages often.

Your doctor may have you take extra vitamin D while you are using calcitonin nasal. Take only the amount of vitamin D that your doctor has prescribed.

To make sure you are not allergic to calcitonin, your doctor may perform an allergy skin test before your first dose.

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Calcitonin is injected under the skin or into a muscle. You may be shown how to use injections at home. Do not self-inject this medicine if you do not understand how to give the injection and properly dispose of used needles and syringes.

Use a disposable needle only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

Use calcitonin regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Calcitonin injection is not a cure for Paget's disease. You may have a relapse, especially if your body forms antibodies and you become immune to calcitonin.

Call your doctor if your symptoms do not improve, or if they get worse while using calcitonin.

Your doctor may want you to take extra calcium and vitamin D while you are using calcitonin. Take only the amounts of calcium and vitamin D your doctor has prescribed.

Store in the refrigerator, do not freeze.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

Calcitonin is part of the drug class:

• Calcitonin preparations

No calcitonin interactions have been identified, however, you should tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Not all drug interactions are known or reported and new drug interactions are continually being reported.

Calcitonin is not approved for premenopausal women, including women who are breastfeeding. It is not known if calcitonin is excreted in human breast milk or if it will harm your nursing baby.

Nasal Spray:

The recommended dose of calcitonin is one spray daily in alternated nostrils, unless directed otherwise by your healthcare provider. Start with a spray in the left nostril on your first day, followed by a spray in the right nostril on the second day. Continue to alternate nostrils every day. There are at least 30 “doses” of calcitonin in each bottle.

You should keep track of the number of doses used from the bottle.

After 30 doses, each spray may not deliver the correct amount of medication, even if the bottle is not completely empty.

When taking calcitonin, it is recommended that you get at least 1000 mg of calcium and 400 I.U. (International Units) of vitamin D each day. Check with your doctor or healthcare provider to see if you are getting enough calcium and vitamin D in your diet. If not, he or she may recommend that you start taking calcium and vitamin D supplements.

If you take too much calcitonin, call your local Poison Control Center or seek emergency medical attention right away. Symptoms of overdose include:

• muscle twitches
• seizures
• irregular heart rhythm

General

Paget’s Disease of Bone

• Monitor by periodic determinations of serum alkaline phosphatase and urinary hydroxyproline excretion as well as evaluation of symptoms.125

• Investigate possibility of antibody formation in any patient who shows initial response but subsequently relapses.125

Postmenopausal Osteoporosis

• Monitor BMD.125 127 145

Administration

Administer by sub-Q or IM injection (Paget’s disease of bone, hypercalcemia, postmenopausal osteoporosis)125 or intranasally (postmenopausal osteoporosis).127 145

IM Administration

IM injection preferred when injection volume >2 mL.125

Use multiple sites of injection when volume >2 mL.125

Sub-Q Administration

Sub-Q injection preferred for patient self-administration.125

Intranasal Administration

Administer once daily (as a single spray in 1 nostril) using metered-dose spray pump supplied by manufacturer.127 145 Alternate nostrils daily.127 145

Allow solution to reach room temperature before priming pump and administering first dose.127 145

Prime pump before first dose; do not prime before each dose.127 145

Miacalcin: To prime pump, hold bottle upright and depress the 2 white side arms of pump toward the bottle until full spray is produced.127

Fortical: To prime pump, hold bottle upright and depress the 2 white side arms of pump toward the bottle at least 5 times until full spray is produced.145

Administer dose by placing nozzle in nostril with head in upright position and firmly depressing pump toward bottle.127 145

Discard spray pump after 30 actuations, since the correct drug dose per actuation cannot be assured if used for additional doses.127

Dosage

Activity of calcitonin salmon expressed in terms of International Units (units).125 127 145

Intranasal spray pumps deliver 0.09 mL of solution per actuation; each 0.09-mL spray delivers 200-unit dose.127 145

Adults

Initial dosage: 100 units (0.5 mL) daily.125

Maintenance: 50 units (0.25 mL) daily or every other day; higher dosage (100 units daily) appropriate in patients with serious deformity or neurologic involvement.125

Dosage >100 units daily usually does not produce an improved response in patients who relapse while receiving calcitonin.101 105 109 110 111 112 125

Initially, 4 units/kg every 12 hours; may increase dosage after 1 or 2 days (if response not adequate) to 8 units/kg every 12 hours; may further increase dosage after 2 days (if response not adequate) to 8 units/kg every 6 hours.125

Minimum effective dosage not established; 100 units every other day may be effective in preserving vertebral BMD.125

200 units (1 spray) daily.127 145

Prescribing Limits

Adults

Maximum 8 units/kg every 6 hours.125

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

• Fortical [DSC]
• Miacalcin

Refer to adult dosing.

Data not available