1 capsule

13 cents

liquid

$3.94/ml

  • Post-menopausal osteoporosis

  • Renal osteodystrophy

  • Secondary hyperparathyroidism

  • Hypoparathyroidism

  • Prevention of corticosteroid-induced osteoporosis


Note: initiation of calcitriol in ICU is rarely indicated and this therapy is often withheld while patients are critically ill (see PRECAUTIONS).

PO / NG:
Calcitriol-AFT 0.25mcg capsules (orange)
Rocaltrol solution 1mcg/ml (colourless to slightly yellowish oily solution). Mix with a drink (eg orange juice). Liquid is available if NG administration is deemed necessary.


ADULT DOSE
The optimal daily dose of calcitriol must be carefully determined for each patient. Calcitriol can be administered orally either as a capsule or as an oral solution.
Calcitriol therapy should always be started at the lowest possible dose and should not be increased without careful monitoring of serum calcium.
PO:
0.25mcg per day; increasing to up to 0.5mcg twice daily if required.

PAEDIATRIC DOSE
PO:
0.02mcg/kg daily oral, increase by 0.02mcg/kg every 4-8 weeks according to serum calcium (usual maximum 0.1mcg/kg)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY
Dose as in normal renal function

Calcitriol is a synthetic vitamin D analog which is active in the regulation of the absorption of calcium from the gastrointestinal tract and its utilization in the body.

CONTRAINDICATIONS:

  • Hypercalcaemia

  • Evidence of vitamin D toxicity

  • Known hypersensitivity to calcitriol


WARNINGS
Calcitriol is the most potent metabolite of vitamin D available. Excessive dosing can cause hypercalcaemia, hypercalciuria, and hyperphosphataemia.


Calcitriol increases inorganic phosphate levels in serum. While this is desirable in patients with hypophosphataemia, caution is called for in patients with renal failure because of the danger of ectopic calcification. A non-aluminum phosphate-binding compound and a low-phosphate diet should be used to control serum phosphorus levels in patients undergoing dialysis.

PRECAUTIONS
General
Excessive dosage of calcitriol induces hypercalcaemia. Should hypercalcaemia develop, treatment with calcitriol should be stopped immediately. Immobilised patients, e.g., the critically ill, are particularly exposed to the risk of hypercalcaemia which is why this medication is often withheld in ICU.

Laboratory Tests:
No tests in addition to routine ICU tests are required

Drug/Laboratory Test Interactions:
None known

Thiazides:
Thiazides are known to induce hypercalcaemia by the reduction of calcium excretion in urine. Some reports have shown that the concomitant administration of thiazides with calcitriol causes hypercalcaemia. Therefore, precaution should be taken when coadministration is necessary.
Digitalis:
Calcitriol dosage must be determined with care in patients undergoing treatment with digitalis, as hypercalcaemia in such patients may precipitate cardiac arrhythmias.

Since calcitriol is believed to be the active hormone which exerts vitamin D activity in the body, adverse effects are, in general, similar to those encountered with excessive vitamin D intake, i.e., hypercalcaemia syndrome or calcium intoxication (depending on the severity and duration of hypercalcaemia) (see WARNINGS). The early and late signs and symptoms of vitamin D intoxication associated with hypercalcaemia include:
Early:
Weakness, headache, somnolence, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain, metallic taste, and anorexia.
Late:
Polyuria, polydipsia, anorexia, weight loss, nocturia, conjunctivitis (calcific), pancreatitis, photophobia, rhinorrhea, pruritus, hyperthermia, decreased libido, elevated Cr, albuminuria, hypercholesterolemia, elevated AST and ALT, ectopic calcification, nephrocalcinosis, hypertension, cardiac arrhythmias, dystrophy, sensory disturbances, dehydration, apathy, arrested growth, urinary tract infections, and, rarely, overt psychosis.

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