Calcitonin injectable

The polypeptide calcitonin is secreted by thyroid C-cells during imminent hypercalcemia. It lowers plasma Ca + levels by inhibiting osteoclast activity. Its uses include hypercalcemia and osteoporosis. Remarkably, calcitonin injection may produce a sustained analgesic effect that is not restricted to bone pain. 

Roxatidine acetate hydrochloride Roxithromycin Saccharomyces boulardi Saccharomyces boulardil Salinomycin Salmetrol xinofate Salmon calcitonin injection Saquinavir capsules Secnidazole... 

One method of treatment is to inject calcitonin, which decreases blood Ca " concentration and increases bone calcification (33). Another is to increase the release of calcitonin into the blood by increasing the blood level of Ca " ( 4). This latter treatment is accompHshed by increasing Ca " absorption from the intestine requiring dietary calcium supplements and avoidance of high phosphate diets. The latter decrease Ca " absorption by precipitation of the insoluble calcium phosphate. 

Calcitonin, LHRH, lypressin, and somatostatin have been formulated in lactide/glycolide copolymers as injectable, controlled release formulations (117). Various agonistic and antagonistic analogs have been studied. Generally these compounds are hydrophilic polypeptides,... 

Caldtonin (p. 264) inhibits osteoclast activity, hence bone resorption. As a peptide it needs to be given by injection (or, alternatively, as a nasal spray). Salmonid is more potent than human calcitonin because of its slower elimination. 

Calcitonin is also moderately effective in Paget s disease, but requires regular subcutaneous or intramuscular injection. Mithramycin has been used with some success, but is relatively toxic, and its use requires careful monitoring of blood counts to avoid marrow suppression, so it is rarely used in current practice. 

Calcitonin (Miacalcin, Miacalcin Nasal Spray) is a synthetic 32-amino acid polypeptide that is identical to salmon calcitonin. Salmon calcitonin is more potent than human calcitonin because of its higher affinity for the human calcitonin receptor and its slower metabolic clearance. Administration is by subcutaneous or intramuscular injection or by nasal spray. The absorption of the nasal form is slower than that of the parenteral routes. 

With the exception of the possible development of a hypervitaminosis associated with high-dose administration of vitamin D2 or D3, the compounds discussed in this chapter are relatively safe. Allergic reactions to the injection of calcitonin and PTH have occurred and chronic use of some bisphosphonates has been associated with the development of osteomalacia. The principal side effects of intravenous bisphosphonates are mild and include low-grade fever and transient increases in serum creatinine and phosphate levels. Oral bisphosphonates are poorly absorbed and can cause esophageal and gastric ulceration. They should be taken on an empty stomach the individual must remain upright for 30 minutes after ingestion. 

Novartis (2002). Miacalcin (Calcitonin-Salmon) T2002-84 89018101. Available at www. http //www.pharma.us.novartis.com/product/pi/pdf/miacalcin injection.pdf search = %22 Miacalcin%20(Calcitonin-Salmon)%20T2002-84%2089018101%22 downloaded 10/04/ 2006. 

A second aCGRP-deficient mouse was produced by Hoff et al. (1998) in order to study the role of calcitonin. CGRP mice are born normally, are fertile and live a normal life span. These mice were tested in a model of chronic arthritis, where a mixture of kaolin/carrageenan was injected into the knee joint and in comparison to wild type mice failed to develop secondary hyperalgesia (Zhang et al., 2001). 

Rash and pruritus can occur at the site of subcutaneous injections of calcitonin (18). 

The adverse effects of parenteral and intranasal calcitonin have been compared (22). Parenteral salmon calcitonin is commonly associated with flushing of the face, ears, hands, and feet within minutes of the injection. Nausea and vomiting can occur within 30 minutes. The flushing needs to be distinguished from the less common but serious and potentially fatal hypersensitivity reactions that have been reported. The nausea, which is mild, usually abates with continued therapy. Intranasal calcitonin is better tolerated rhinitis of mild or moderate severity is the most frequent adverse effect. 

Nishi Y, Hamamoto K, Kajiyama M, Ono H, Kihara M, Jinno K. Effect of long-term calcitonin therapy by injection... 

The major location of calcium in the body is in the skeleton, which contains more than 90% of the body calcium as phosphate and carbonate. Bone resorption and formation keeps this calcium in dynamic equilibrium with ionized and complexed calcium in blood, cellular fluids and membranes. Homeostasis is mainly regulated by the parathyroid hormone and vitamin D which lead to increased blood calcium levels, and by a thyroid hormone, calcitonin, which controls the plasma calcium concentration J5 Increasing the concentration of calcitonin decreases the blood calcium level, hence injections of calcitonin are used to treat severe hyperalcaemia arising from hyperparathyroidism, vitamin D intoxication or the injection of too high a level of parathyroid extract. High levels of calcitonin also decrease resorption of calcium from bone. Hypocalcaemia stimulates parathyroid activity, leading to increased release of calcium from bone, reduction in urinary excretion of calcium and increased absorption of calcium from the intestine. Urinary excretion of phosphate is enhanced. 

Transmucosal delivery of salmon calcitonin (sCT) via the buccal route was studied using a mucoadhesive bilayer thin-film composite (TFC) [104], In vitro studies showed that over 80% of sCT was released from the TFCs within 240 min. The relative bioavailability for rabbits treated with the film composites was 43.8% + 10.9% as compared to intravenous injection. 

Calcitonin is a peptide hormone produced in the thyroid gland that serves to lower serum calcium and phosphate levels by inhibiting bone resorption. Calcitonin has been used in the treatment of a variety of diseases, such as primary hyperparathyroidism, Paget s disease, and postmenopausal osteoporosis [99,100]. Salmon calcitonin has a longer half-life than human calcitonin. Salmon calcitonin, 3.6 kDa, is available as a nasal formulation that contains only benzalkonium chloride as a preservative, without an absorption enhancer, and as a parenteral product for injection. The direct effect of benzalkonium chloride on the nasal mucosa is under... 

In the past, calcitonin was administered by injection (intramuscular or subcutaneous), but aerosolized versions of calcitonin are now available that allow delivery in the form of nasal sprays.51,68 Oral delivery of calcitonin is difficult because this hormone is absorbed poorly from the gastrointestinal (GI) tract and because calcitonin is degraded by proteolytic enzymes in the stomach.57 Nonetheless, efforts are being made to overcome these limitations, and an oral form of calcitonin may be available someday.62... 

Hence, calcitonin has emerged as an effective and easy way to treat a variety of conditions that are characterized by increased bone resorption.59,82 Calcitonin preparations used clinically are either identical to the human form of this hormone (Cibacalcin) or chemically identical to salmon calcitonin (Calcimar, Miacal-cin). Redness and swelling may occur locally when these agents are administered by injection. Other side effects include gastrointestinal disturbances (stomach pain, nausea, vomiting, and diarrhea), loss of appetite, and flushing or redness in the head, hands, and feet. 

Other Systemic Effects. Other systemic effects have been observed. Barium sulfate was observed to act as an appendocolith in two cases following barium enema procedures (Palder and Dalessandri 1988). This is a rare occurrence and probably not significant in cases of human barium toxicity. Intravenous injection of barium sulfate into pigs increased calcitonin secretion from the thyroid (Pento 1979). This is probably not a significant effect for humans since intravenous exposure is not a common route and the dose required was so high (1.7 mg/kg/minute for 20 minutes) it caused cardiotoxicity. 

Calcitonin is also another option that may be used if a patient cannot take bisphosphonates. It is administered intranasally or via subcutaneous or intramuscular injection. It is usually only prescribed in specialist clinics. 

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