Cinacalcet dosing

The most effective way to use cinacalcet with other therapies has not been decided. The starting dose is 30 mg daily, which can be titrated to the desired PTH and calcium concentrations every 3 to 4 weeks and to a maximum of 180 mg daily. 

Cinacalcet (Sensipar) [Hyperparathyroidism Agent/ Calcimimetic] Uses Secondary hyperparathyroidism in CRF T Ca2+ in parathyroid carcinoma Action 4- PTH by T Ca-sensing receptor sensitivity Dose ... 

CINACALCET BUPROPION T plasma concentrations of these substrates, with risk of toxic effects Bupropion and its metabolite hydroxybupropion inhibit CYP2D6 Initiate therapy of these drugs, particularly those with a narrow therapeutic index, at the lowest effective dose. Interaction is likely to be important with substrates for which CYP2D6 is considered the only metabolic pathway (e.g. hydrocodone, oxycodone, desipramine, paroxetine, chlorpheniramine, mesoridazine, alprenolol, amphetamines, atomoxetine)... 

Cinacalcet lowers serum calcium and may cause hypocalcemia therefore this agent should not be started if the serum calcium is less than the lower limit of normal, approximately 8.4 mg/dL. Serum calcium should be measured within 1 week after initiation or dose adjustment of cinacalcet. Once the maintenance dose has been estab-... 

Drug-Drug and Drug-Food Interactions. Since cinacalcet is metabolized by multiple hepatic enzymes there is potential for drug interactions. Cinacalcet is also a potent inhibitor of the enzyme CYP2D6. As a result, dose adjustments of concomitant medications that are predominantly metabolized by this enzyme and have a narrow therapeutic index such as flecainide, thioridazine, vinblastine, and most tricyclic antidepressants (i.e., amitriptyline) may be required. ... 

Dosing and Administration. The recommended starting oral dose of cinacalcet is 30 mg once daily. The dose should be titrated every 2 to 4 weeks to a maximum dose of 180 mg once daily to achieve the desired PTH levels and maintain near normal serum calcium concentrations. Patients with hepatic disease may require lower doses, as studies have shown a decrease in metabolism of cinacalcet in this patient population. Cinacalcet is available as a film-coated tablet containing 30, 60, or 90 mg. 

A review of the use of cinacalcet HCl for secondary hyperparathyroidism is provided in Chap. 44. Cinacalcet HCl is administered at a starting dose of 30 mg given orally twice daily for the treatment of parathyroid carcinoma. The dosage is titrated every 2 to 4 weeks in 30-mg increments twice daily. The maximum approved dosage is 90 mg three to four times daily. 

Cinacalcet is available in 30-, 60-, and 90-mg tablets. Optimal doses have not been defined. The recommended starting dose for treatment of secondary hyperparathyroidism in patients with chronic kidney disease on dialysis is 30 mg once daily, with a maximum of 180 mg/day. For treatment of parathyroid carcinoma, a starting dose of 30 mg twice daily is recommended, with a maximum of 90 mg four times daily. The starting dose is titrated upward every 2 to 4 weeks to maintain the PTH level between 150 and 300 pg/mL (secondary hyperparathyroidism) or to normalize serum calcium (parathyroid carcinoma). The principal adverse event with cinacalcet is hypocalcemia. Thus, the drug should not be used if the initial serum calcium concentration is less than 8.4 mg/dL serum calcium and phosphorus concentrations should be measured within 1 week, and PTH should be measured within 4 weeks after initiating therapy or after changing dosage. 

The principal adverse effect of cinacalcet is hypocalcemia. The drug should not be used if the initial serum calcium is <8.4 mg/dL serum calcium and phosphate concentrations should be measured within one week and PTH should be measured within 4 weeks of therapy initiation. Adynamic bone disease may develop in patients with secondary hyperparathyroidism, so the drug should be discontinued or the dose decreased if the PTH level falls below 150 pg/mL. 

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