Flushing calcitonin

Calcitonin 4-8 lU/kg SQ or IM q6-12 hours 2-4 hours 1-3 days 2-3 mg/dL Salmon-derived formulation preferred 1-unit test dose recommended can be given in renal failure may cause flushing, nausea. 

Calcitonin 4 unitykg eveiy 12 hours SC/IM 10-12 units/hour IV 1-2 hours Allergy to calcitonin Facial flushing nausea/vomiting allergic reaction... 

Flushing occurs soon after administration of calcitonin in up to 20% of patients and usually settles within several minutes (10). 

A 46-year-old woman with low back pain and osteoporosis took salmon calcitonin subcutaneously 100 U/ day and calcium carbonate orally 1.5 g/day for 7 days before developing nausea and facial flushing (13). Calcitonin was continued for a further 8 days and then stopped. The next day she developed intermittent generalized convulsions. She was subsequently found to have breast cancer with skeletal metastases and hypercalcemia (3.9 mmol/1) without a reduced... 

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. 

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. 

Side effects of calcitonin are nausea, vomiting and diarrhoea together with flushing, paraesthesia and a peculiar taste in the mouth. 

Calcitonin therapy requires the concomitant oral administration of elemental calcium (500 mg/day). Clinical studies have shown that the combination of intranasal calcitonin salmon (200 lU/day), oral calcium supplementation (>1,000 mg/day of elemental calcium), and vitamin D (400 lU/day) has decreased the rate of new fractures by more than 75% and has improved vertebral BMD by as much as 3% annually (3). Calcitonin prevents the abnormal bone turnover characteristic of Paget s disease of the bone and has antiresorptive activity. In the presence of calcitonin, the osteoclast brush borders disappear, and the osteoclasts move away from the bone surface undergoing remodeling (36). Side effects are significantly more pronounced when calcitonin-salmon Is administered by injection and can include nausea, vomiting, anorexia, and flushing. Because calcitonin-salmon Is protein in nature, the possibility of a systemic allergic reaction should be considered. 

The adverse effects of salmon calcitonin have again been reviewed [1 ]. Salmon calcitonin nasal spray is thought to be safe. Hypersensitivity is the only contraindication. The systemic adverse reactions of flushing and nausea that occur with injections are rare. Loccd reactions due to nasal irritation are the most common adverse reactions. 

Several new reports on the use of human, porcine or salmon calcitonin in the management of Paget s disease of bone have appeared. Biochemical and clinical improvement (especially reduction of pain) is obvious although not always complete 4 5, 6 ). Addition of diphosphonate to the treatment with calcitonin improved the biochemical results (8 ). Side effects (nausea, vomiting, transient facial flushing or diarrhoea) usually subside after a few days of treatment (4 ). The possibility of acute renal failure due to salmon calcitonin is raised by the report of a single case (7 ). 

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