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calcitriol (Rx)Brand and Other Names:Calcijex, Rocaltrol

 
 
 

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 0.25mcg
  • 0.5mcg

oral solution

  • 1mcg/mL

injectable solution

  • 1mcg/mL
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Chronic Renal Dialysis Associated Hypocalcemia

Oral

  • Initial: 0.25 mcg PO qDay to every other day; titrate by 0.5-1 mcg/day q4-8Weeks

IV

  • Initial: 1-2 mcg IV (0.02 mcg/kg) 3 times/week; adjust dose every 2-4 weeks 
  • Maintenance: 0.5-4 mcg IV 3 times/week

Hypoparathyroidism/Pseudohypoparathyroidism

Initial: 0.25 mcg PO qDay; titrate by 0.25 mcg q2-4Weeks

Maintenance: 0.5-2 mcg PO qDay

Secondary Hyperparathyroidism in Moderate to Severe Kidney Disease

0.25 mcg/day PO; may increase to 0.5 mcg/day

Vitamin D Dependent Rickets (Off-label)

1 mcg PO qDay

Administration

Goal is to maintain serum Ca 9-10 mg/dL

Doing Forms & Strengths

capsule

  • 0.25mcg
  • 0.5mcg

oral solution

  • 1mcg/mL

injectable solution

  • 1mcg/mL

Chronic Renal Dialysis Associated Hypocalcemia

0.25-2 mcg/day PO qDay

Hypoparathyroidism/Pseudohypoparathyroidism

<1 year: 0.04-0.08 mcg/kg PO qDay 

1-5 years: 0.25-0.75 mcg PO qDay

>6 years: 0.5-2 mcg PO qDay

Familial Hypophosphatemia

Initial: 0.015-0.02 mcg/kg PO qDay  

Maintenance: 0.03-0.06 mcg/kg PO qDay

No more than 2 mcg PO qDay

Secondary Hyperparathyroidism in Moderate to Severe Kidney Disease

<3 years: 0.01-0.015 mcg/kg/day 

≥3 years: 0.25 mcg/day PO; may increase to 0.5 mcg/day

Hypocalcemia in Premature Infants

1 mcg qDay PO for 5 days

Vitamin D-Dependent Rickets (Off-label)

0.5 mg PO twice daily; adjust dose to maintain normal serum calcium and PTH levels; after 2 years, median dose is 0.25 mcg/day

Hypocalcemic Tetany in Premature Infants (Off-label)

0.05 mcg/kg IV qDay for 5-12 days 

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Interactions

Interaction Checker

calcitriol and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            Frequency Not Defined

            Abdominal pain

            Apathy

            BUN and creatinine increased

            Cardiac arrhythmia

            Constipation

            Dry mouth

            Dehydration

            Growth suppression

            Headache

            Hyperthermia

            Hypercalcemia

            Hypercholesteremia

            Hypermagnesemia

            Hyperphosphatemia

            Hypertension

            Libido decreased

            Metallic taste

            Muscle or bone pain

            N/V

            Nocturia

            Pruritus

            Psychosis

            Somnolence

            Weakness

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            Warnings

            Contraindications

            Hypercalcemia or evidence of vitamin D toxicity

            Hypersensitivity to calcitriol, other vitamin D analogues, or other ingredients

            Cautions

            Excessive vitamin D may suppress parathyroid hormone

            Risk of hyperphosphatemia, hypercalciuria

            Efficacy may be unpredictable in patients with malabsorption syndrome

            Adequate dietary calcium supplementation necessary for clinical response to vitamin D

            Use caution in malabsorption syndrome, renal/hepatic impairment,

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            Pregnancy & Lactation

            Pregnancy category: C

            Lactation: Enters breast milk; not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Calcitriol is a potent metabolite to the active form of vitamin D, which in turn controls the reabsorption of calcium by the kidneys, controls the intestinal absorption of dietary calcium; decreases excessive serum phosphate levels, bone resorption, and parathyroid hormone levels

            Absorption

            Onset of action: 2-6 hr (PO)

            Peak plasma time: 3-6 hr

            Duration: 3-5 days (PO/IV)

            Distribution

            Protein bound: 99.9%

            Metabolism

            24-hydroxylase to calcitroic acid; also by stepwise hydroxylation to vitamin D3 lactone ring

            Elimination

            Half-life elimination: 5-8 hr (adults); 27 hr (children)

            Excretion: Feces (50%); urine (16%)

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            Administration

            IV Administration

            Rapid injection through catheter at end of hemodialysis

            Usually single daily dose

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            Images

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            Formulary

            FormularyPatient Discounts

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            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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