calcitriol (Rx)

Brand and Other Names:Calcijex, Rocaltrol
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 0.25mcg
  • 0.5mcg

oral solution

  • 1mcg/mL

injectable solution

  • 1mcg/mL

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

Moderate to severe kidney disease

  • 0.25 mcg/day PO; may increase to 0.5 mcg/day; lower doses of 0.25 mcg 3 to 4 times per week also used

Chronic renal dialysis

  • Oral
    • 0.25 mcg qDay; may increase by 0.25mcg/day at 4-8 week intervals, up to 0.5-1 mcg/day; patients with mildly decreased serum calcium levels may respond to 0.25 mcg every other day
  • Intravenous
    • Initiate with caution; may consider 0.5 mcg 3 times weekly approximately every other day or if necessary higher doses at 1-2 mcg 3 times weekly approximately every other day; adjust dose by 0.5-1 mcg at 2-4 week intervals
    • Maintenance: 0.5-4 mcg 3 times weekly

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

and calcitriol

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    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

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            Contraindicated (1)

            • conivaptan

              conivaptan will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

            Serious - Use Alternative (22)

            • abametapir

              abametapir will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

            • apalutamide

              apalutamide will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

            • atazanavir

              atazanavir will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • carbamazepine

              carbamazepine will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • clarithromycin

              clarithromycin will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • darunavir

              darunavir will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • enzalutamide

              enzalutamide will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • fexinidazole

              fexinidazole will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

            • idelalisib

              idelalisib will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

            • indinavir

              indinavir will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • itraconazole

              itraconazole will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • ivosidenib

              ivosidenib will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

            • lonafarnib

              lonafarnib will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration with sensitive CYP3A substrates. If coadministration unavoidable, monitor for adverse reactions and reduce CYP3A substrate dose in accordance with product labeling.

            • lopinavir

              lopinavir will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • mifepristone

              mifepristone will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • nafcillin

              nafcillin will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • nefazodone

              nefazodone will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • nelfinavir

              nelfinavir will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • posaconazole

              posaconazole will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • ritonavir

              ritonavir will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

            • tucatinib

              tucatinib will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

            • voxelotor

              voxelotor will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

            Monitor Closely (35)

            • amobarbital

              amobarbital will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • axitinib

              calcitriol decreases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • bosentan

              bosentan will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • crofelemer

              crofelemer increases levels of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.

            • dabrafenib

              dabrafenib will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • dienogest/estradiol valerate

              calcitriol will decrease the level or effect of dienogest/estradiol valerate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Advise women to use alternative method of contraception or back-up method when moderate or weak enzyme inducer is used with combination contraceptives. Back-up contraception should be continued for 28 days after discontinuing medication to ensure contraceptive reliability.

            • duvelisib

              duvelisib will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. will increase the level or effect of

            • efavirenz

              efavirenz will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • elagolix

              elagolix will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

            • elvitegravir/cobicistat/emtricitabine/tenofovir DF

              elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

            • encorafenib

              encorafenib, calcitriol. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.

            • etravirine

              etravirine will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • fedratinib

              fedratinib will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

            • fosphenytoin

              fosphenytoin will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • iloperidone

              iloperidone increases levels of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

            • istradefylline

              istradefylline will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.

            • ketoconazole

              ketoconazole will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • linagliptin

              calcitriol will increase the level or effect of linagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use of alternative treatments is strongly recommended when linagliptin is to be administered with a CYP3A4 inducer

            • lorlatinib

              lorlatinib will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • magnesium supplement

              magnesium supplement will increase the level or effect of calcitriol by Other (see comment). Modify Therapy/Monitor Closely. Drug may increase absorption of magnesium in the intestine and colon, which increases risk of hypermagnesemia

            • mitotane

              mitotane will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • phenobarbital

              phenobarbital will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • phenytoin

              phenytoin will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

            • primidone

              primidone will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ribociclib

              ribociclib will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rifampin

              rifampin will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • rucaparib

              rucaparib will increase the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

            • secobarbital

              secobarbital will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • sodium sulfate/?magnesium sulfate/potassium chloride

              calcitriol increases levels of sodium sulfate/?magnesium sulfate/potassium chloride by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely.

            • sodium sulfate/potassium sulfate/magnesium sulfate

              calcitriol increases levels of sodium sulfate/potassium sulfate/magnesium sulfate by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely.

            • stiripentol

              stiripentol, calcitriol. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.

            • tazemetostat

              tazemetostat will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

              calcitriol will decrease the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • tecovirimat

              tecovirimat will decrease the level or effect of calcitriol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

            • tinidazole

              calcitriol will decrease the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

            • ubrogepant

              calcitriol will decrease the level or effect of ubrogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Dose adjustment is recommended with concomitant use of ubrogepant and moderate and weak CYP3A4 inducers. (see Dosage Modifications)

            Minor (0)

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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

              Other vitamin D compounds should be withheld during treatment in order to avoid the development of hypervitaminosis D; excessive vitamin D may suppress parathyroid hormone

              If patients are "changed over" from ergocalciferol to calcitriol it may take many months for blood levels of ergocalciferol to return to pre-treatment values; overdosage of any form of vitamin D is dangerous; chronic hypercalcemia can lead to generalised vascular calcification, nephrocalcinosis and other soft-tissue calcification

              Patients with hypophosphatemic rickets (familial hypophosphatemia) should pursue their oral phosphate therapy; however, the possible stimulation of intestinal phosphate absorption may modify the requirement for phosphate supplements; during the stabilisation phase of treatment, serum calcium levels should be checked at least twice weekly

              Efficacy may be unpredictable in patients with malabsorption syndrome

              Sudden increases in calcium consumption due to dietary change (eg, dairy products) or injudicious calcium supplements may precipitate hypercalcaemia; patients and relatives should receive instruction in dietary management, be informed about symptoms of hypercalcaemia, and be warned of consequences of not adhering to dietary recommendations

              In patients with normal renal function, chronic hypercalcaemia may be associated with an increase in serum creatinine

              Therapy raises serum inorganic phosphate levels; while this is a desirable effect in patients with hypophosphatemic states, caution must be taken in patients with renal failure

              Calcitriol may increase plasma phosphate levels; while this effect is desirable in hypophosphatemic osteomalacia, it may cause ectopic calcification, especially in patients with renal failure; plasma phosphate levels should be kept normal in such patients by the oral administration of phosphate binding agents

              Patients with normal renal function should avoid dehydration; adequate fluid intake should be maintained

              Use caution in malabsorption syndrome, renal/hepatic impairment

              Patients immobilized after surgical procedures are more at risk of developing hypercalcaemia, therefore more frequent monitoring is recommended

              Special care should be taken when administering therapy to patients with renal dysfunction; more frequent monitoring in these patients is appropriate

              In elderly patients suffering from ischemic heart disease, serum calcium levels should be carefully monitored; if hypercalcemia is observed, therapy should be suspended immediately; it should also be remembered that geriatric patients receive many other drugs and that their compliance may not be ideal

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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

              BRAND FORM. UNIT PRICE PILL IMAGE
              Rocaltrol oral
              -
              1 mcg/mL solution
              Rocaltrol oral
              -
              0.25 mcg capsule
              Rocaltrol oral
              -
              0.5 mcg capsule
              calcitriol oral
              -
              0.25 mcg capsule
              calcitriol oral
              -
              1 mcg/mL solution
              calcitriol oral
              -
              0.5 mcg capsule
              calcitriol oral
              -
              0.25 mcg capsule
              calcitriol oral
              -
              1 mcg/mL solution
              calcitriol oral
              -
              0.5 mcg capsule
              calcitriol oral
              -
              0.25 mcg capsule
              calcitriol oral
              -
              0.5 mcg capsule
              calcitriol oral
              -
              0.25 mcg capsule
              calcitriol oral
              -
              0.5 mcg capsule
              calcitriol oral
              -
              0.25 mcg capsule
              Vectical topical
              -
              3 mcg/gram ointment
              calcitriol topical
              -
              3 mcg/gram ointment
              calcitriol intravenous
              -
              1 mcg/mL solution
              calcitriol intravenous
              -
              1 mcg/mL solution

              Copyright © 2010 First DataBank, Inc.

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              Patient Handout

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              Patient Education
              calcitriol oral

              CALCITRIOL - ORAL

              (KAL-si-TRYE-ol)

              COMMON BRAND NAME(S): Rocaltrol

              USES: Calcitriol is a man-made active form of vitamin D. Most people get enough vitamin D from exposure to the sun and from fortified food products (e.g., dairy products, vitamins). Vitamin D helps control parathyroid hormone and the levels of certain minerals (e.g., calcium, phosphorus) that are needed for building and keeping strong bones.Before regular vitamin D can be used by the body, it needs to be changed to the active form by the liver and kidneys. Calcitriol is used in patients with kidney disease who can't make enough of the active form of Vitamin D. This medication is also used to prevent and treat certain types of calcium/phosphorus/parathyroid problems that can happen with long-term kidney dialysis or hypoparathyroidism. Calcitriol is usually used along with specific diet recommendations and sometimes other medications.

              HOW TO USE: Take this medication by mouth with or without food, usually once daily or as directed by your doctor. If you are using the liquid form, measure your dose with a special measuring spoon or device. Do not use a normal household spoon since you may not get the correct dose.Dosage is based on your medical condition and response to therapy. Your doctor may start you on a low dose and adjust the dose slowly to find the best dose for you. Follow your doctor's directions carefully. Use this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time each day.It is very important to follow the diet recommended by your doctor to get the most benefit from this medication and to prevent serious side effects. Do not take other supplements/vitamins (e.g., calcium, vitamin D) unless ordered by your doctor.Certain medications (bile acid sequestrants such as cholestyramine/colestipol, mineral oil, orlistat) can decrease the absorption of vitamin D. Therefore, separate your doses of these medications as far as possible from your doses of calcitriol (at least 2 hours apart, longer if possible). It may be easiest to take calcitriol at bedtime if you are also taking these other medications. Ask your doctor or pharmacist about finding a good dosing schedule that will work with all your medications.

              SIDE EFFECTS: Calcitriol does not usually have side effects. Your doctor may check your calcium and phosphate blood levels and adjust your dose if you have side effects.Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if any of these unlikely but serious side effects occur: loss of appetite, back/bone/joint/muscle pain, constipation, dry mouth, eye pain/redness/sensitivity to light, headache, fast/slow/irregular heartbeat, nausea/vomiting/diarrhea, sleepiness, stomach/abdominal pain, increased thirst, signs of kidney problems (such as change in the amount of urine), weakness.A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction may include: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

              PRECAUTIONS: Before taking calcitriol, tell your doctor or pharmacist if you are allergic to it; or to other vitamin D products; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: high calcium levels.Before using this medication, tell your doctor or pharmacist your medical history, especially of: heart disease (e.g., irregular heartbeat, coronary artery disease), kidney disease, kidney stones.Notify your doctor beforehand if you will be having surgery or will be confined to a chair/bed (immobile) for a long time. Being immobile for long periods of time increases your risk of side effects.Be sure to drink plenty of fluids unless otherwise directed by your doctor.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.

              DRUG INTERACTIONS: See also How to Use section.Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: burosumab, cardiac glycosides (e.g., digoxin, digitalis), magnesium-containing medications (e.g., antacids, milk of magnesia), phosphate binders, vitamins/nutritional supplements (especially calcium and vitamin D), drugs that can speed up the removal of calcitriol from your body (e.g., ketoconazole, phenobarbital, phenytoin).Check the labels on all your prescription and nonprescription/herbal products (e.g., antacids, laxatives, vitamins) because they may contain calcium, magnesium, phosphate, and vitamin D. Ask your pharmacist about using those products safely.Calcitriol is very similar to other forms of vitamin D. Do not use medications containing other forms of vitamin D while using calcitriol.This medication may interfere with certain laboratory tests (e.g., cholesterol test), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

              OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: weakness, headache, loss of appetite, metallic taste, nausea, vomiting, stomach cramps, dizziness.

              NOTES: Do not share this medication with others.Laboratory and/or medical tests (e.g., calcium, magnesium, phosphorus, parathyroid levels) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.Foods rich in vitamin D include: fortified dairy products, eggs, sardines, cod liver oil, chicken livers and freshwater fish. Vitamin D is also obtained from periodic exposure to the sun.It is important to maintain a well-balanced diet while taking this medication. Calcium supplements may be recommended in addition to this medication. The usual recommendation for calcium is 600 to 1200 milligrams per day. Discuss this with your doctor. Do not take supplements unless directed by your doctor.

              MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

              STORAGE: Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

              Information last revised March 2021. Copyright(c) 2021 First Databank, Inc.

              IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

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              Formulary

              FormularyPatient Discounts

              Adding plans allows you to compare formulary status to other drugs in the same class.

              To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

              Adding plans allows you to:

              • View the formulary and any restrictions for each plan.
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              • Access your plan list on any device – mobile or desktop.

              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.
              Additional Offers
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              Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.