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Cinacalcet
ℹ️ About
Always check the BNF link here for full prescribing information. 👩⚕️ Cinacalcet is a specialist-only medicine, usually initiated and monitored under secondary care / renal teams.
⚙️ Mode of Action
- A calcimimetic → acts by allosteric activation of the calcium-sensing receptor (CaSR) in parathyroid and other tissues.
- Reduces secretion of parathyroid hormone (PTH) 🧬.
- Secondary effect → ↓ serum calcium and phosphate concentrations.
💊 Indications & Dosing
- Secondary hyperparathyroidism in patients with end-stage renal disease on dialysis.
- Hypercalcaemia due to parathyroid carcinoma.
- Primary hyperparathyroidism where surgery (parathyroidectomy) is inappropriate.
- Dose: Initially 30 mg once daily; titrate every 2–4 weeks; maximum 180 mg/day. ✔️ Regular monitoring of Ca²⁺ and PTH is essential.
🔄 Interactions
- See BNF for full list. ⚠️ Metabolised by CYP3A4, 2D6, and 1A2 → check for strong inhibitors/inducers.
⚠️ Cautions
- Hypocalcaemia (risk of tetany, seizures, arrhythmias).
- History of seizures (risk ↑ with ↓Ca²⁺).
- Close monitoring in patients with hepatic impairment.
⛔ Contraindications
- Pre-existing hypocalcaemia.
💥 Side Effects
- Nausea 🤢, vomiting 🤮, diarrhoea.
- Hypocalcaemia → muscle cramps, paraesthesia, seizures.
- Headache, dizziness, myalgia, hypotension.
- Biochemical: ↓PTH, ↓Ca²⁺, ↓PO₄³⁻.
📚 References
📝 Revisions
- Last updated September 2025
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