Cinacalcet is a tablet used to lower parathyroid hormone (PTH), calcium, and phosphate levels in patients with specific kidney or thyroid conditions.
Cinacalcet is a type of medicine known as a calcimimetic.
It ‘mimics’ the action of calcium on the parathyroid glands to trick them into producing less parathyroid hormone (PTH).
It is primarily used for patients with chronic kidney disease (CKD) on dialysis who develop overactive parathyroid glands.
Main advantage: Unlike vitamin D supplements (which can also lower PTH but raise calcium), cinacalcet effectively lowers PTH without increasing calcium or phosphate levels in the blood.
The main uses of cinacalcet include the treatment of:
Secondary hyperparathyroidism in patients with CKD who are on dialysis.
Hypercalcaemia (high blood calcium) in patients with parathyroid cancer.
Primary hyperparathyroidism in patients who have high calcium levels but cannot undergo surgery to remove the parathyroid gland.
By controlling PTH and calcium, cinacalcet helps reduce the risk of bone disease and vascular calcification (hardening of the heart and blood vessels).
Adults: The starting dose for secondary hyperparathyroidism (in CKD patients) is usually 30 mg once daily.
Titration: Your doctor may increase the dose every 2–4 weeks (up to a maximum of 180 mg daily) until your PTH levels reach the target range.
Administration: Cinacalcet should be taken with food or shortly after a meal, as this helps the body absorb the medicine better and reduces stomach upset.
The most common side-effects are often related to the digestive system or a drop in calcium levels.
Nausea and vomiting (very common, but often improves over time)
Dizziness
Reduced appetite
Muscle pain or cramps
Signs of low calcium (hypocalcaemia):
Spasms, twitches, or cramps in the muscles.
Numbness or ‘pins and needles’ (tingling) in the fingers, toes, or around the mouth.
Seizures or confusion.
Note. If you experience any of these problems, you should contact your medical team immediately.
The mechanism of action of cinacalcet involves increasing the sensitivity of calcium-sensing receptors on the parathyroid glands:
By making these receptors more sensitive, the glands believe there is more calcium in the blood than there actually is.
In response, the glands reduce the production and release of parathyroid hormone (PTH).
Lowering PTH helps stabilise calcium and phosphate balance, preventing minerals from being pulled out of the bones and into the bloodstream.
Your doctor should monitor:
Blood Calcium Levels: This is the most important test. It is usually checked within one week of starting the drug or changing the dose.
PTH Levels: To ensure the medication is effectively controlling the parathyroid gland.
Phosphate Levels: To maintain overall mineral balance in CKD patients.
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