What is the appropriate dose of calcitonin for Hypercalcemia?

There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.

From the FDA Drug Label

1. 2 Hypercalcemia The recommended starting dose of calcitonin-salmon injection for early treatment of hypercalcemia is 4 International Units/kg body weight every 12 hours by subcutaneous or intramuscular injection. If the response to this dose is not satisfactory after one or two days, the dose may be increased to 8 International Units/kg every 12 hours If the response remains unsatisfactory after two more days, the dose may be further increased to a maximum of 8 International Units/kg every 6 hours.

The appropriate dose of calcitonin for Hypercalcemia is:

• Initial dose: 4 International Units/kg body weight every 12 hours
• Increased dose: 8 International Units/kg every 12 hours if response is not satisfactory after 1-2 days
• Maximum dose: 8 International Units/kg every 6 hours if response remains unsatisfactory after 2 more days 1

From the Research

Dosing of Calcitonin for Hypercalcemia

The appropriate dose of calcitonin for hypercalcemia can vary depending on the specific condition and the patient's response to treatment.

• In a study published in 1992 2, patients with hypercalcemia of malignancy were treated with salmon calcitonin, 100 IU subcutaneously, every 12 hours for 3 days.
• A study from 1998 3 used a combination of a single dose of pamidronate and serial doses of eel calcitonin, with the calcitonin dose not specified.
• In a 1988 study 4, patients with neoplastic hypercalcemia were treated with synthetic human calcitonin, either 0.5 mg or 1 mg, administered 6-hourly by the intravenous route.

Response to Treatment

The response to calcitonin treatment can also vary, with some studies showing a significant reduction in serum calcium levels, while others show a more limited response.

• The 1984 study 5 found that calcitonin therapy reduced plasma calcium concentrations in four out of 10 patients with renal osteodystrophy and hypercalcemia.
• The 1992 study 2 found that the combination of salmon calcitonin and etidronate effectively lowered serum calcium concentrations in patients with hypercalcemia of malignancy.
• The 2021 study 6 found that the addition of calcitonin to bisphosphonate therapy resulted in a higher decrease in corrected calcium levels at 48 hours, but did not provide substantial clinical benefit beyond 48 hours.

Dosage and Administration

The dosage and administration of calcitonin can also impact its effectiveness.

• The 1988 study 4 found that the therapeutic effect of synthetic human calcitonin was obtained within the first 24 hours of treatment, and that increasing the dosage did not result in a further reduction of calcemia.
• The 1998 study 3 used a combination of pamidronate and serial doses of eel calcitonin, with the calcitonin dose not specified, but found that this combination allowed for rapid, long-term control of hypercalcemia.