From the Research
For patients experiencing GI upset with cinacalcet who need an oral option for managing hypercalcemia or secondary hyperparathyroidism, consider vitamin D analogs like paricalcitol (1-4 mcg daily) as an alternative. These medications work differently than cinacalcet by suppressing PTH through vitamin D receptor activation rather than through calcium-sensing receptor modulation 1. The study by 1 suggests that paricalcitol is a viable option for managing secondary hyperparathyroidism, especially in patients who cannot tolerate cinacalcet due to GI upset. Other options like calcitriol (0.25-1 mcg daily) or doxercalciferol (1-5 mcg daily) may also be considered. Phosphate binders such as sevelamer (800-1600 mg with meals), calcium acetate (667 mg, 2-4 tablets with meals), or lanthanum carbonate (500-1000 mg with meals) may also help manage calcium-phosphate balance. It's essential to closely monitor calcium, phosphorus, and PTH levels when using these alternatives, as they may be less effective than cinacalcet for certain conditions. If symptoms persist, consider administering cinacalcet with food, dividing the dose, or using anti-nausea medications before trying these alternatives. Etelcalcetide (Parsabiv) is not a suitable alternative as it's administered intravenously 2, 3. The most recent study 4 highlights the importance of managing secondary hyperparathyroidism to prevent cardiovascular disease, but it does not provide a direct alternative to cinacalcet for GI upset. Overall, paricalcitol is a suitable oral alternative for patients experiencing GI upset with cinacalcet, and its use should be considered in the context of individual patient needs and medical history.