From the FDA Drug Label
2.3 Patients with Parathyroid Carcinoma and Primary Hyperparathyroidism The recommended starting oral dose of cinacalcet tablets is 30 mg twice daily. The dose of cinacalcet tablets should be titrated every 2 to 4 weeks through sequential doses of 30 mg twice daily, 60 mg twice daily, and 90 mg twice daily, and 90 mg 3 or 4 times daily as necessary to normalize serum calcium levels Serum calcium should be measured within 1 week after initiation or dose adjustment of cinacalcet tablets
Starting Cinacalcet for Primary Hyperparathyroidism: You should start cinacalcet at a dose of 30 mg twice daily for primary hyperparathyroidism.
- The dose can be titrated every 2 to 4 weeks to normalize serum calcium levels.
- Serum calcium levels should be measured within 1 week after initiation or dose adjustment of cinacalcet tablets 1
From the Research
Cinacalcet should be started for primary hyperparathyroidism when surgery is not an option or has failed, and the patient has symptomatic hypercalcemia, as evidenced by the most recent study in 2021 2. When considering cinacalcet for primary hyperparathyroidism, it's essential to evaluate the patient's suitability for surgery and the presence of symptomatic hypercalcemia.
- The typical starting dose of cinacalcet is 30 mg once daily, which can be titrated every 2-4 weeks to a maximum of 90 mg four times daily, based on serum calcium levels, as supported by the study in 2021 2.
- Monitor calcium and phosphorus levels within 1 week after starting or adjusting the dose to ensure effective management of hypercalcemia.
- Common side effects of cinacalcet include nausea, vomiting, and diarrhea, which can be minimized by taking the medication with food, as reported in the study in 2019 3.
- Cinacalcet works as a calcimimetic by increasing the sensitivity of calcium-sensing receptors on parathyroid cells, reducing parathyroid hormone secretion and subsequently lowering serum calcium levels, as described in the study in 2012 4.
- It's crucial to note that while cinacalcet effectively controls hypercalcemia, it doesn't address the underlying parathyroid disease and is not curative like surgery, making it primarily a management rather than definitive treatment option, as highlighted in the study in 2008 5. Key considerations for starting cinacalcet include:
- Medical contraindications for surgery
- Patient refusal for surgery
- Failed previous surgery
- Unidentifiable parathyroid glands
- Symptomatic hypercalcemia By prioritizing the most recent and highest-quality study, we can ensure that the recommendation for starting cinacalcet is based on the best available evidence, which is the study from 2021 2.