What is the treatment for hypercalcemia?

From the Guidelines

The treatment for hypercalcemia should be initiated with hydration, bisphosphonates, denosumab, steroids, and/or calcitonin, with zoledronic acid being the preferred bisphosphonate according to the NCCN MM Panel members 1. The approach to managing hypercalcemia depends on its severity and the underlying cause. For mild cases, increasing fluid intake and reducing calcium consumption may be sufficient. However, for moderate to severe hypercalcemia, more aggressive treatment is necessary.

• Intravenous fluids, typically normal saline, are used to enhance calcium excretion through the kidneys.
• Bisphosphonates, such as zoledronic acid (4 mg IV) or pamidronate (60-90 mg IV), are crucial as they inhibit bone resorption and can reduce calcium levels within 24-48 hours 1.
• Calcitonin (4-8 IU/kg subcutaneously every 12 hours) provides a rapid but short-term reduction in calcium levels.
• Denosumab (120 mg subcutaneously) is useful for malignancy-related hypercalcemia that is resistant to bisphosphonates.
• Glucocorticoids like prednisone (40-60 mg daily) are effective when hypercalcemia is caused by certain cancers or granulomatous diseases.
• Loop diuretics such as furosemide may be used after adequate hydration to enhance calcium excretion. Treating the underlying cause of hypercalcemia, whether it's primary hyperparathyroidism, malignancy, or medication effects, is crucial for long-term management. In severe cases with renal failure or when medical therapy is ineffective, dialysis may be necessary. The most recent guidelines from the NCCN MM Panel emphasize the importance of careful management of hypercalcemia to prevent complications and improve patient outcomes 1.

From the FDA Drug Label

1. 2 Treatment of Hypercalcemia Calcitonin-salmon injection is indicated for the early treatment of hypercalcemic emergencies, along with other appropriate agents, when a rapid decrease in serum calcium is required, until more specific treatment of the underlying disease can be accomplished It may also be added to existing therapeutic regimens for hypercalcemia such as intravenous fluids and furosemide, oral phosphate or corticosteroids, or other agents.
2. 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 treatment for hypercalcemia includes calcitonin-salmon injection as an early treatment option, particularly for hypercalcemic emergencies. The recommended starting dose is 4 International Units/kg body weight every 12 hours, which can be increased to 8 International Units/kg every 12 hours or every 6 hours if the initial response is not satisfactory. Additionally, intravenous fluids, furosemide, oral phosphate, and corticosteroids may be used as part of the therapeutic regimen for hypercalcemia 2.

From the Research

Treatment Options for Hypercalcemia

The treatment for hypercalcemia typically involves addressing the underlying cause of the condition. According to 3, treatment should start with hydration, and loop diuretics may be required in individuals with renal insufficiency or heart failure to prevent fluid overload.

• Medications:
  • Calcitonin is administered for the immediate short-term management of severe symptomatic hypercalcemia 3, 4, 5.
  • Bisphosphonates, such as zoledronic acid or pamidronate, are used for long-term control of severe or symptomatic hypercalcemia 3, 6, 7.
  • Glucocorticoids are effective in hypercalcemia due to lymphoma or granulomatous diseases 3, 4, 5.
• Other Interventions:
  • Dialysis is generally reserved for those with severe hypercalcemia complicated with kidney failure 3, 7.
  • Parathyroidectomy may be considered in patients with primary hyperparathyroidism, depending on age, serum calcium level, and kidney or skeletal involvement 6.
  • Treatment of the underlying malignancy is the most effective strategy for hypercalcemia of malignancy 7.