From the Guidelines
Oral bisphosphonates, such as alendronate or risedronate, are not the primary choice for treating hypercalcemia, instead, cinacalcet (Sensipar) is a suitable oral medication option for decreasing elevated calcium levels, specifically for treating hypercalcemia, as it can be effective in reducing calcium levels, especially if the hypercalcemia is due to hyperparathyroidism 1.
When considering treatment options for hypercalcemia, it is essential to evaluate the underlying cause and choose a medication that targets the specific pathophysiology. Cinacalcet, a calcimimetic agent, works by mimicking calcium on the parathyroid gland, thereby reducing parathyroid hormone (PTH) secretion and subsequently lowering calcium levels. The initial dose of cinacalcet can be 30 mg daily, with titration up to 90 mg daily as needed, based on serum calcium levels and patient tolerance.
Key considerations in managing hypercalcemia include:
- Identifying and treating the underlying cause
- Ensuring adequate hydration to promote calcium excretion
- Monitoring serum calcium levels, renal function, and electrolytes to assess treatment effectiveness and adjust dosing accordingly
- Being aware of potential side effects, such as hypocalcemia, and taking steps to mitigate them, such as supplementing with calcium and vitamin D if necessary.
It is crucial to note that while bisphosphonates, such as pamidronate and zoledronic acid, are effective in treating hypercalcemia, they are typically administered intravenously, not orally 1. Denosumab, a human monoclonal antibody, is another option for treating hypercalcemia, particularly in cases refractory to bisphosphonate therapy, but it is administered subcutaneously, not orally, and its use should be carefully considered due to the risk of hypocalcemia 1.
From the Research
Oral Medication for Hypercalcemia
- There are no oral medications specifically mentioned in the provided studies for the treatment of hypercalcemia.
- However, the studies discuss various treatments for hypercalcemia, including:
- The use of bisphosphonates, such as zoledronic acid, is supported by studies as an effective treatment for severe hypercalcemia 5, 4, 6
- It is essential to note that the treatment of hypercalcemia depends on the underlying cause and severity of the condition, and the choice of treatment should be made under medical supervision.