From the Guidelines
Medications that can raise calcium levels include thiazide diuretics, lithium, vitamin D supplements, calcium-containing antacids, and certain hormonal therapies, as well as paricalcitol, a vitamin D analogue, which has been shown to increase serum calcium levels in patients with chronic kidney disease (CKD) 1. These medications can increase calcium levels by various mechanisms, such as decreasing urinary calcium excretion, increasing parathyroid hormone levels, or enhancing calcium absorption from the gut. Some key points to consider when prescribing these medications include:
- Monitoring calcium levels periodically, especially in patients with risk factors for hypercalcemia
- Being aware of the potential for hypercalcemia, particularly when using paricalcitol, as seen in the PRIMO and OPERA studies 1
- Considering alternative therapies or adjusting dosages to minimize the risk of hypercalcemia
- Educating patients on the symptoms of elevated calcium levels, such as constension, fatigue, muscle weakness, and confusion. It is essential to weigh the benefits and risks of these medications and to carefully monitor patients to prevent hypercalcemia and its associated complications, particularly in patients with CKD or other conditions that may affect mineral metabolism 1.
From the FDA Drug Label
Calcium excretion is decreased by thiazides, and pathologic changes in the parathyroid glands, with hypercalcemia and hypophosphatemia, have been observed in a few patients on prolonged thiazide therapy.
Medications that commonly raise calcium include thiazide diuretics, such as hydrochlorothiazide.
- Hypercalcemia has been observed in a few patients on prolonged thiazide therapy.
- Pathologic changes in the parathyroid glands have also been associated with thiazide use. 2
From the Research
Medications that Commonly Raise Calcium
- The following medications can cause hypercalcemia:
- Vitamin D supplements and 1α-hydroxylated vitamin D analogues, which increase intestinal calcium absorption, renal calcium reabsorption, and bone resorption 3
- Thiazide diuretics, which enhance renal proximal calcium reabsorption, potentially leading to hypercalcemia, especially in patients with pre-existing hyperparathyroidism 3, 4, 5, 6
- Lithium, which can cause hypercalcemia mainly by inducing hyperparathyroidism 3, 7
- Recombinant human PTH, which can cause transient hypercalcemia in patients with hypoparathyroidism, particularly during acute illness 3
- These medications can lead to various degrees of hypercalcemia, ranging from mild to severe, and may require medical management, including discontinuation of the offending drug, hydration, and other treatments 4, 5, 7