Hypercalcaemia

Cinacalcet may be prescribed for primary hyperparathyroidism (PHPT), where it should be initiated by a specialist and may be continued by the patients GP after 3 months.
It can also be prescribed for secondary hyperparathyroidism, in end stage renal disease in certain clearly defined patients this indication is not for primary care prescribing

Monitoring

Calcium levels should be checked before initiation and then within 1 week after initiation or dose adjustment of cinacalcet. The dose may need to be adjusted depending on clinical response. Once calcium levels are stable, monitoring should be undertaken once every 3 months.

Dose adjustment

Calcium level less than 2.2mmol/L stop medication and refer back to Endocrinologist

Calcium level 2.2- 2.6mmol/L continue treatment and repeat calcium level in 3 months

Calcium level greater than 2.6mmol/L. Adjust dose of cinacalcet as above, contact endocrinologist for advice on dose if calcium failing to fall despite dose adjustment

Any questions or concerns should be communicated to the consultant endocrinologist. However, treatment should be stopped and the consultant endocrinologist contacted directly if a patient should develop hypocalcaemia (calcium level less than 2.2), seizures (which may develop as a consequence of hypocalcaemia), worsening liver function, gastrointestinal side effects or rash.

Secondary Hyperparathyroidism

Cinacalcet is for specialist prescribing in end-stage renal disease in certain clearly defined patients only.

Etelcalcetide is for the treatment of secondary hyperparathyroidism in adult patients with chronic kidney disease on haemodialysis therapy in specialist dialysis centres only.