Adult Initially 25 mg once daily. May be adjusted w/in a range of 25-75 mg once daily w/ careful management of the patient's serum parathyroid hormone (PTH). If no improvement, increase up to 100 mg once daily. Increase dose by 25 mg at a time, at intervals of at least 3 wk.
Ca level should not be low (≥9 mg/dL) prior to administration. Avoid hypocalcaemia during treatment. Determine serum Ca level once wkly at the start of administration & during the dose adjustment period, & at least once every 2 wk during the maintenance period. Determine serum PTH level twice mthly at the start of administration & during the dose adjustment period, & at least once mthly after the serum PTH level is confirmed to be almost stable. Caution in patients w/ hypocalcaemia; seizure or a history of seizure; hepatic function disorder; GI hemorrhage &/or ulcer or a history of GI hemorrhage &/or ulcer; risk factors for QT prolongation. Use in patients w/ chronic renal failure accompanied by secondary hyperthyroidism & not on dialysis has not been approved. Reports of adynamic bone disease; hungry bone syndrome accompanied by hypocalcaemia & hypophosphataemia. Not recommended during pregnancy. Avoid use in nursing mothers. Elderly ≥65 yr.
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