Parathyroid hormone

Generic Medicine Info
Indications and Dosage
Adult: Initially, 50 mcg once daily, in conjunction w/ activated vit D and Ca supplement. Active forms of vit D and Ca supplement may require adjustment based on albumin-corrected serum Ca concentration. Dose may be increased in increments of 25 mcg every 4 wk up to max of 100 mcg if serum Ca cannot be maintained >8 mg/dL w/o an active form of vit D and/or oral Ca supplementation. May be decreased to Min of 25 mcg once daily if total serum Ca is repeatedly >9 mg/dL after the active form of vit D has been discontinued and Ca supplement has been decreased to a dose sufficient to meet daily needs. Maintenance: Use the lowest dose that achieves albumin-corrected serum Ca w/in the lower half of the normal range (i.e. 8-9 mg/dL).
Attach the mixing device to the drug cartridge according to manufacturer’s instructions. Slowly move the cartridge back and forth (approx 10 times) to mix the contents; do not shake.
Special Precautions
Patient at increased risk of osteosarcoma (e.g. patient w/ Paget’s disease of bone or unexplained elevations of alkaline phosphatase, hereditary disorders predisposing to osteosarcoma, history of external beam or implant radiation therapy involving skeleton; young adult w/ open epiphyses). Pregnancy and lactation.
Adverse Reactions
Osteosarcoma, paraesthesia, hypocalcaemia, headache, hypercalcaemia, nausea, hypoaesthesia, diarrhoea, vomiting, arthralgia, hypercalciuria, pain in extremity.
Parenteral/SC: C
Monitoring Parameters
Ensure that serum Ca is >7.5 mg/dL prior to therapy, then monitor w/in 3-7 days following initiation or dosage adjustments and until maintenance dose is achieved, and periodically thereafter; urinary Ca excretion (after maintenance dose is achieved).
Drug Interactions
May increase risk of digoxin toxicity. Reduced Ca-sparing effect w/ alendronic acid.
Mechanism of Action: Parathyroid hormone elevates serum Ca concentrations by increasing renal tubular Ca reabsorption and intestinal Ca absorption, and by increasing bone turnover, thus releasing Ca into the circulation.
Onset: Peak effect: 10-12 hr.
Duration: >24 hr.
Absorption: Absolute bioavailability: 53%. Time to peak plasma concentration: 5-30 min.
Distribution: Volume of distribution: 5.35 L (at steady state).
Metabolism: Primarily hepatic; via cleavage by cathepsins.
Excretion: Via urine. Elimination half-life: Approx 3 hr.
Store between 2-8°C. Protect from heat and light. Do not freeze or shake.
MIMS Class
Agents Affecting Bone Metabolism
ATC Classification
H05AA03 - parathyroid hormone ; Belongs to the class of parathyroid hormones and analogues. Used in the management of calcium homeostasis.
Anon. Parathyroid Hormone. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. Accessed 04/04/2016.

McEvoy GK, Snow EK, Miller J et al (eds). Parathyroid Hormone . AHFS Drug Information (AHFS DI) [online]. American Society of Health-System Pharmacists (ASHP). Accessed 04/04/2016.

Natpara Injection, Powder, Lyophilized, for Solution (NPS Pharmaceuticals, Inc.). DailyMed. Source: U.S. National Library of Medicine. Accessed 04/04/2016.

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