Calcitonin
Calcitonin
Definition
Calcitonin is a hormone involved in regulating calcium metabolism. The hormone calcitonin is produced by the thyroid gland. A synthetic human product is available.
Purpose
Calcitonin is often ordered for cancer patients experiencing bone pain due to metastasis . Calcitonin is also used to treat Paget's disease, post-menopausal osteoporosis and increased levels of calcium in the blood.
Description
Calcitonin reduces breakdown of bone. It causes less bone tissue to be reabsorbed. It slows the rate of bone destruction and decreases the amount of calcium released into the blood. Most calcitonin ordered for patients is derived from salmon. Calcitonin is not effective when given orally, and is available for injection or in a nasal spray. It is sold under the brand name Calcimar in the United States.
Recommended dosage
The usual dose for patients receiving Calcitoninsalmon for bone metastases is 200 IU given through the vein twice daily. It is important to take this drug exactly as ordered. If a dose is missed and is noticed within two hours, the drug should be taken. If it is not noted until later, the patient should skip the dose and return to the regular schedule. Patients should not take additional or double doses. When using calcitonin to lower calcium levels, therapy is limited to approximately 5 days. Extended use of calcitonin results in a loss of effect at lowering the calcium.
Precautions
Calcitonin-salmon solution should be stored in the refrigerator, not frozen. Patients should allow a new bottle of nasal spray to warm to room temperature. It may be kept at room temperature for two to four weeks. The nasal spray pump should be primed before using. Patients should push the plunger until a mist is observed. This usually occurs within several pushes. Before using, the patient should blow his or her nose. The patient should alternate nostrils with each dose. The head should be kept upright. The pump should be pressed toward the bottle one time. The patient should not inhale when spraying. The patient should then inhale through the nose and exhale through the mouth. The nosepiece should be wiped clean after each use. Patients giving themselves an injection should check that the contents are clear. Patients should not inject medication that is colored or grainy.
Calcitonin should be used cautiously when breast feeding, as it may decrease the amount of available milk. Its use during pregnancy has not been adequately studied. However, animal studies indicated a risk for low birth weight offspring.
Side effects
Calcitonin is a protein. It may cause a severe allergic reaction. The doctor should be notified if a rash or hives develop. Patients should have supplies on hand to manage an allergic reaction. Skin testing may be done prior to treatment. Allergic reactions are rarer in the human product than in the salmon product.
Diarrhea , red skin, poor appetite, nausea, vomiting, stomach pain, and back and joint pain are common side effects. Other side effects include increased or decreased appetite, gas, constipation, or an unusual taste in the mouth. Nausea is usually mild and temporary. Giving calcitonin at bedtime may decrease nausea and vomiting . Patients may experience dizziness, difficulty sleeping, anxiety, headache, agitation, palpitations, or other heart problems. Redness, swelling and soreness may occur at the injection site. Patients using the nasal spray may develop crusting or patches in the nose, as well as nasal dryness, redness, swelling or irritation. Less often, those using the nasal spray may experience difficulty with urination, breathing problems, loss of smell, or cold symptoms. Some patients injecting the drug may develop frequent urination, chills, dizziness, headache, chest pressure, a congested nose, tingling or discomfort in the hands and feet, difficulty breathing or weakness. Patients should notify the doctor if side effects occur. Side effects may subside as the patient's body becomes accustomed to the drug. Patients should receive regular medical checks and lab work to assess for adverse reactions and changes in urine content.
Interactions
At present, there are no known interactions with other drugs.
Debra Wood, RN
KEY TERMS
Osteoporosis
—Disease causing bone tissue to become brittle.
Paget's disease
—Chronic inflammation of the bone, with the bones becoming thinner and softer. Long bones bow.