Drug Interactions between etelcalcetide and palopegteriparatide

MONITOR: Concomitant use with calcimimetic agents may affect serum calcium levels, which may alter the therapeutic effects of palopegteriparatide. Calcimimetic therapy alone may increase the risk of severe hypocalcemia via binding and activation of the calcium-sensing receptor on the parathyroid gland. On the other hand, serious events of both hypercalcemia and hypocalcemia have been reported with palopegteriparatide. The risk for hypocalcemia is reported to be highest when palopegteriparatide is abruptly discontinued, while the risk for hypercalcemia is highest when initiating or increasing the dose of palopegteriparatide. However, both hypocalcemia and hypercalcemia may occur at any time.

MANAGEMENT: Close monitoring of serum calcium levels is recommended if palopegteriparatide is to be administered concomitantly with calcimimetic agents, particularly upon their initiation, cessation, or after dosage adjustment. Patients should be advised to contact their doctor promptly if they develop symptoms of hypercalcemia such as nausea, vomiting, constipation, lethargy, and muscle weakness; or symptoms of hypocalcemia such as muscle spasms, carpopedal spasm, laryngeal spasm, tetany, convulsions, mental changes (irritability, depression, psychosis), increased intracranial pressure, papilledema, QT interval prolongation, and cardiac arrhythmias.